目的 探讨腹针联合高频重复经颅磁刺激(HF-rTMS)对偏瘫肩痛的临床疗效.方法 选取2016年1月～2017年5月就诊于徐州市中心医院符合研究标准的60例偏瘫肩痛患者,按照随机数字表法将其分为腹针组、rTMS组和联合组,每组20例.所有患者禁止服用止痛药,均接受常规对症药物及常规康复训练,腹针组进行腹针治疗,rTMS组给予HF-rTMS治疗,联合组给予腹针联合10 Hz的rTMS治疗,刺激部位为患侧M1区.治疗前及治疗4周后采用简易Fugl-Meyer运动功能量表上肢部分(FMA)、视觉模拟评分法(VAS)评价疗效.结果 三组治疗后VAS评分均较治疗前降低,FMA评分均较治疗前提高,差异有统计学意义(P＜ 0.05).治疗后,联合组VAS评分低于腹针组、rTMS组,腹针组VAS评分低于rTMS组,差异有统计学意义(P＜0.05).治疗后,联合组FMA评分高于腹针组、rTMS组,rTMS组FMA评分高于腹针组,差异有统计学意义(P＜0.05).结论 腹针联合HF-rTMS可显著改善肩关节疼痛与上肢运动功能.%Objective To investigate the clinical effects of abdominal acupuncture combined with high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) for hemiplegic shoulder pain.Methods Sixty patients with hemiplegic shoulder pain met with research criteria treated in Xuzhou Central Hospital from January 2016 to May 2017 were selected and randomly divided into abdominal acupuncture group,rTMS group and combination group according to random number table method,with 20 cases in each group.All patients were forbidden to take painkillers and given conventional symptomatic drugs and rehabilitation training.The abdominal acupuncture group was treated with abdominal acupuncture,the rRMS group was treated with HF-rTMS,the combination group was given abdominal acupuncture combined with 10 Hz rTMS.The stimulation site was ipsilateral hemisphere M1 area.Before treatment and after treatment for 4 weeks,the upper extremity portion of simple Fugl-Meyer assessment (FMA) and visual analogue scale (VAS) were used to evaluate the efficacy.Results After treatment,the scores of VAS in the three groups were all lower than those before treatment,and the scores of FMA were all higher than those before treatment,the differences were statistically significant (P ＜ 0.05).After treatment,the VAS score of combination group was lower than those of abdominal acupuncture group and rTMS group,the VAS score of abdominal acupuncture group was lower than that of rTMS group,the differences were statistically significant (P ＜ 0.05).After treatment,the FMA score of the combination group was higher than those of abdominal acupuncture group and rTMS group,and the FMA score of rTMS group was higher than that of abdominal acupuncture group,the differences were statistically significant (P ＜ 0.05).Conclusion Abdominal acupuncture combined with HF-rTMS can significantly improve the miplegic shoulder pain and upper extremity motor function.
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