| ObjectiveThe method of Hegu needling was used to intervene the gluteal muscles of stroke patients.The activate features of the muscles related to the lower limbs in the supporting phase were observed by surface electromyography,and the effect on the walking ability of the lower limbs of stroke patients was evaluated by using the relevant scale.Analyze and evaluate the therapeutic effect from the aspects of electrophysiology and clinical function to explore the activation of the muscles of the lower limbs.Seek a treatment idea and plan with high feasibility,significant effect and high repetition rate for patients with walking disorder after stroke.MethodsIn this study,60 patients with stroke hemiplegia were randomly divided into the observation group and the control group,with 30 patients in each group.They were treated for 4 weeks,and 57 cases were finally completed,including 29 cases in the observation group and 28 cases in the control group.The control group was given routine medical treatment of basic diseases,ordinary acupuncture and rehabilitation training,while the observation group was given Hegu needling at Zhibian,Juliao and Huantiao points on the affected side on the basis of the control group.The activation onset time point,activation sequence,and activation degree of bilateral gluteus maximus,gluteus medius and rectus femoris were observed by surface electromyography before the first treatment and after 4 weeks of treatment in both groups.And the Fugl-Meyer lower limb motor function and Berg balance(BBS)scale were evaluated before the first treatment,2 weeks after treatment and 4 weeks after treatment.Results1.Activation start time point Analysis: Before treatment,there was no statistical significance in the comparison of activation start time point of the same muscle on the same side between the two groups(P>0.05),indicating comparability.The comparison of the onset time point of muscle activation between the internal healthy side and the affected side of the two groups showed statistically significant difference(P<0.01).The onset time point of muscle activation in the gluteus maximus and the affected side of the gluteus was later than that in the healthy side,and the onset time point of muscle activation in the affected side of the rectus femoris was earlier than that in the healthy side.After 4 weeks of treatment,there was a statistically significant difference in the activation time of the three muscles on the affected side and the rectus femoris on the healthy side between the two groups(P<0.01),and the observation group was better than the control group.There was significant difference in the starting time of muscle activation between the two groups before and after treatment(P<0.05).The starting time of gluteus maximus muscle and gluteus medius muscle activation was earlier than before,and the starting time of rectus femoris muscle activation was delayed.2.Activation sequence analysis: there was no significant difference in activation sequence between the two groups before treatment(P>0.05).The main activation order of the affected side was rectus femoris,gluteus medius,gluteus maximus.The main activation order of the healthy side was gluteus maximus,gluteus medius,rectus femoris.After 4 weeks of treatment,there was significant difference in muscle activation order between the two groups of affected muscles(P<0.01),but there was no significant difference between the two groups of healthy muscles(P<0.05).The muscle activation order of the affected side in the observation group and the healthy side in the two group was mainly gluteus maximus,gluteus medius,rectus femoris,while the affected side in the control group was still rectus femoris,gluteus maximus,gluteus medius.3.RMS peak analysis: Before treatment,there was no significant difference in RMS peak value of three muscles on the same side between the two groups(P>0.05),which was comparable.The peak value of RMS of the healthy side and affected side of the three muscles in the two groups was significantly different(P<0.01),and the RMS of the affected side was lower than that of the healthy side.After 4 weeks of treatment,there were significant differences before and after treatment in the three muscles of the affected side and healthy side of the two groups(P<0.05).The peak value of RMS in the affected side was higher than that before treatment,and the peak value of RMS in the healthy side was lower than that before treatment.There was significant difference in the peak RMS of the three muscles of the affected side and the gluteus maximus muscle of the healthy side between the two groups(P<0.05),and the peak value of RMS in the observation group was higher than that in the control group.The peak RMS of gluteus medius muscle and rectus femoris muscle had no significant difference between the two groups(P>0.05).There was significant difference between the healthy side and affected side in the peak value of RMS of gluteus maximus muscle and gluteus medius muscle of the observation group(P<0.05),but there was no significant difference between the healthy side and affected side in the peak value of RMS of rectus femoris muscle in the observation group.There was significant difference between the healthy side and affected side in the peak value of RMS of the three groups in the control group.4.FMA score of lower extremities: After repeated measurement and analysis,there were significant differences in time point,time point * group and group(P<0.05).There were significant differences between the two groups in after 2 weeks of treatment with before treatment,and in 4 weeks of treatment with before treatment(P<0.01).The scores of both groups increased after 2 weeks of treatment and after 4 weeks of treatment.After 2 weeks of treatment,there was no significant difference in the scores between the two groups(P>0.05),but there was significant difference in the scores between the two groups after 4 weeks of treatment(P<0.05)and the scores in the observation group were higher than those in the control group after 4 weeks of treatment.5.BBS score:After repeated measurement and analysis,there were significant differences in time point,time point * group and group(P<0.05).There were significant differences between the two groups in after 2 weeks of treatment with before treatment,and in 4 weeks of treatment with before treatment(P<0.01).The scores of both groups increased after 2 weeks of treatment and after 4 weeks of treatment.After 2 weeks of treatment,there was no significant difference in the scores between the two groups(P>0.05),but there was significant difference in the scores between the two groups after 4 weeks of treatment(P<0.05)and the scores in the observation group were higher than those in the control group after 4 weeks of treatment.Conclusions1.Gluteal muscle Hegu needling can effectively activate gluteal muscle,enhance gluteal muscle strength and improve gait stability in support phase.2.Gluteal muscle Hegu needling can effectively adjust the activation order of lower limb muscle group and further restore normal walking ability.3.Gluteal muscle Hegu needling can improve the motor function and balance function of lower limbs and improve hemiplegic gait in stroke patients. |
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