不同经颅磁刺激模式对脑卒中后下肢运动障碍患者肢体运动功能的影响  

Effects of different transcranial magnetic stimulation modes on motor function of patients with lower limb dyskinesia after stroke

作　　者：王佳 王先斌 宋宁 张兴 吴霜 WANG Jia;WANG Xianbin;SONG Ning;ZHANG Xing;WU Shuang(Department of Rehabilitation Medicine,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;School of Clinical Medicine,Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院康复医学科,贵州贵阳550004 [2]贵州医科大学临床医学院,贵州贵阳550004

出　　处：《贵州医科大学学报》2023年第6期702-709,共8页Journal of Guizhou Medical University

基　　金：国家自然科学基金委员会地区项目(82060419,82260452);贵州省科技计划项目(黔科合基础-ZK[2022]重点045,黔科合基础-ZK[2022]一般438)。

摘　　要：目的探讨不同经颅磁刺激模式对脑卒中后下肢运动障碍患者患侧肢体运动功能的影响。方法54例脑卒中后下肢运动障碍患者随机均分为对照组(常规康复治疗+假刺激)、高频重复经颅磁治疗(rTMS)组(常规康复治疗+10 Hz rTMS)、间歇性Theta爆发式经颅磁刺激治疗(iTBS)组(常规康复治疗+iTBS),1次/d、6 d/周、持续3周;采用等速肌力测试系统评定3组患者治疗前后患侧下肢膝关节屈伸肌峰力矩(PT)及其比值(F/E),采用Fugl-Meyer运动功能量表(FMA-LE)、Berg平衡量表(BBS)及改良Ashworth量表(MAS)评定3组患者治疗前后的下肢运动、平衡功能及下肢伸膝肌群痉挛情况,采用磁刺激仪评定3组患者治疗前后运动诱发电位(MEP)皮质潜伏期及中枢运动传导时间(CMCT)。结果治疗后,3组患者患侧下肢膝关节屈伸肌PT、F/E、FMA-LE评分、BBS评分、MAS评分、MEP皮质潜伏期和CMCT与同组治疗前相比,差异均有统计学意义(P<0.05);与对照组相比,rTMS组和iTBS组患者患侧下肢膝关节屈伸肌PT、F/E、FMA-LE评分、BBS评分升高(P<0.05),MEP皮质潜伏期及CMCT减小(P<0.05),但rTMS组和iTBS组组间比较、差异无统计学意义(P>0.05);治疗后,3组患者MAS评分比较,差异无统计学意义(P>0.05)。结论10 Hz rTMS及iTBS治疗可改善脑卒中后下肢运动障碍患者患侧下肢运动功能。Objective To investigate the effects of different transcranial magnetic stimulation modes on motor function of the affected lower limb in patients with lower limb dyskinesia after stroke.Methods A total of 54 stroke patients with lower limb dyskinesia were randomly divided into control group(conventional rehabilitation training+sham stimulation),high repetitive transcranial magnetic stimulation(rTMS)group(conventional rehabilitation training+10 Hz rTMS)and intermittent theta burst stimulation(iTBS)group(conventional rehabilitation training+iTBS)with once a day,6d/week,and lasting 3 weeks.Before and after treatment,the isokinetic muscle strength testing system was used to evaluate the peak torque(PT)and its ratio(F/E)of knee flexor extensor muscle on the affected side in the three groups.The lower extremity motor function,balance ability and spasticity of lower limb extensor muscles were separately evaluated by the Fugl-Meyer assessment of lower extremity scale(FMA-LE),Berg balance scale(BBS),and the modified Ashworth rating scale(MAS).Motor evoked potential(MEP)cortical latency and central motor conduction time(CMCT)were evaluated by magnetic stimulation.Results After treatment of three weeks,PT,F/E,FMA-LE scores,BBS scores,MAS scores,cortical latency of MEP and CMCT of knee flexor and extensor muscles of the affected side in three groups were different from those before treatment compared to the same group,the differences were statistically significant(P<0.05).Compared with the control group,PT,F/E,FMA-LE scores and BBS scores of knee flexor and extensor muscles on the affected side were increased in rTMS and iTBS groups(P<0.05);cortical latency and CMCT of MEP were decreased(P<0.05),but there was no statistical significance between rTMS and iTBS groups(P>0.05).After treatment,there was no statistical significance in MAS scores among the three groups(P>0.05).Conclusion 10 Hz rTMS and iTBS can significantly improve the motor function of the affected lower limb in patients with lower limb dyskinesia after stroke.

关 键 词：卒中 康复 经颅磁刺激 下肢运动功能 高频 Theta爆发式经颅磁刺激 重复经颅磁刺激 

分 类 号：R493[医药卫生—康复医学]