| ObjectiveTo explore the clinical efficacy and mechanism of acupotomy combined with rehabilitation training in the treatment of spastic hemiplegia after stroke.To provide a more effective treatment method for the disease and provide new ideas for further expanding the application of acupotomy therapy in the future.Part 1:Clinical studyMethodsPatients with spastic hemiplegia after stroke who met the inclusion criteria were randomly divided into two groups:the control group(rehabilitation group)and the treatment group(needle knife combined with rehabilitation group).Basic medical interventions were given to all patients,including circulation enhancement,blood pressure,blood sugar,blood lipids,and neurotrophy management.On this basis,the control group is given routine rehabilitation training,which included eliminating various incentives that may lead to spasticity,as well as appropriate positioning and physical therapy.Each time,the upper and lower limbs are trained,a total of 40 minutes,daily 1 time.This treatment should be performed five times a week,followed by two days off,for a total of four weeks of treatment.The treatment group was guided by musculoskeletal ultrasound to locate the soft tissue attachment of the relevant limb band bone on the body surface(the starting and ending points of the relevant muscles and ligaments),and received needle knife treatment at 2-3 selected points of upper and lower limbs each time,once a week,for a total of 4 weeks.Each time,a small needle knife treatment was given first,and then rehabilitation treatment was given.The Modified Ashworth Spasticity Scale(MAS),the Fugl-Meyer Assessment of Motor Function(FMA)and the Barthel Index of Activities of Daily Living(BI)were observed during passive activities on the hemiplegic side of the patient before and after treatment.Moreover,the sEMG signal of the patients’ afflicted side muscles is also detected using surface electromyography,both before and after treatment,and the integral electromyography(iEMG)was selected as the index to explore the therapeutic effect and clinical mechanism of needle knife therapy on spastic hemiplegia after stroke.The use of acupotomy is promoted since it offers sufficient evidence-based medical support.Results1.Clinical efficacy is compared:after two weeks of treatment,the treatment group had 5 cases that are noticeably effective,12 cases are effective,and 23 cases are not effective;the control group had 3 cases that are noticeably effective,12 cases,and 25 cases that are not effective;Z=-0.575,P=0.565.There was no significant difference in the distribution of overall efficacy grades between the groups.After 4 weeks of therapy,14 cases in the treatment group show a significant improvement,23 cases show improvement,and 3 cases show no improvement.In the control group,10 cases show a significant improvement,18 cases showed improvement,and 12 cases show no improvement,Z=-2.015,P=0.044.The overall efficacy grade distribution show differences that are statistically significant,indicating that the treatment group’s total effective rate is higher than the control group’s.2.Rating results of the scale(1)FMA Score comparison:Upper limb FMA Score:between Fgroups=11.48,between Pgroups=0.001;Ftime=199.46,Ptime=0.000;Finteraction=10.08,Pineraction=0.000.It is suggested that there is a significant statistical difference between the treatment group and the control group,and the upper limb FMA scores were higher in the treated compared to the control group.At various intervals before and after treatment,significant statistical differences were observed between the two groups.The upper limb FMA Score are superior at 2 and 4 weeks after treatment than before treatment,and 4 weeks after treatment than 2 weeks after treatment.There was interaction between groups and time,and different trends of change were observed at different times.The FMA score of the upper limbs of the treatment group is better than that of the control group at 2 and 4 weeks.Lower limb FMA Score:between Fgroups=0.06,between Pgroups=0.813;Ftime=35.69,Ptime=0.000;Finteration=5.37,Pinteraotion= 0.006.It is suggested that there is no statistical difference between the treatment group and the control group,and there is no difference between the two groups in improving the FMA score of lower limbs;there were changes at different time points in the two groups before and after treatment,the FMA score of lower limbs in the treatment group had no significant difference 2 weeks after treatment compared with that before treatment,but it was better 4 weeks after treatment than that before treatment and 2 weeks after treatment;in the control group,the FMA scores of lower limbs at 2 and 4 weeks after treatment were better than those before treatment,and there was no difference between 4 weeks after treatment and 2 weeks after treatment;there was an interaction between groups and time,and the change trends of the two different groups at various time periods are discordant,pre-treatment lower limb FMA scores were not significantly different between the two groups,and the treatment group had better FMA scores for the lower limbs at 2 weeks,lower limb FMA scores were not significantly different between groups at week 4.