rTMS刺激运动前区改善脊髓损伤后肌张力障碍1例报告  

Improvement of Dystonia after Spinal Cord Injury by Applying Repetitive Transcranial Magnetic Stimulation on the Premotor Cortex:Case Report

作　　者：顾春雅 程媛 赵丽娟[1] 许东升 GU Chun-ya;CHENG Yuan;ZHAO Li-juan;XU Dong-sheng(Department of Spine Surgery,Tongji Hospital,Shanghai 200065,China;Department of Rehabilitation Medicine,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai 200437,China;School of Rehabilitation Science,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]同济大学附属同济医院脊柱外科,上海200065 [2]上海中医药大学附属岳阳中西医结合医院康复中心,上海200437 [3]上海中医药大学康复医学院,上海201203

出　　处：《四川大学学报（医学版）》2020年第5期618-621,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：本文报道1例脊髓损伤患者,术后康复期采用康复常规治疗+重复经颅磁刺激(rTMS)治疗,观察rTMS对肌张力障碍的影响。患者男性,66岁,8个月前从床上跌落,当时即感觉颈部疼痛,四肢活动障碍,躯干及四肢感觉消失。磁共振成像(MRI)检查提示脊髓损伤。全麻下行"颈前路减压植骨融合内固定术",颈椎(C)内固定C3~C6,术后进行高压氧舱治疗和常规康复治疗。术后8个月因双下肢运动功能、平衡功能障碍、神经源性膀胱/直肠功能障碍要求进一步治疗入院。入院后采用常规康复+rTMS治疗,1次/d、5次/周,共4周。rTMS通过佩戴经颅磁刺激的定位帽进行治疗,刺激运动前区(取80%静息运动阈值,1 Hz,30 min),然后进行步行、平衡本体感觉、肌力训练、协调等训练。结果显示,经过4周的治疗和训练,患者MEP、sEMG、H反射等评估结果上均有改善。我们认为rTMS刺激运动前区改善脊髓损伤后肌张力障碍在此例报道中有效,今后可做进一步研究。This article reports a patient with spinal cord injury who was treated with conventional rehabilitation therapy plus repeated transcranial magnetic stimulation(rTMS) during the postoperative rehabilitation, and to observe the effects of rTMS on dystonia. A 66-year-old male patient fell from the bed 8 months ago. At that time, he felt pain in his neck, dysfunction in limbs movement, and loss of sensation in trunk and limbs. Magnetic resonance imaging(MRI)revealed spinal cord injury. Under general anesthesia, anterior cervical decompression and bone graft fusion(ACDF) and cervical spine internal fixation of C3-C6 were performed. Postoperative hyperbaric oxygen chamber and conventional rehabilitation treatment were performed. Eight months after surgery, he was admitted to the hospital due to motor function, balance dysfunction, neurogenic bladder/rectal dysfunction. After admission, the patient was treated with rTMS plus rehabilitation treatment, once per day, 5 times/week, for 4 weeks. rTMS worked by wearing a positioning cap for transcranial magnetic stimulation(80% resting motor threshold, 1 Hz, 30 min), and then conduct walking, balance proprioception, muscle strength training, and coordination training. After 4 weeks, MEP, sEMG and H reflex were improved. Therefore, rTMS on the premotor cortex to improve the dystonia after spinal cord injury is effective in this case, which can be further studied.

关 键 词：重复经颅磁刺激 脊髓损伤 肌张力障碍 

分 类 号：R651.2[医药卫生—外科学]