大脑皮层下肢运动区联合小脑皮质区iTBS对脑卒中后偏瘫患者下肢运动功能的影响  

Effect of iTBS in the lower limb motor area of the cerebral cortex combined with the cerebellar cortical area on lower limb motor function in hemiplegia patients after stroke

作　　者：孙思杰 邓罗义 王先斌 潘晓 张静 吴霜 SUN Sijie;DENG Luoyi;WANG Xianbin;PAN Xiao;ZHANG Jing;WU Shuang(Department of Rehabilitation Medicine,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Rehabilitation Medicine and Physiotherapy,School of Clinical Medicine of 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康复医学与理疗学教研室,贵州贵阳550004 [3]贵州医科大学

出　　处：《贵州医科大学学报》2024年第8期1170-1175,1197,共7页Journal of Guizhou Medical University

基　　金：国家自然科学基金地区科学基金项目(82260452、82060419);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：目的探讨大脑皮层下肢运动区及健侧小脑皮质区间歇性Theta爆发性刺激(iTBS)对脑卒中偏瘫患者下肢运动功能的影响。方法63例脑卒中后偏瘫患者随机均分为对照组(常规康复治疗+假刺激)、iTBS单靶点组(常规康复治疗+大脑皮质区iTBS)及iTBS双靶点组(常规康复治疗+大脑皮层下肢运动区iTBS+健侧小脑皮质区iTBS),1次/d、21 d,收集3组患者的一般资料[年龄、性别、卒中类型(脑梗死、脑出血)、病程时间、偏瘫侧及布氏分期等基线指标];与治疗前及治疗第21天,采用改良Barthel指数评定量表(MBI)、Fugl-Meyer下肢运动功能评定量表(FMA)及Berg平衡评定量表(BBS)评定3组患者的日常生活能力、下肢运动功能及下肢平衡功能,采用表面肌电系统评估患者下肢双侧胫前肌、股直肌、股二头肌及腓肠肌的肌电信号的均方根平均值(RMS)及平均功率频率(MPF)。结果各组患者治疗后临床评分均较治疗前升高(P<0.01);与对照组比较,单靶点组患者MBI、FMA、BBS评分及股直肌RMS升高(P<0.05),双靶点组患者临床评分、胫前肌RMS、股直肌RMS提高(P<0.01);与单靶点组比较,双靶点组患者FMA、BBS评分、胫前肌RMS提高(P<0.05)。结论与单靶点相比,双靶点iTBS治疗对脑卒中后偏瘫患者下肢行走能力的恢复效果更优。Objective To explore the effect of intermittent Theta burst stimulation(iTBS)in the lower limb motor area of the cerebral cortex and lateral cortical area cortex on the lower limb motor function in stroke patients with hemiplegia.Methods Sixty-three patients after stroke hemiplegia were randomly divided into control group(conventional rehabilitation therapy+sham stimulation),iTBS single-target group(conventional rehabilitation therapy+iTBS of lower limb motor area)and iTBS dual target group(conventional rehabilitation therapy+iTBS of lower limb motor area+iTBS of healthy cerebellar cortex area)for once/d,21 d.General data[age,sex,stroke type(cerebral infarction,cerebral hemorrhage),duration of disease,hemiplegia side and baseline indicators such as Brinell stage]were collected from the 3 patient groups.Before treatment and on treatment day 21,the modified Barthel Index Assessment Scale(MBI),Fugl-Meyer Lower Extremity Motor Function Assessment Scale(FMA),and Berg Balance Assessment Scale(BBS)assessed the daily living ability,lower limb motor function and lower limb balance function in group 3.The root mean square(RMS)and mean power frequency(MPF)of the electromyographic signals of the tibialis anterior,rectus femoris,biceps femoris and gastrocnemius muscles of the lower limbs of the patients were assessed by surface electromyography system.Results The clinical scores of patients in all group were higher after treatment compared with those before treatment(P<0.01).MBI,FMA,BBS scores,and rectus femoris RMS were improved in the single-target group compared with the control group(P<0.05),and clinical scores,tibialis anterior RMS,and rectus femoris RMS were improved in the dual-target group(P<0.01).Compared with the single-target group,the FMA,BBS score,and tibialis anterior RMS in the dual-target group were improved(P<0.05).Conclusion Compared with single-target,dual-target iTBS treatment shows better recovery of lower limb walking ability in poststroke hemiplegia patients.

关 键 词：卒中 偏瘫 下肢运动功能 间歇性Theta爆发性刺激 表面肌电 双靶点刺激 

分 类 号：R493[医药卫生—康复医学]