超声引导下针刀松解联合通督调神法针刺治疗脑卒中后足内翻:随机对照试验OA

Objective To observe the clinical efficacy of ultrasound-guided acupotomy release combined with Tongdu Tiaoshen acupuncture in the treatment of post-stroke talipes varus.Methods Eighty-four patients with post-stroke talipes varus were randomly divided into a combination group(42 cases,1 case dropped out)and an acupuncture group(42 cases,1 case dropped out and 1 case was discontinued).The acupuncture group received Tongdu Tiaoshen acupuncture treatment.On the basis of the acupuncture group,the combination group additionally received ultrasound-guided acupotomy release treatment.The release sites included the tibialis anterior muscle,tibialis posterior muscle,gastrocnemius muscle,achilles tendon,deltoid ligament,calcaneofibular ligament,and anterior talofibular ligament on the affected side.Acupuncture treatment was administered once daily,5 times per week,and ultrasound-guided acupotomy treatment was administered once weekly.Both groups were treated continuously for 4 weeks.Before and after treatment,the Fugl-Meyer assessment(FMA)score,talipes varus angle,modified Ashworth scale(MAS)grade,Berg balance scale(BBS)score,modified Barthel index(MBI)score,and gait parameters(walking speed and cadence)were observed in both groups.Clinical efficacy was evaluated after treatment.Results After treatment,FMA scores,BBS scores,and MBI scores were increased compared with those before treatment in both groups(P<0.05),and all three scores in the combination group were higher than those in the acupuncture group(P<0.05).After treatment,the talipes varus angle was decreased compared with that before treatment in both groups(P<0.05),and the talipes varus angle in the combination group was lower than that in the acupuncture group(P<0.05).After treatment,MAS grades were improved compared with those before treatment in both groups(P<0.05),and the improvement in the combination group was superior to that in the acupuncture group(P<0.05).After treatment,walking speed and cadence were increased compared with those before treatment in both groups(P<0.05),and walking speed and cadence in the combination group were faster than those in the acupuncture group(P<0.05).The total effective rate in the combination group was 85.4％(35/41),higher than 75.0％(30/40)in the acupuncture group(P<0.05).Conclusion Ultrasound-guided acupotomy release combined with Tongdu Tiaoshen acupuncture could reduce the talipes varus angle in patients with post-stroke talipes varus,improve lower limb motor function,and enhance activities of daily living.