头针联合皮内针同步康复疗法对脑卒中患者上肢运动功能的效果

doi:10.3969/j.issn.1006-9771.2025.10.011

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (10): 1194-1205.doi: 10.3969/j.issn.1006-9771.2025.10.011

头针联合皮内针同步康复疗法对脑卒中患者上肢运动功能的效果

于子夫¹^,², 杨晓霞³, 赵霞⁴, 曹新燕¹, 陈良侠², 刘西花⁴()

1.山东中医药大学，山东济南市 250355
2.山东省疾病预防控制中心，山东济南市 250014
3.山东第一医科大学附属省立医院，山东济南市 250021
4.山东中医药大学附属医院，山东济南市 250014

收稿日期:2025-05-22 修回日期:2025-09-12 出版日期:2025-10-25 发布日期:2025-11-10
通讯作者: 刘西花(1983-)，女，汉族，博士，主任医师，博士研究生导师，主要研究方向：中西医结合康复，E-mail： xihualiu0629@163.com
作者简介:于子夫(1997-)，男，汉族，山东莱西市人，硕士，主管技师，主要研究方向：慢性病健康管理与中西医结合康复。
基金资助:
1.山东省中医药科技项目(M-2023142);2.山东省医务职工科技创新计划项目(SDYWZGKCJH2022024)

Effect of scalp combined with intradermal-needle acupuncture synchronized rehabilitation therapy on upper limb motor function after stroke

YU Zifu¹^,², YANG Xiaoxia³, ZHAO Xia⁴, CAO Xinyan¹, CHEN Liangxia², LIU Xihua⁴()

1. Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250355, China
2. Shandong Center for Disease Control and Prevention, Ji'nan, Shandong 250014, China
3. Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong 250021, China
4. Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250014, China

Received:2025-05-22 Revised:2025-09-12 Published:2025-10-25 Online:2025-11-10
Contact: LIU Xihua, E-mail: xihualiu0629@163.com
Supported by:
Shandong Province Traditional Chinese Medicine Science & Technology Research Project(M-2023142);Shandong Medical Workers Science and Technology Innovation Program(SDYWZGKCJH2022024)

摘要/Abstract

摘要：

目的探讨头针联合皮内针同步康复疗法对脑卒中患者上肢运动功能的效果。
方法 2022年12月至2023年12月，选取山东中医药大学附属医院的卒中后上肢运动功能障碍患者144例，随机分为对照组、皮内针组、头针组和针刺组，各36例。4组均进行常规治疗和上肢康复训练，皮内针组增加皮内针治疗，头针组增加头针治疗，针刺组增加头针和皮内针治疗，共4周。治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、Wolf运动功能测试(WMFT)和改良Barthel指数(MBI)进行评定，每组随机抽取20例采用弥散张量成像采集病灶区和内囊后肢的各向异性分数(FA)值和各向异性分数比值(rFA)。
结果对照组和皮内针组各脱落2例，头针组和针刺组各脱落1例。治疗后，4组FMA-UE、WMFT、MBI评分及病灶区和内囊后肢的FA值、rFA值均显著改善(t > 5.532, P < 0.001)；针刺组治疗前后的FMA-UE差值以及病灶区FA差值、rFA差值、内囊后肢rFA差值均高于另外3组(|Z| > 3.256, P < 0.05)，WMFT和MBI差值均高于皮内针组和对照组(|Z| > 5.483, P < 0.001)。皮内针与头针在改善患者FMA-UE评分方面存在明显交互效应(偏η²= 0.035, P = 0.029)。4组FMA-UE差值与内囊后肢FA差值之间均呈正相关(r > 0.453, P < 0.05)。
结论头针联合皮内针同步康复疗法能更有效改善脑卒中患者上肢运动功能，可能与促进内囊功能恢复有关。

关键词: 脑卒中, 上肢, 运动功能, 针刺同步康复疗法, 弥散张量成像

Abstract:

Objective To explore the effect of scalp combined with intradermal-needle acupuncture synchronized rehabilitation therapy on upper limb motor function in stroke patients.
Methods From December, 2022 to December, 2023, 144 stroke patients with upper limb motor dysfunction in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine were randomly divided into control, intradermal-needle, scalp-acupuncture and acupuncture groups (36 cases repectively). All groups received conventional treatment and upper limb rehabilitation training, the intradermal-needle group added intradermal-needle therapy, the scalp-acupuncture group added scalp-acupuncture therapy, and the acupuncture group added both scalp- and intradermal-needle therapies, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT) and modified Barthel Index (MBI) before and after treatment. Twenty cases were selected randomly from each group, fractional anisotropy (FA) values and ratio of fractional anisotropy (rFA) of the lesion area and the posterior limb of the internal capsule were also measured with diffusion tensor imaging.
Results Two cases dropped out in both the control group and the intradermal-needle group, while one case dropped out in both the scalp-acupuncture group and the acupuncture group. All groups showed significant improvement in FMA-UE, WMFT and MBI scores, as well as in the FA and rFA values of the lesion area and the posterior limb of the internal capsule (t > 5.532, P < 0.001) after treatment. The acupuncture group demonstrated the greatest pre- to post-treatment differences in FMA-UE scores, lesion-area FA and rFA values, and posterior-limb rFA values compared with the other three groups (|Z| > 3.256, P < 0.05), and more WMFT and MBI improvements than those of the intradermal-needle group and the control group (|Z| > 5.483, P < 0.001). A significant interaction effect was observed between intradermal and scalp acupuncture in improving FMA-UE scores (partial η² = 0.035, P = 0.029). The change in FMA-UE scores was positively correlated with the change in FA values of the posterior limb of the internal capsule (r > 0.453, P < 0.05) across four groups.
Conclusion Scalp combined with intradermal-needle acupuncture synchronized rehabilitation therapy can more effectively improve upper-limb motor function in stroke patients, which may associate with the recovery of internal capsule.

Key words: stroke, upper limb, motor function, acupuncture synchronized rehabilitation therapy, diffusion tensor imaging

中图分类号:

R743.3

于子夫, 杨晓霞, 赵霞, 曹新燕, 陈良侠, 刘西花. 头针联合皮内针同步康复疗法对脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2025, 31(10): 1194-1205.

YU Zifu, YANG Xiaoxia, ZHAO Xia, CAO Xinyan, CHEN Liangxia, LIU Xihua. Effect of scalp combined with intradermal-needle acupuncture synchronized rehabilitation therapy on upper limb motor function after stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(10): 1194-1205.

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组别	n	性别(男/女)/n	年龄/岁	病程/d	卒中类型(出血/梗死)/n	偏瘫侧(左/右)/n
对照组	36	23/13	60.72±11.13	88.50(47.25, 129.75)	18/18	15/21
皮内针组	36	22/14	62.19±9.39	82.50(36.50, 125.00)	17/19	14/22
头针组	36	21/15	60.89±10.76	77.00(34.75, 121.75)	19/17	13/23
针刺组	36	25/11	60.25±10.62	86.00(42.25, 136.50)	17/19	15/21
χ²/F/H值		1.045^a	0.226^b	2.109^c	0.305^a	0.319^a
P值		0.790	0.878	0.550	0.959	0.956

变量	组别	n	治疗前	治疗后	治疗前后差值	t值	P值
FMA-UE	对照组	34	29.85±7.86	37.56±7.89	7.71±1.32	34.171	< 0.001
	皮内针组	34	27.82±9.32	38.44±9.65	10.62±2.19	28.291	< 0.001
	头针组	35	26.91±7.88	40.43±7.71	13.51±1.54	51.882	< 0.001
	针刺组	35	29.66±8.13	47.89±9.53	18.23±1.80	59.909	< 0.001
WMFT	对照组	34	31.29±8.38	40.03±7.40	8.74±2.06	24.675	< 0.001
	皮内针组	34	29.68±8.97	39.76±9.11	10.09±2.38	24.729	< 0.001
	头针组	35	28.71±8.62	42.57±7.71	13.86±2.16	37.995	< 0.001
	针刺组	35	31.70±9.91	47.54±7.25	15.83±2.89	32.460	< 0.001
MBI	对照组	34	47.76±8.72	58.26±9.81	10.50±2.95	20.779	< 0.001
	皮内针组	34	46.32±11.88	60.91±12.38	14.59±2.81	30.291	< 0.001
	头针组	35	45.80±9.22	63.09±9.87	17.29±1.96	52.070	< 0.001
	针刺组	35	48.71±12.20	68.26±11.02	19.54±2.41	48.070	< 0.001

对比组	FMA-UE差值		WMFT差值		MBI差值
对比组	Z值	P值	Z值	P值	Z值	P值
对照组vs.皮内针组	-3.053	0.014	-1.624	0.626	-3.489	0.003
对照组vs.头针组	-6.166	< 0.001	-6.417	< 0.001	-6.474	< 0.001
对照组vs.针刺组	-10.213	< 0.001	-8.066	< 0.001	-8.997	< 0.001
皮内针组vs.头针组	-3.092	0.012	-4.781	< 0.001	-2.960	0.018
皮内针组vs.针刺组	-7.138	< 0.001	-6.430	< 0.001	-5.483	< 0.001
头针组vs.针刺组	-4.076	< 0.001	-1.661	0.580	-2.541	0.066

变量		平方和	自由度	均方	F值	P值	偏η²
FMA-UE	皮内针	599.719	1	599.719	7.853	0.006	0.055
	头针	1307.634	1	1307.634	17.124	< 0.001	0.113
	皮内针×头针	372.762	1	372.762	4.881	0.029	0.035
WMFT	皮内针	191.032	1	191.032	3.064	0.082	0.022
	头针	918.420	1	918.420	14.731	< 0.001	0.099
	皮内针×头针	236.423	1	236.423	3.792	0.054	0.028
MBI	皮内针	527.125	1	527.125	4.505	0.036	0.033
	头针	1276.413	1	1276.413	10.908	0.001	0.075
	皮内针×头针	54.951	1	54.951	0.470	0.494	0.003