(2)BI Score comparison:between Fgroups=27.37,between Pgroups=0.000;Ftime=37.83,Ptime=0.000;Finteraction=19.08,Pinteraction=0.000.There was significant difference between the treatment group and the control group,and the score of BI scale in the treatment group was better than that in the control group.There were changes in the two groups at different time points before and after treatment.The BI scale score in the treatment group at 2 weeks after treatment was no significant difference compared with that before treatment.It was better after 4 weeks of treatment than 2 weeks of treatment in the treatment group;the BI scale score of the control group was better than that before treatment at 2 and 4 weeks after treatment,and there was no significant difference between 4 weeks after treatment and 2 weeks after treatment;there was interaction between groups and time,the change patterns of the two different groups at various time points are discordant,there was no difference in BI scale score between the treatment group and the control group at 2 weeks,and the BI scale scores in the treatment group were higher than those in the control group after 4 weeks.3.Test results of surface iEMG(1)Surface iEMG of upper limb biceps brachiiBefore treatment,there was no significant difference between the affected biceps brachii iEMG groups(P>0.05),which was comparable.After therapy,there was a difference between the two groups(P<0.01)and the iEMG ratings of the two groups were higher after treatment than they were before treatment(P<0.05).(2)Surface iEMG of lower limb rectus femorisPrior to treatment,there was no statistically significant difference between the iEMG groups on the similar rectus femoris iEMG of the lower limb(P>0.05).which was comparable.After treatment,the iEMG scores were higher than before treatment(P<0.01),and the difference between the two groups was significant after treatment(P<0.05).Conclusion1.Needle knife therapy combined with rehabilitation training can effectively relieve the spasticity of limbs of hemiplegic patients after stroke during the treatment period,enhance the recovery of patients with optional movement and coordination ability,and thus increase the confidence of patients in the rehabilitation of affected limbs,so that patients can take care of themselves as soon as possible and improve the quality of life;2.Needle knife combined with rehabilitation training can increase the total discharge of motor units involved in the activity of muscles in stroke spasticity,that to improve the muscle strength of the affected limb.Part 2:Experimental studyMethodsForty male SD rats were randomly divided into blank group,sham-operated group,model group,and needle knife group,and the spastic hemiplegia model after cerebral infarction in SD rats was constructed by the thread-bolus method,and the Zea Longa score of rats as well as the Modified Ashworth Score(MAS)were used to evaluate whether the rats were successful in the modeling upon awakening,and the needle knife group was intervened once after 24 hours,once after 7 days,and 14 days once,for a total of 3 times.Neurologic function as well as muscle tone levels were evaluated using the Zea Longa score as well as the MAS score on days 7,14,and 21.After 1 week of treatment,Nissl staining was used to observe the structure of Nissl vesicles,neuronal and synaptic ultrastructure,transcriptome sequencing technology was used to analyze signaling pathways and differential genes,and qRT-PCR was used to verify the differential genes,protein expression of Sdcl,col6a6,and MAPK/Erk signaling pathways(Erk1/2,p38 MAPK,p-Erk1/2,p-p38 MAPK)was detected by WB,expression of p-Erk,p-p38 MAPK,and Sdcl was detected using IHC.To investigate the mechanism of action of needle knife therapy in the treatment of spastic hemiplegic rats after cerebral infarction,with a view to providing a theoretical basis for clinical research.Results1.needle knife can improve the rate of weight loss in spastic paralyzed rats after cerebral infarctionThe body weight of rats in needle knife group was higher than that of model group(P<0.05),and the needle knife treatment had a good regulating effect on the body weight of spastic paralyzed rats after cerebral infarction.2.Scale evaluation results(1)Needle knife can reduce Zea Longa score of spastic hemiplegic rats after strokeOn day 7,there was no difference in Zea Longa scores between the rats in the needle-knife group and the model group(P>0.05),after day 14,there was a decrease in Zea Longa scores in the needle-knife group(P<0.05),and after day 21,Zea Longa scores in the needle-knife group were significantly lower compared with those in the model group(P<0.05).