|
针灸治疗卒中后足下垂的临床研究进展
|
Abstract:
足下垂是脑卒中常见的后遗症之一,属于肢体功能障碍性神经系统疾病,临床表现为不能足背屈,在行走、抬腿或者落地的时候往往足尖先着地。其发病率高,致残率高,对患者生活质量产生严重影响。本文对近五年来针灸治疗脑卒中后足下垂的方法进行疏理,包括毫针刺法、围刺、巨刺、灸法、毫火针、电针、头针等其他针灸疗法,临床疗效安全显著,且操作便捷,无毒副作用,经证实能有效改善卒中患者足下垂症状,以期为临床治疗卒中后足下垂提供参考依据。
Foot drop is one of the common sequelae of stroke, classified as a functional limb disorder of the nervous system. Clinically, it is characterized by the inability to dorsiflex the foot, often resulting in the toes touching the ground first when walking, lifting the leg, or landing. It has a high incidence rate and a high disability rate, significantly affecting the quality of life of patients. This paper reviews acupuncture treatment methods for foot drop following stroke over the past five years, including filiform needle technique, encircling needling, scalp acupuncture, moxibustion, fire needle, electroacupuncture, and other acupuncture therapies. These methods have been proven to be safe and effective, with convenient operation and no toxic side effects. They can effectively improve foot drop symptoms in stroke patients and provide a reference for clinical treatment of foot drop following stroke.
[1] | Tater, P. and Pandey, S. (2021) Post-Stroke Movement Disorders: Clinical Spectrum, Pathogenesis, and Management. Neurology India, 69, 272-283. https://doi.org/10.4103/0028-3886.314574 |
[2] | 龚英, 石国凤. 脑卒中后足下垂的中西医康复治疗研究进展[J]. 中国疗养医学, 2021, 30(8): 808-811. |
[3] | Gil-Castillo, J., Alnajjar, F., Koutsou, A., Torricelli, D. and Moreno, J.C. (2020) Advances in Neuroprosthetic Management of Foot Drop: A Review. Journal of NeuroEngineering and Rehabilitation, 17, Article No. 46. https://doi.org/10.1186/s12984-020-00668-4 |
[4] | 支亮, 王玉龙, 张清芳, 等. 脑卒中患者偏瘫步态中的推进力缺陷[J]. 中国组织工程研究, 2024, 28(35): 5709-5715. |
[5] | 葛亚丽, 曹磊, 张艳明, 等. 节律性听觉刺激对背侧前运动皮质卒中后偏瘫患者步行功能的疗效分析[J]. 中国脑血管病杂志, 2023, 20(8): 505-512. |
[6] | 矫非桐, 王春艳. 脑卒中偏瘫患者的中医康复治疗及护理研究进展[J]. 吉林医药学院学报, 2023, 44(5): 371-372+375. |
[7] | Wu, S., Wu, B., Liu, M., Chen, Z., Wang, W., Anderson, C.S., et al. (2019) Stroke in China: Advances and Challenges in Epidemiology, Prevention, and Management. The Lancet Neurology, 18, 394-405. https://doi.org/10.1016/s1474-4422(18)30500-3 |
[8] | Agarwal, P., Gupta, M., Kukrele, R. and Sharma, D. (2020) Tibialis Posterior (TP) Tendon Transfer for Foot Drop: A Single Center Experience. Journal of Clinical Orthopaedics and Trauma, 11, 457-461. https://doi.org/10.1016/j.jcot.2020.03.007 |
