健侧皮质高频重复经颅磁刺激对大面积脑梗死患者下肢运动功能障碍的治疗效果  

CLINICAL EFFECT OF HIGH-FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION ON THE CONTRALATERAL CORTEX IN TREATMENT OF LOWER LIMB DYSKINESIA IN PATIENTS WITH MASSIVE CEREBRAL INFARCTION

作　　者：丛小萌 李闻宇 杨传美[1] 王玉阳[1] 潘晓娜 宋晨 李江[1] CONG Xiaomeng;LI Wenyu;YANG Chuanmei;WANG Yuyang;PAN Xiaona;SONG Chen;LI Jiang(Department of Rehabilitation Medicine,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院康复医学科,山东青岛266003

出　　处：《精准医学杂志》2021年第3期235-238,242,共5页Journal of Precision Medicine

基　　金：山东省教育厅科技发展计划项目(2012YD18031)。

摘　　要：目的观察健侧皮质高频重复经颅磁刺激(rTMS)对大面积脑梗死(MCI)患者下肢运动障碍的治疗效果。方法将MCI患者45例随机分为高频组、低频组及对照组,每组各15例,3组患者均给予常规药物及常规康复训练,其中高频组患者给予健侧半球初级运动皮质代表区(M1区)10 Hz rTMS治疗,低频组患者给予健侧半球M1区1 Hz rTMS治疗,对照组患者则给予健侧半球M1区假刺激,并于治疗前、治疗3周后采用Fugl-Meyer量表的下肢部分(FMA-LE)、Berg平衡量表(BBS)以及改良Barthel指数(MBI)等评定3组患者的运动功能及日常生活能力,并采集扩散张量成像(DTI)图像中表观弥散系数(ADC)和各向异性分数(FA)评估3组患者的肢体运动功能。结果高频组患者治疗前后FMA-LE、BBS、MBI评分差值与低频组、对照组患者比较,差异有显著性(F=3.337~77.408,t=2.033~11.213,P<0.05);低频组患者治疗前后上述差值与对照组患者比较,差异无显著性(P>0.05)。磁共振检查结果显示,3组患者梗死灶FA、ADC治疗前后差值比较,差异无显著性(P>0.05);高频组患者治疗前后胼胝体FA差值、ADC差值与低频组、对照组患者比较,差异具有显著性(F=8.756、24.984,t=3.324~6.299,P<0.05),低频组患者治疗前后上述差值与对照组患者比较,差异无显著性(P>0.05)。结论高频rTMS作用于健侧半球M1区,有助于MCI后下肢运动障碍患者的运动功能恢复,其疗效优于低频rTMS作用于健侧半球M1区及未接受rTMS治疗的患者。Objective To investigate the clinical effect of high-frequency repetitive transcranial magnetic stimulation(rTMS) on the contralateral cortex in the treatment of lower limb dyskinesia in patients with massive cerebral infarction(MCI). Methods A total of 45 patients with MCI were enrolled and randomly divided into high frequency group, low frequency group, and control group, with 15 patients in each group. All patients were given routine medication and rehabilitation training;the patients in the high frequency group received 10 Hz rTMS on the contralesional primary motor cortex(M1), those in the low frequency group received 1 Hz rTMS on the contralesional M1 region, and those in the control group received sham rTMS on the contralesional M1 region. Before treatment and after 3 weeks of treatment, Fugl-Meyer Assessment-Lower Extremity(FMA-LE), Berg Balance Scale(BBS), and modified Barthel Index(MBI) were used to evaluate motor function and activities of daily living, and apparent diffusion coefficient(ADC) and fractional anisotropy(FA) were collected on diffusion tensor imaging(DTI) to eva-luated limb motor function. Results Compared with the low frequency group and the control group, the high frequency group had significantly greater changes in FMA-LE, BBS, and MBI scores after treatment(F=3.337-77.408,t=2.033-11.213,P<0.05), while there were no significant differences in the changes in FMA-LE, BBS, and MBI scores between the low frequency group and the control group(P>0.05). Magnetic resonance results showed that there were no significant differences between the three groups in the changes in FA and ADC values of the infarct after treatment(P>0.05);compared with the low frequency group and the control group, the high frequency group had significantly greater changes in FA and ADC values of the corpus callosum after treatment(F=8.756,24.984,t=3.324-6.299,P<0.05), while there were no significant differences in the above changes between the low frequency group and the control group(P>0.05). Conclusion High-frequency

关 键 词：脑梗死 经颅磁刺激 运动障碍 功能恢复 弥散张量成像 各向异性 运动皮质 治疗结果 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R493.2[医药卫生—临床医学]