健侧小脑间歇性θ短阵脉冲刺激康复治疗对脑卒中患者下肢步行功能的影响  

Effect of contralesional cerebellar iTBS combined with routine rehabilitation on lower limb walking func⁃tion in stroke patients

作　　者：邓罗义 陈彦 曾妮 黄璞 张兴 胡康杰 郑鹏 吴霜 DENG Luoyi;CHEN Yan;ZENG Ni;HUANG Pu;ZHANG Xing;HU Kangjie;ZHENG Peng;WU Shuang(Department of Rehabilitation Medicine,Affiliated Hospital of Guizhou Medical University,Guiyang 550000,China)

机构地区：[1]贵州医科大学附属医院康复医学科,贵阳550000

出　　处：《实用医学杂志》2024年第13期1797-1802,共6页The Journal of Practical Medicine

基　　金：国家自然科学基金委员会地区项目(编号:82060419,82260452);贵州省卫生健康委科学技术基金项目(编号:gzwkj2023-014);贵州省科技计划项目(编号:黔科合基础-ZK[2022]重点045)。

摘　　要：目的探讨健侧小脑间歇性θ短阵脉冲刺激(intermittent theta-burst stimulation,iTBS)对脑卒中患者步行功能的影响。方法采用随机、单盲、假对照研究。共纳入50例脑卒中患者,随机分为iTBS组和Sham组各25例。iTBS组采用常规康复治疗+健侧小脑iTBS刺激,Sham组采用常规康复治疗+健侧小脑iTBS假刺激。对治疗前及治疗21d相关指标进行分析:比较两组下肢FMA评分、Berg评分、Brunnstrom下肢分期、H/Q比值、MBI评分,步态分析参数以及TMS测得的MEP值,评估小脑iTBS对卒中后步行功能康复的有效性。结果治疗21 d时,iTBS组下肢Brunnstrom分期、Holden分级、Berg评分、下肢FMA评分、6 min步行距离、NIHSS评分和MBI评分改善程度均明显优于Sham组(P<0.05);治疗后iTBS组H/Q比值较前明显增加(P<0.05),但组间比较差异无统计学意义(P>0.05);iTBS组步速、步频、步宽、患侧单支撑相及GDI评分均较Sham组显著改善(P<0.05),两组治疗后步长比较差异无统计学意义(P>0.05);iTBS组治疗后患侧大脑皮层MEP波幅较前降低(P<0.05)。结论健侧小脑iTBS联合常规康复治疗可改善卒中患者步行功能及日常生活能力。Objective To investigate the effect of iTBS stimulation on walking function in patients with stroke.Methods Fifty patients with post-stroke walking dysfunction who met the inclusion criteria were selected for 3-week rehabilitation treatment,and were randomly divided into iTBS group(n=25)and sham group(n=25).The iTBS group was treated with conventional rehabilitation therapy combined with iTBS stimulation of contral-esional cerebellum,and the sham group was treated with conventional rehabilitation therapy plus iTBS stimulation of contralesional cerebellum.Relevant indicators were analyzed before treatment and at 21 days of treatment.Lower limb motor function scores of the two groups were compared before and after treatment.Fugl-Meyer motor function lower limb activity score,Berg Balance Scale score,Brunnstrom stage(lower limb),hamstring/quadriceps(H/Q)on the affected side,Modified Barthel index(MBI),gait analysis parameters,and TMS-MEP were used to evaluate the effectiveness of cerebellar iTBS in the rehabilitation of walking dysfunction after stroke.Results After 21 days of treatment,the improvements of Brunnstrom stage,Holden grade,Berg score,FMA score,6-minute walking dis-tance,NIHSS score and MBI score in iTBS group were significantly better than those in sham group(P<0.05).Af-ter treatment,the H/Q in iTBS group was significantly higher thanbefore(P<0.05),but there was no significant difference between the two groups(P>0.05).Stride speed,stride frequency,stride width,single support phase on the affected side and GDI score in iTBS group were significantly improved compared with sham group(P<0.05),and there was no significant difference in stride length between the two groups after treatment(P>0.05).The amplitude of MEP in the affected cerebral cortex of iTBS group was lower after treatment than before(P<0.05).Conclusion Contralesional cerebellar iTBS combined with routine rehabilitation could improve lower limb walk-ing function and daily living ability of stroke patients.

关 键 词：脑卒中 间歇θ短阵脉冲刺激 三维步态分析 步行功能 

分 类 号：R493[医药卫生—康复医学]