[9] | Küçükdeveci, A.A., Stibrant Sunnerhagen, K., Golyk, V., Delarque, A., Ivanova, G., Zampolini, M., et al. (2019) Evidence-Based Position Paper on Physical and Rehabilitation Medicine Professional Practice for Persons with Stroke. The European PRM Position (UEMS PRM Section). European Journal of Physical and Rehabilitation Medicine, 54, 957-970. https://doi.org/10.23736/s1973-9087.18.05501-6 |
[10] | Birch, S. and Robinson, N. (2022) Acupuncture as a Post-Stroke Treatment Option: A Narrative Review of Clinical Guideline Recommendations. Phytomedicine, 104, Article ID: 154297. https://doi.org/10.1016/j.phymed.2022.154297 |
[11] | 李旭阳, 孙红, 刘悦, 等. 毫火针结合经筋理论治疗缺血性卒中踝关节拘挛临床研究[J]. 辽宁中医药大学学报, 2019, 21(9): 112-115. |
[12] | 孙峰, 丁永民, 谢晶军. 超声引导下BTX-A联合针刺对脑卒中痉挛性足下垂及足内翻患者步态功能的疗效观察[J]. 浙江临床医学, 2023, 25(8): 1166-1168. |
[13] | 李薇薇, 武连仲, 满斌, 等. 武连仲教授对中风后痉挛性瘫痪阴阳分型探讨[J]. 天津中医药, 2022, 39(6): 701-705. |
[14] | Lee, J., Kim, J. and Lee, B. (2017) The Effects of Posterior Talar Glide with Dorsiflexion of the Ankle on Mobility, Muscle Strength and Balance in Stroke Patients: A Randomised Controlled Trial. Journal of Physical Therapy Science, 29, 452-456. https://doi.org/10.1589/jpts.29.452 |
[15] | 武家竹, 陈林玲, 邸嘉玮, 等. 针灸改善缺血性脑卒中侧支循环的血管作用机制[J]. 针灸临床杂志, 2023, 39(6): 105-109. |
[16] | Chavez, L., Huang, S., MacDonald, I., Lin, J., Lee, Y. and Chen, Y. (2017) Mechanisms of Acupuncture Therapy in Ischemic Stroke Rehabilitation: A Literature Review of Basic Studies. International Journal of Molecular Sciences, 18, Article No. 2270. https://doi.org/10.3390/ijms18112270 |
[17] | 王路, 杜志伟, 吴立德, 等. 镜像疗法对脑卒中偏瘫患者足下垂的影响[J]. 按摩与康复医学, 2019, 10(4): 9-10. |
[18] | Yan, R., Zhang, Y., Lim, J., Yang, F., Zhou, L., Lyu, D., et al. (2018) The Effect and Biomechanical Mechanisms of Intradermal Needle for Post-Stroke Hemiplegia Recovery: Study Protocol for a Randomized Controlled Pilot Trial. Medicine, 97, e0448. https://doi.org/10.1097/md.0000000000010448 |
[19] | 关敏, 刘四维, 李宝金, 等. 运动再学习训练对脑卒中急性期偏瘫患者运动功能的康复作用[J]. 中国现代神经疾病杂志, 2017, 17(3): 197-201. |
[20] | Ward, N.S. (2017) Restoring Brain Function after Stroke—Bridging the Gap between Animals and Humans. Nature Reviews Neurology, 13, 244-255. https://doi.org/10.1038/nrneurol.2017.34 |
