高频重复经颅磁刺激治疗不完全性脊髓损伤后运动障碍疗效的Meta分析  

Clinical effects of high frequency repeated transcranial magnetic stimulation therapy on dyskinesia in patients with incomplete spinal cord injury:a Meta-analysis

作　　者：高正超[1] 牛斌斌 顾梦超 李宇欢 刘俭涛 王一斌[1] 贺西京[1] 

机构地区：[1]西安交通大学第二附属医院骨科,陕西西安710004

出　　处：《中国骨伤》2018年第1期47-55,共9页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金(编号:81571209)~~

摘　　要：目的:系统评价高频重复经颅磁刺激(HF r TMS)治疗不完全性脊髓损伤患者运动障碍的临床疗效。方法:计算机检索2016年10月前Pub Med、Google scholar、Cochrane library、Clinical trial、Medline、Web of science、中国知网(CNKI)、维普(VIP)和万方数据库(Wanfang database),查找有关经颅磁刺激治疗脊髓损伤患者运动障碍的随机对照试验(RCT),由2位评价员依据纳入与排除标准分别进行文献筛选、数据提取和评价纳入研究的方法学质量后,通过Cochrane协作网Rev Man 5.2软件对治疗后的ASIA运动总评分、ASIA下肢运动评分(LEMS)、改良Ashworsh量表(MAS)、10 m步行速度(10MWT)和脊髓损伤步行指数Ⅱ(WISCIⅡ)进行Meta分析。结果 :最终共纳入5个RCT研究,103例不完全性脊髓损伤患者,61例接受HF r TMS治疗和常规物理康复治疗(试验组),51例接受常规物理康复治疗(对照组)。Meta分析结果显示:经HF r TMS治疗后,两组患者ASIA运动总评分、LEMS以及10MWT的评分差异具有统计学意义(检验结果分别为Z=2.96,P=0.003;Z=3.04,P=0.002;Z=2.16,P=0.03);当刺激下肢运动皮质区时,两组患者的MAS评分差异有统计学意义(Z=2.79,P=0.005);而当刺激头顶正中位置时,两组患者的MAS评分差异无统计学意义(Z=0.09,P=0.93);两组患者的WISCIⅡ评分差异无统计学意义(Z=0.90,P=0.37)。结论:HF r TMS能够提高不完全性脊髓损伤患者的运动评分,改善患者下肢的痉挛状态,提高患者的运动能力。Objective：To systematically evaluate the clinical effect of high frequency repeated transcranial magnetic stimulation（HF r TMS）therapy on dyskinesia in patients with incomplete spinal cord injury. Methods：Randomized controlled trials（RCTs） about HF r TMS therapy on patients with motor incomplete spinal cord injury were searched electronically in Pub Med,Google scholar,Cochrane library,Clinical trial,Medline,Web of science,CNKI,VIP,and Wanfang database before October 2016. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria,as well as extracted the data and assessed the methodological quality. The observed outcomes included ASIA motor score,ASIA lower extremities motor score（LEMS）,Modified Ashworth score（MAS）,Ten-meter walking test（10 MWT） and Walking index for SCI Ⅱ（WISCI Ⅱ）,and the outcomes were analyzed using Rev Man5.2 software provided by the Cochrane information management system. Results：Five RCTs involved 103 patients were included,and 61 patients（experimental group） accepted real r TMS and physical rehabilitation care for SCI,51 patients（control group） accepted only physical rehabilitation care. There were significant differences in ASIA motor score,LEMS and 10 MWT between two groups after HF r TMS therapy（statistics were Z =2.96,P =0.003;Z =3.04,P =0.002;Z =2.16,P =0.03;respectively）. When stimulating the leg motor cortex,there was significant difference in MAS between two groups（Z=2.79,P=0.005）,and when stimulating the vertex,there was no significant difference（Z=0.09,P=0.93）. There was no significant difference in WISCIⅡscore after HF r TMS therapy between two groups（Z =0.90,P =0.37）.Conclusion：HF r TMS can raise motor score in patients with incomplete spinal cord injury,improve the spasticity of the lower extremities,and increase the motor ability.

关 键 词：脊髓损伤 重复经颅磁刺激 运动障碍 META分析 

分 类 号：R651.2[医药卫生—外科学]