重复经颅磁刺激联合运动训练对不完全性脊髓损伤患者疼痛、肌张力及生活质量的影响  

Effects of repetitive transcranial magnetic stimulation combined with exercise training on patients with incomplete spinal cord injuries

作　　者：王佳 宋俊友 徐冰 吕杭州 赵晓博 巩浩然 李尧兴 Wang Jia;Song Junyou;Xu Bing;Lyu Hangzhou;Zhao Xiaobo;Gong Haoran;Li Yaoxing(Department of Rehabilitation,Xingtai General Hospital,North China Medical and Health Group,Xingtai,Hebei Province 054000,China)

机构地区：[1]华北医疗健康集团邢台总院康复科,河北邢台054000

出　　处：《创伤外科杂志》2024年第12期936-940,共5页Journal of Traumatic Surgery

基　　金：邢台市重点研发计划自筹项目(2021ZC078)。

摘　　要：目的探讨重复经颅磁刺激(rTMS)联合运动训练对不完全性脊髓损伤(ISCI)患者疼痛、肌张力及生活质量的影响。方法前瞻性研究华北医疗健康集团邢台总院康复科2019年8月—2021年8月收治的64例ISCI患者,男性37例,女性27例;年龄22~78岁,平均49.8岁;病程3~12个月,平均6.6个月;ASIA分级:C级37例,D级27例;BMI 21~31 kg/m^(2),平均23.3 kg/m^(2);道路交通伤40例,高处坠落伤18例,其他6例;行前路椎管减压术31例,行后路椎板切除术16例,未手术17例。随机数字表法分为两组,对照组31例给予运动训练治疗[行上肢及手功能训练、体位转移训练、下肢运动训练、站立训练、步行训练,45 min/(次·d),5次/周,连续训练4周],治疗组33例在对照组的基础上联合重复经颅磁刺激治疗(YRDCCY-Ⅰ型经颅磁刺激仪刺激初级运动皮质,每日1次,1周5次,连续治疗4周),对比两组治疗前后神经电生理指标、下肢肌力指标、功能独立性评定(FIM)量表、简化McGill疼痛问卷(SF-MPQ)、Barthel指数评定量表(BI)评分,分析临床疗效和不良反应。结果与对照组比较,治疗组总有效率更高(93.9%vs.71.0%,P=0.015)。治疗后两组静息运动阈值(RMT)降低、运动诱发电位(MEP)升高,且治疗组RMT低于对照组[(49.17±4.25)%vs.(53.12±5.08)%]、MEP高于对照组[(2.63±0.51)nV vs.(1.95±0.42)nV],差异有统计学意义(P<0.05)。治疗后两组屈肌群峰力矩(PT)、力矩加速能(TAE),伸肌群PT、TAE,胭绳肌与股四头肌肌力比率(H/Q)均升高,且治疗组上述指标优于对照组(P<0.05)。治疗后两组FIM与BI评分升高、SF-MPQ评分降低,且治疗组上述指标优于对照组(P<0.05)。治疗组头痛、眩晕、失眠等不良反应总发生率与对照组相比(6.1%vs.3.2%)差异无统计学意义(P>0.05)。结论对ISCI患者应用rTMS不但能缓解患者疼痛,恢复神经功能和下肢肌力,同时还能提高生活质量。Objective To explore the effects of repetitive transcranial magnetic stimulation(rTMS)combined with exercise training on pain,muscle tone,and quality of life in patients with incomplete spinal cord injuries(ISCI).Methods A total of 64 patients with ISCI admitted to our hospital from Aug.2019 to Aug.2021 were prospectively selected,including 37 males and 27 females.The average age was 49.8 years,ranging from^(2)2 to 78 years.The course of diseases ranged from^(3) to 12 months,6.6 months on average;the body mass index(BMI)was 21-31 kg/m^(2),23.28 kg/m^(2) on average.ASIA classification showed 37 cases of grade C and 27 of grade D.The causes of injuries were road traffic accidents in 40 cases,falls in 18,and others in 6.Among them,31 cases underwent anterior decompression,16 cases underwent posterior laminectomy,and 17 cases had non-surgical treatment.Patients were divided into two groups by the randomized number table method:31 were enrolled in the control group and took simple exercise training(upper limb and hand function training,position transfer training,lower limb movement training,standing training,walking training;45 min once a day and 5 times a week for a continuous 4 weeks;the other 33 patients were enrolled in the rTMS group and received repetitive transcranial magnetic stimulation using the Yr DCCY-Ⅰtranscranial magnetic stimulation instrument to stimulate the primary motor cortex;once a day,5 times a week for 4 weeks)in additional to exercise training.The neuroelectrophysiological indexes[resting motor threshold(r MT)and motor evoked potential(MEP)],lower limb muscle strength indexes[peak torque(PT)and torque acceleration energy(TAE)of the extensor/flexor muscles,and quadriceps femoris to hamstrings muscle strength ratio(H/Q)],functional independence rating(FIM)scale,short-for m McGill pain questionnaire(SF-MPQ)and Barthel index rating scale(BI)scores befor e and after treatment were compared between the two groups.The clinical efficacy and adverse reactions were also analyzed.r esults The effective

关 键 词：脊髓损伤 重复经颅磁刺激 运动训练 疼痛 肌张力 生活质量 

分 类 号：R651.2[医药卫生—外科学]