[21] | Chandran, K.P., Chandran, P.P., Arumugam, N. and Muthappan, S. (2021) Effect of Remote and Local Acupuncture Points on Periarthritis of Shoulder: A Comparative Study. Journal of Acupuncture and Meridian Studies, 14, 13-20. https://doi.org/10.51507/j.jams.2021.14.1.13 |
[22] | 黄春莉, 韩冰, 孙文, 等. 针刺联合重复经颅磁刺激疗法治疗脑卒中后偏瘫足下垂41例临床研究[J]. 江苏中医药, 2023, 55(1): 36-40. |
[23] | 卢燕, 童心, 杨春花, 等. 针刺联合肌电生物反馈疗法治疗脑卒中偏瘫患者足下垂的临床研究[J]. 中国康复, 2023, 38(2): 73-77. |
[24] | 迟世浩, 秦梦妮, 张梦龙, 等. 近10年不同针刺法在中风后足内翻中的应用概况[J]. 天津中医药大学学报, 2023, 42(3): 375-381. |
[25] | 王馨若, 王勇军. 解溪穴围刺联合等速肌力训练治疗脑卒中后足内翻临床观察[J]. 光明中医, 2022, 37(23): 4325-4328. |
[26] | 张兆星, 张保平, 郭奎奎, 等. 围刺联合冷敷加压治疗急性踝关节扭伤疗效观察[J]. 针刺研究, 2023, 48(7): 694-698+726. |
[27] | 陈希源, 李雪青. 巨刺昆仑、丘墟结合康复训练治疗脑卒中后足下垂50例临床观察[J]. 中医药导报, 2018, 24(2): 66-68.. |
[28] | Jiang, Y., Yang, S., Tao, J., Lin, Z., Ye, X., You, Y., et al. (2016) Opposing Needling Promotes Behavior Recovery and Exerts Neuroprotection via the cAMP/PKA/CREB Signal Transduction Pathway in Transient MCAO Rats. Molecular Medicine Reports, 13, 2060-2070. https://doi.org/10.3892/mmr.2016.4773 |
[29] | Xu, M., Zi, Y., Wu, J., Xu, N., Lu, L., Liu, J., et al. (2021) Effect of Opposing Needling on Motor Cortex Excitability in Healthy Participants and in Patients with Post-Stroke Hemiplegia: Study Protocol for a Single-Blind, Randomised Controlled Trial. Trials, 22, Article No. 481. https://doi.org/10.1186/s13063-021-05443-x |
[30] | 甘文俊, 袁小敏, 何其达, 等. 基于电生理技术探讨毫火针治疗脑卒中后足下垂患者下肢功能重建的临床研究[J]. 辽宁中医杂志, 2023, 50(10): 213-216. |
[31] | 刘姝, 池响峰, 邝伟川, 等. 毫火针牵拉滞针术治疗卒中后足下垂的临床观察[J]. 针刺研究, 2019, 44(5): 367-372. |
[32] | 谢青, 龙佳佳, 黄金艳, 等. 头针联合背俞穴毫火针点刺对脑梗死偏瘫患者肢体功能恢复的影响[J]. 世界中医药, 2023, 18(18): 2661-2665. |
[33] | 颜玲玲, 陈媛, 王欣宇, 等. “治痿独取阳明”指导下康复锻炼配合针刺、电针改善脑卒中患者足下垂的临床研究[J]. 按摩与康复医学, 2022, 13(11): 6-10. |
[34] | 谢捷. 电针拮抗肌运动点结合康复训练治疗中风后足下垂的疗效分析[J]. 中医临床研究, 2022, 14(12): 39-42. |
[35] | 黄慧, 陈健, 邱斐, 等. 电针对脑卒中后下肢痉挛患者运动功能及步态的影响[J]. 中国针灸, 2022, 42(1): 23-27. |
[36] | 王新伟, 杨晓伟, 代静. 电针对缺血性脑卒中足下垂患者下肢运动功能的临床疗效[J]. 针灸临床杂志, 2017, 33(9): 41-43. |
[37] | 李晓泉, 王淑娟, 张雷. 头针治疗缓解脑卒中患者足下垂症状的效果[J]. 中国当代医药, 2019, 26(10): 178-180+195. |
[38] | 林润, 罗菁, 许明珠, 等. 不同针灸方法治疗缺血性卒中下肢功能障碍疗效的系统评价[J]. 中国康复医学杂志, 2023, 38(1): 87-94. |
