重复经颅磁刺激对不完全性脊髓损伤患者运动和步行功能的疗效

Effect of Repetitive Transcranial Magnetic Stimulation on Motor and Ambulation Function for Incomplete Spinal Cord Injury

目的观察重复经颅磁刺激（rTMS）治疗对不完全性脊髓损伤患者运动和步行功能的影响。方法 18例C2~T12节段不完全性脊髓损伤患者（AIS D级）随机分为治疗组（n=10）和对照组（n=8）。治疗组于Cz部位给予rTMS,对照组患者给予假刺激。两组患者均接受常规康复治疗。治疗前后比较ASIA下肢运动评分（LEMS）、改良Ashworsh量表（MAS）、10 m步行速度、脊髓损伤步行指数Ⅱ（WISCIⅡ）和脊髓功能独立性评定（SCIM）。治疗后随访2周。结果治疗后,治疗组LEMS、10 m步行速度、SCIM均有改善（P〈0.05）,随访2周上述指标与治疗前比较仍有提高（P〈0.05）;对照组随访2周与治疗前比较SCIM有所改善（P〈0.05）。与对照组比较,治疗组治疗后LEMS改善更多,随访2周LEMS仍优于对照组（P〈0.05）;MAS、10 m步行速度、WISCIⅡ和SCIM治疗后及随访两组比较均无显著性差异（P〉0.05）。结论 rTMS可进一步改善不完全性脊髓损伤患者的下肢运动功能。

Objective To assess the effect of repetitive transcranial magnetic stimulation（rTMS） on motor and ambulatory function in incomplete spinal cord injury（SCI） patients.Methods 18 incomplete SCI patients（AIS D） were randomized to treatment group（n=10） and control group（n=8）.The treatment group received rTMS while the control group received sham stimulation for 2 weeks.All the patients received routine rehabilitation.They were assessed with Lower Extremity Motor Score（LEMS）,10 m Walking Test for Walking Speed,modified Ashworth scale（MAS）,Walking Index for SCI Scale II（WISCI II）,and Spinal Cord Independence Measure（SCIM） before and after treatment,and followed up for 2 weeks after treatment.Results The treatment group significantly improved in LEMS,walking speed,and SCIM after treatment and during follow up（P＆lt;0.05）,while the control group improved only in SCIM（P＆lt;0.05）.There was more significant improvement in LEMS in the treatment group than in the control group（P＆lt;0.05） after treantment and during follow up.There was no difference between two groups in MAS,walking speed,WISCI II and SCIM.Conclusion rTMS can further improve the motor of lowere limbs for incomplete SCI patients.