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

Abstract

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

CLC Number:

R743.3

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.

Figures/Tables 12

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References 45

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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

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