针刺		平方和	自由度	均方	F值	P值	偏η²
无头针	对比	13.235	1	13.235	0.173	0.678	0.001
无头针	误差	10232.879	134	76.365
有头针	对比	973.157	1	973.157	12.744	< 0.001	0.087
有头针	误差	10232.879	134	76.365
无皮内针	对比	142.032	1	142.032	1.860	0.175	0.014
无皮内针	误差	10232.879	134	76.365
有皮内针	对比	1538.365	1	1538.365	20.145	< 0.001	0.131
有皮内针	误差	10232.879	134	76.365

头针联合皮内针同步康复疗法对脑卒中患者上肢运动功能的效果

Effect of scalp combined with intradermal-needle acupuncture synchronized rehabilitation therapy on upper limb motor function after stroke

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变量	组别	n	治疗前	治疗后	治疗前后差值	t值	P值
病灶区FA	对照组	18	0.33±0.04	0.35±0.03	0.02±0.01	5.532	< 0.001
	皮内针组	20	0.33±0.03	0.35±0.02	0.03±0.01	15.013	< 0.001
	头针组	19	0.33±0.02	0.36±0.03	0.03±0.01	19.804	< 0.001
	针刺组	18	0.33±0.03	0.38±0.02	0.05±0.01	16.597	< 0.001
病灶区rFA	对照组	18	0.51±0.04	0.53±0.03	0.02±0.01	13.310	< 0.001
	皮内针组	20	0.51±0.03	0.55±0.04	0.04±0.02	9.585	< 0.001
	头针组	19	0.52±0.03	0.56±0.02	0.04±0.01	17.277	< 0.001
	针刺组	18	0.51±0.03	0.58±0.03	0.07±0.01	36.460	< 0.001
内囊后肢FA	对照组	18	0.49±0.03	0.51±0.03	0.02±0.01	13.262	< 0.001
	皮内针组	20	0.48±0.04	0.52±0.04	0.04±0.02	9.492	< 0.001
	头针组	19	0.49±0.02	0.54±0.04	0.05±0.01	29.198	< 0.001
	针刺组	18	0.49±0.03	0.55±0.03	0.06±0.01	23.892	< 0.001
内囊后肢rFA	对照组	18	0.71±0.02	0.73±0.03	0.03±0.01	7.940	< 0.001
	皮内针组	20	0.71±0.03	0.76±0.03	0.05±0.01	25.249	< 0.001
	头针组	19	0.72±0.02	0.76±0.02	0.05±0.01	35.146	< 0.001
	针刺组	18	0.71±0.02	0.78±0.04	0.07±0.01	32.081	< 0.001

组别	部位	FA差值		rFA差值
组别	部位	r值	P值	r值	P值
对照组	病灶区	0.494	0.037	0.378	0.121
对照组	内囊后肢	0.508	0.031	0.293	0.238
皮内针组	病灶区	0.437	0.054	0.337	0.147
皮内针组	内囊后肢	0.453	0.045	0.175	0.461
头针组	病灶区	0.388	0.101	0.105	0.669
头针组	内囊后肢	0.587	0.008	0.510	0.026
针刺组	病灶区	0.574	0.013	0.479	0.044
针刺组	内囊后肢	0.585	0.011	0.222	0.375

组别	n	原因	发生率/%
对照组	0		0
皮内针组	2	2例均为肢体局部疼痛、酸胀不适	5.9
头针组	5	3例患者产生头痛，2例患者出现头晕	14.3
针刺组	5	2例患者出现头痛，2例患者出现头晕，1例患者出现局部皮肤红肿	14.3

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对比组	病灶区FA差值		病灶区rFA差值		内囊后肢FA差值		内囊后肢rFA差值
对比组	Z值	P值	Z值	P值	Z值	P值	Z值	P值
对照组vs.皮内针组	-1.687	0.549	-2.718	0.039	-2.287	0.133	-3.985	< 0.001
对照组vs.头针组	-2.796	0.031	-3.249	0.007	-4.584	< 0.001	-3.262	0.007
对照组vs.针刺组	-5.972	< 0.001	-7.077	< 0.001	-6.025	< 0.001	-7.238	< 0.001
皮内针组vs.头针组	-1.160	> 0.999	-0.580	> 0.999	-2.387	0.102	-0.693	> 0.999
皮内针组vs.针刺组	-4.440	< 0.001	-4.543	< 0.001	-3.894	0.001	-3.441	0.003
头针组vs.针刺组	-3.256	0.007	-3.922	0.001	-1.521	0.769	-4.073	< 0.001