阳极经颅直流电刺激联合康复治疗对外伤性脊髓损伤运动功能障碍的康复疗效  

Anodal transcranial direct current stimulation combined with rehabilitation interventions for motor dysfunction after traumatic spinal cord injury

作　　者：刘莹[1] 桂裕昌 许建文[1] 廖媚[1] 黄潇潇 胡金翠 樊继波[1] 苏义基[1] LIU Ying;GUI Yuchang;XU Jianwen;LIAO Mei;HUANG Xiaoxiao;HU Jincui;FAN Jibo;SU Yiji(Department of Rehabilitation,the First Affiliated Hospital ofGuangxi Medical University,Nanning,Guangxi 530021,P.R.China)

机构地区：[1]广西医科大学第一附属医院康复医学科,南宁530021

出　　处：《华西医学》2019年第5期520-525,共6页West China Medical Journal

基　　金：广西自然科学基金(2016GXNSFBA380020;2018GXNSFAA138010;2018GXNSFAA050033);广西医疗卫生适宜技术开发与推广应用项目(S2018021)

摘　　要：目的探讨阳极经颅直流电刺激(transcranial direct current stimulation,tDCS)联合常规康复治疗对外伤性脊髓损伤(spinal cord injury,SCI)所致运动功能障碍的康复疗效。方法回顾性纳入2015年9月—2018年11月SCI患者225例,按其接受的康复治疗方案分为对照组和观察组。对照组采用常规康复治疗(包括肢体功能训练、理疗和针灸等综合康复治疗),观察组采用阳极tDCS联合常规康复治疗(方案同对照组);为探讨SCI部位和程度对康复疗效的影响,进一步按照损伤部位(颈段、胸腰段)和程度(完全性和不完全性)进行亚组分析;分别于治疗前、治疗30 d后对患者进行运动功能、功能独立性量表及改良Barthel指数评分;并用运动诱发电位对运动功能进行客观评估。结果治疗30 d后,观察组的运动功能评分[(48.26±6.57)分]、功能独立性量表评分[(60.68±6.05)分]和改良Barthel指数[(68.73±7.57)分]均较其治疗前及对照组显著增高(P<0.05),而第7颈椎棘突旁、皮质手区、腓骨小头、皮质腿区运动诱发电位潜伏期[(9.20±0.42)、(17.81±0.56)、(3.24±0.47)、(23.06±0.98)ms]以及上肢、下肢中枢运动传导时间[(6.08±0.50)、(18.06±0.99)ms]明显降低(P<0.05);进一步以损伤部位及程度两个因素分别进行亚组分析显示,治疗30 d后观察组运动功能、功能独立性量表和改良Barthel指数评分均显著高于对照组,而运动诱发电位上、下肢中枢运动传导时间明显低于对照组(P<0.05)。结论阳极tDCS联合常规康复治疗能显著促进SCI患者运动功能的恢复,可能成为SCI神经功能障碍康复干预的新方案。Objective To investigate the effect of anodal transcranial direct current stimulation(tDCS) combined with rehabilitation interventions on the patients suffering from motor dysfunction after traumatic spinal cord injury(SCI).Methods Two hundred and twenty-five patients with SCI from September 2015 to November 2018 were retrospectively included in this study.According to their accepted rehabilitation interventions,patients were divided into the intervention group and the control group.In the control group,the patients just accepted routine rehabilitation interventions,including movement therapy on limbs,physical therapy and acupuncture,while the patients in the intervention group accepted anodal tDCS combined with routine interventions(the same as the control group).The baseline between the two groups was similar.Moreover,subgroup analysis including trauma site and extent were carried out for further exploration for the positive effect of tDCS on motor function suffering from acute traumatic SCI.American Spinal Injury Association(ASIA) motor item,Functional Independence Measure(FIM) and modified Barthel index(MBI),as well as motor evoked potential(MEP) were carried out for the evaluation of motor function ahead of and 30 days after intervention.Results After 30-day rehabilitation intervention,the scores of ASIA motor item(48.26±6.57),FIM(60.68±6.05) and MBI(68.73±7.57) were all significantly higher in the intervention group than those in the control group(all P<0.05).Besides,MEP latency of C7 [(9.20±0.42) ms],hand area [(17.81±0.56) ms],Pf [(3.24±0.47) ms] and leg area [(23.06±0.98) ms],as well as central motor conduction time of upper limbs [(6.08±0.50) ms] and lower limbs[(18.06±0.99) ms] were all significantly lower in the intervention group than those in the control group(P<0.05).In addition,the subgroup analyses based on injury site and injury extent also showed that anodal tDCS associated with better motor recovery,in that the scores of ASIA motor item,FIM and MBI were all significantly higher in the

关 键 词：经颅直流电刺激 外伤 脊髓损伤 运动功能 康复 

分 类 号：R651.2[医药卫生—外科学] R493[医药卫生—临床医学]