【目的】观察超微针刀联合高低频重复经颅磁刺激 （rTMS） 治疗脑卒中后上肢痉挛的临床疗效。 【方法】将106例脑卒中后 上肢痉挛患者随机分为观察组和对照组，每组各53例，2组患者均给予常规药物与运动疗法治疗，对照组给予高低频rTMS 治疗，观察组在对照组治疗的基础上，给予超微针刀治疗。2组均治疗4周。治疗2、4周后，分别评价2组临床疗效，观察 2组患者治疗前后改良Ashworth量表 （MAS） 评分的变化情况，以及上肢Fugl-Meyer量表评分的情况。比较2组患者治疗前后 Berg平衡量表 （BBS） 评分与改良Barthel指数 （BI） 评分的变化情况。并评价2组的安全性及不良反应的发生情况。 【结果】（1） 治疗 2周后，观察组总有效率为81.13% （43/53） ，对照组为62.26% （33/53） 。观察组疗效优于对照组，差异有统计学意义 （P＜ 0.05） 。 （2） 治疗4周后，观察组总有效率为90.57% （48/53） ，对照组为73.58% （39/53） 。观察组疗效优于对照组，差异有统计 学意义 （P＜0.05） 。 （3） 治疗2、4周后，观察组MAS评分与上肢Fugl-Meyer评分均明显改善 （P＜0.05） ，且观察组在改善MAS 评分与上肢Fugl-Meyer评分方面明显优于对照组，差异均有统计学意义 （P＜0.05） 。 （4） 治疗2、4周后，观察组BBS评分与改 良Barthel指数评分均明显改善 （P＜0.05） ，且观察组在改善BBS评分与改良Barthel指数评分方面明显优于对照组，差异均有 统计学意义 （P＜0.05） 。 （5） 观察组与对照组不良反应发生率比较，差异无统计学意义 （P＞0.05） 。 【结论】超微针刀联合高低频 重复经颅磁刺激治疗脑卒中后上肢痉挛，能明显改善患者的临床症状，改善患者上肢的肌力状态，提高上肢运动与平衡能 力，提高患者日常生活能力，疗效显著。

Objective To observe the clinical efficacy of ultra-micro acupotomology combined with high and low frequency repetitive transcranial magnetic stimulation （rTMS） in the treatment of upper limb spasm after stroke. Methods A total of 106 patients with upper limb spasm after stroke were randomly divided into observation group and control group，53 cases in each group. Both groups were treated with conventional drugs and exercise therapy. The control group was treated with high and low frequency rTMS. The observation group was treated with ultra- micro needle knife on the basis of the control group. Both groups were treated for four weeks. After two weeks and four weeks of treatment，the clinical efficacy of the two groups was evaluated respectively. The changes of modified Ashworth scale （MAS） score and upper limb Fugl-Meyer scale score were observed before and after treatment in the two groups. The changes of Berg Balance Scale （BBS） score and modified Barthel Index （BI） score were compared before and after treatment between the two groups. The safety and adverse reactions of the two groups were evaluated. Results （1）After two weeks of treatment，the total effective rate was 81.13%（43/53） in the observation group and 62.26%（33/53） in the control group. The curative effect of the observation group was superior to that of the control group，and the difference was statistically significant （P＜0.05） . （2） After four weeks of treatment，the total effective rate was 90.57% （48/53） in the observation group and 73.58% （39/53） in the control group. The curative effect of the observation group was superior to that of the control group，and the difference was statistically significant （P＜0.05） . （3）After two and four weeks of treatment，the MAS score and upper limb Fugl-Meyer score of the observation group were significantly improved （P＜0.05） ，and the observation group was significantly superior to the control group in improving the MAS score and upper limb Fugl-Meyer score， the differences were statistically significant （P＜0.05） . （4） After two and four weeks of treatment，the BBS score and modified BI Score of the observation group were significantly improved（P＜0.05），and the improvement of BBS score and modified BI score in the observation group was significantly superior to that in the control group，the differences were statistically significant（P＜0.05） . （5）There was no significant difference in the incidence of adverse reactions between the observation group and the control group （P＞0.05） . Conclusion Ultra-micro acupotomology combined with high and low frequency rTMS in the treatment of upper limb spasm after stroke can significantly improve the clinical symptoms of patients，improve the muscle strength of the upper limbs of patients， the movement and balance ability of the upper limbs，and improve the daily living ability of patients，there being remarkable curative effect.

R246.9

广东省自然科学基金基础与应用基础研究基金资助项目 （编号：2022A1515220157）