高-低频重复经颅磁刺激对脑卒中患者上肢肌肉形态与表面肌电的影响  

Effects of combined high-low frequency repetitive transcranial magnetic stimulation on upper limb muscle morphology and surface electromyography in stroke patients

作　　者：张孟利 孙建淼 刘睿 赵雨亭 焦卉朵 ZHANG Meng-li;SUN Jian-miao;LIU Rui;ZHAO Yu-ting;JIAO Hui-duo(Department of Rehabilitation Medicine,Tangdu Hospital Affiliated of Air Force Army,Xi'an 710000,China)

机构地区：[1]空军军医大学唐都医院康复医学科,陕西西安710000

出　　处：《创伤与急危重病医学》2025年第2期97-101,127,共6页Trauma and Critical Care Medicine

基　　金：空军军医大学第二附属医院科技创新发展基金(2019LCYJ016)。

摘　　要：目的探讨高-低频重复经颅磁刺激(rTMS)对脑卒中患者上肢肌肉形态与表面肌电的影响。方法选取2023年1月至2024年1月空军军医大学唐都医院收治的62例脑卒中患者,男性37例,女性25例,年龄(58.91±10.64)岁,年龄范围为39~77岁。采用随机数字表法将患者随机分为分为联合组(n=31)与对照组(n=31)。两组患者均接受常规康复治疗与健侧初级运动皮层(M1区)低频重复经颅磁刺激治疗,联合组额外进行患侧M1区高频重复经颅磁刺激治疗。记录两组患者治疗前后患侧肱三头肌、肱二头肌的表面肌电图(sEMG)均方根值与协同收缩率(CR),使用超声检测肱三头肌、肱二头肌的厚度,并记录Fugl-Meyer运动功能量表(UFMA)评分。结果治疗后,两组UFMA评分均较治疗前改善,且联合组UFMA评分高于对照组;联合组肱三头肌、肱二头肌sEMG均方根值高于对照组;联合组屈肘肱二头肌、伸肘肱三头肌CR低于对照组,差异有统计学意义(P<0.05)。联合组与对照组患者肱三头肌、肱二头肌厚度均大于治疗前,差异有统计学意义(P<0.05)。联合组与对照组患者肱三头肌、肱二头肌厚度比较,差异无统计学意义(P>0.05)。结论高-低rTMS可提高脑卒中患者肱二头肌、肱三头肌运动功能情况,增加其sEMG均方根值、CR及厚度。Objective To study the effects of the combined programme of high-low frequency repetitive transcranial magnetic stimulation(rTMS)on upper limb muscle morphology and surface electromyography in stroke patients.Methods A total of 62 stroke patients who were treated in Tangdu Hospital Affiliated of Air Force Army from January 2023 to January 2024 were selected,including 37 males and 25 females,aged(58.91±10.64)years old,ranging from 39 to 77 years old.The patients were divided into the combined group(n=31)and the control group(n=31).Both groups of patients received routine rehabilitation treatment and healthy primary motor cortex(M1 area)low-frequency repetitive transcranial magnetic stimulation treatment,while the combined group received additional M1 area high-frequency repetitive transcranial magnetic stimulation treatment on the affected side.The root mean square value of surface electromyography(sEMG)and co-contraction rate(CR)of the affected triceps brachii and biceps brachii muscles were recorded in both groups before and after treatment,the thickness of triceps brachii and biceps brachii muscles were detected using ultrasound,and the Fugl-Meyer motor function assessment scale(UFMA)scores were recorded.Results After treatment,the UFMA scores in both groups improved compared with those before treatment,and the UFMA score in combined group was higher than that in the control group;the triceps and biceps sEMG in combined group were higher than those in the control group;the biceps in combined group was lower than that in the control group,with statistically significant(P<0.05).The thickness of triceps and biceps in the combined and control group was thicker than that before treatment,with statistically significant(P<0.05).There was no significant difference in triceps and biceps thickness between the combined group and the control group(P>0.05).Conclusion The rTMS regimen combined with high-low frequency can improve the motor function of biceps and triceps in stroke patients,and increase the sEMG root mean squa

关 键 词：重复经颅磁刺激 超声 脑卒中 表面肌电图 上肢运动功能 

分 类 号：R493[医药卫生—康复医学]