[39] | Zhang, Y., Lou, H., Lu, J., Tang, X., Pang, T., Lei, S., et al. (2023) Scalp Acupuncture Alleviates Cerebral Ischemic Stroke-Induced Motor Dysfunction in Rats via Regulating Endoplasmic Reticulum Stress and ER-Phagy. Scientific Reports, 13, Article No. 10119. https://doi.org/10.1038/s41598-023-36147-8 |
[40] | Zhang, D., Zou, W., Zhang, B. and Guo, P. (2024) Scalp Acupuncture for Post-Stroke Spastic Hemiparesis: A Systematic Review and Meta-Analysis. Medicine, 103, e37167. https://doi.org/10.1097/md.0000000000037167 |
[41] | Hu, X., Li, B. and Wang, X. (2021) Scalp Acupuncture Therapy Combined with Exercise Can Improve the Ability of Stroke Patients to Participate in Daily Activities. Complementary Therapies in Clinical Practice, 43, Article ID: 101343. https://doi.org/10.1016/j.ctcp.2021.101343 |
[42] | 关风光, 纪秋露, 江月卿, 等. 循经穴位拍打联合雷火灸治疗脑卒中上肢偏瘫临床观察[J]. 中国针灸, 2021, 41(7): 717-720. |
[43] | 史镇平, 魏晓楠, 郝铁成, 等. 雷火灸联合康复训练治疗脑卒中后足下垂的临床应用效果[J]. 大众科技, 2022, 24(2): 70-73. |
[44] | 陈芷枫, 尹建军, 金义羚. 针刺阴经穴联合雷火灸对脑卒中偏瘫肢体肌张力的影响[J]. 陕西中医, 2024, 45(7): 971-974+979. |
[45] | 何清平, 季束玲, 蒋宗庆, 等. 超声引导神经入肌点温针灸治疗对脑卒中患者步态与平衡功能影响的临床研究[J]. 中国康复医学杂志, 2020, 35(9): 1114-1116. |
[46] | 朱丽臻. 温针灸治疗中风后下肢痉挛性瘫痪的临床探讨[J]. 双足与保健, 2019, 28(21): 191-192. |
[47] | 王瑞奇, 黄春华, 吴清忠. 不同针灸疗法治疗中风后痉挛性偏瘫的网状Meta分析[J]. 世界针灸杂志(英文版), 2022, 32(1): 78-84. |
[48] | 林凌, 程熙, 林志诚, 等. 栝楼桂枝汤经穴导入对脑卒中后痉挛性足下垂的疗效观察[J]. 上海针灸杂志, 2018, 37(7): 746-750. |
[49] | 卢哲, 高萍, 王洁, 等. 通脉化瘀方内服结合定向透药技术在脑卒中上肢偏瘫中的应用研究[J]. 中华中医药学刊, 2025, 43(3): 250-253. |
[50] | 吴荷花, 邓奕文, 黄慧芝, 等. 穴位注射联合生物反馈训练对脑卒中后痉挛性足下垂、足内翻及下肢运动功能的影响[J]. 中国老年学杂志, 2022, 42(12): 2872-2875. |
[51] | Liu, M., Wang, Y., Li, N., Cui, J., Fan, W., Yang, S., et al. (2021) Effects of Acupoint Injection for Stroke Patients with Hemiplegia: A Protocol for Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine, 100, e28374. https://doi.org/10.1097/md.0000000000028374 |
[52] | 王晓景, 毛立亚, 马齐. 脑卒中后足下垂的中西医治疗现状研究进展[J]. 按摩与康复医学, 2021, 12(15): 63-66+71. |
[53] | 高俊虎, 刘建伟, 韩旭, 等. 针灸治疗踝关节扭伤临床研究进展[J]. 中医药学报, 2020, 48(8): 73-76. |
[54] | 李鹏程, 顾力华, 陈奇刚, 等. 脑卒中后踝关节功能障碍的中西医康复治疗现状[J]. 中西医结合心脑血管病杂志, 2019, 17(14): 2128-2131. |
[55] | 冷琴, 尹燕. 丘墟透照海临床应用探析[J]. 按摩与康复医学, 2022, 13(10): 51-53. |
[56] | Gao, Y., Gang, X., Yuan, Y., Yin, K. and Gong, X. (2022) Efficacy and Safety of Acupuncture in the Treatment of Foot Drop in Post-Stroke: A Protocol for Systematic Review and Meta-Analysis. Medicine, 101, e30994. https://doi.org/10.1097/md.0000000000030994 |