(2)Needle knife can alleviate the level of muscle tone in rats with spastic hemiplegia after cerebral infarctionOn day 7,there was no difference between the rats in the model and needle knife groups(P>0.05).Compared with the model group,the MAS score was reduced in the needle knife group on day 14(P<0.05)and significantly reduced in the needle knife group after day 21(P<0.05).3.Needle knife can reduce the infarcted area of brain tissue in spastic paralyzed rats after cerebral infarctionTTC staining was performed to observe the infarcted area of rats,and compared with the model group,the infarcted area of rats in the needle knife group was improved(P<0.05).4.Needle knife treatment can improve nerve cell structure and promote neuronal recoveryAccording to the results of Nissl staining,it can be observed that there are fewer Nitrosomes in the tissues around the cerebral infarction in the model group,and the transcellular cells are severely degenerated and necrotic in large numbers,with disorganized cell structure,cytoplasmic atrophy,cytosolic shrinkage,cytosolic nucleus shrinkage,unclear boundaries and deepened staining,and large number of vacuoles appearing around the cytosolic nucleus,presenting a honeycomb-like alteration;compared to the model group,there is a reduction in the infarcted area in the needle knife group,and a decrease in the infarcted area in the model group.Compared with the model group,the infarcted area was reduced,the necrotic nerve cells were relatively reduced,and the cytoplasm and nucleus were restored to different degrees,and the difference was statistically significant(P<0.05).5.Needle knife improves the expression of Sdcl in rats with spastic hemiplegia after cerebral infarctionRats in the sham-operated group,model group and needle knife group were subjected to transcriptome gene sequencing,and four genes with significant differences were screened out,namely,cdhl,co16a6,Sdcl and F11r(P<0.05).After qRT-PCR to verify the differential genes,the mRNA levels of Sdcl and co16a6 in the needle knife group were significantly higher compared to that of the model group(P<0.05),and the expression level of Sdc1 and col6a6 in the needle knife group was significantly higher than that of the model group(P<0.05).Then WB detection of Sdcl and col6a6 protein expression levels in the tissues of the region around cerebral infarction was performed,and the protein level of Sdcl in the needle knife group was significantly higher compared with the model group(P<0.05),while the difference in co16a6 protein expression levels was not statistically significant(P>0.05).6.Effect of needle knife on the expression of p38 MAPK and Erk1/2 proteins related to MAPK/Erk signaling pathway and their phosphorylation levels in rats with spastic hemiplegia after cerebral infarctionWB was used to detect the expression levels of p38 MAPK,Erk1/2 proteins of MAPK/Erk-related pathway and their phosphorylation expression levels.The results showed that compared with the model group,the protein levels of p38 MAPK,Erk1/2,p-p3 8 MAPK,and p-Erk 1/2 were significantly decreased in the needle knife group(P<0.05).7.Effect of needle knife on the expression of Sdcl,p-p38 MAPK and p-Erk in the tissues surrounding the cerebral infarction region of rats with spasm after cerebral infarction.The expression of Sdcl,p-p38 MAPK and p-Erk in tissues around the cerebral infarction area was detected using IHC,and the expression of Sdcl in the model group was significantly decreased,and the expression of p-p38 MAPK and p-Erk was significantly increased compared with that of the sham-operated group,and the difference was statistically significant(P<0.05);in the needle knife treatment group,the expression of Sdcl was significantly increased compared with that of the model group,and the difference was statistically significant(P<0.05),p-Erk,p-p38 MAPK significantly decreased,the difference was statistically significant(P<0.05).ConclusionNeedle knife can improve limb recovery in spastic hemiplegic rats after cerebral infarction,reduce the area of cerebral infarction,and promote neuronal recovery,and the mechanism may be that needle knife enhances the expression of Sdcl and inhibition of MAPK/Erk signaling pathway thereby alleviating spasticity in post-stroke spastic hemiplegic rats. |
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