经颅磁刺激神经调控治疗在肌张力低下型脑性瘫痪患儿康复中的应用研究

Applied Research of Transcranial Magnetic Stimulation( rTMS) in the Rehabilitation of Children With Hypotonia and Cerebral Palsy

目的探讨经颅磁刺激神经调控治疗在肌张力低下型脑性瘫痪患儿康复中的作用。方法选取2014年6月—2015年3月徐州市儿童医院收治的肌张力低下型脑性瘫痪患儿57例为研究对象,采用随机数字表法分为治疗组27例和对照组30例。治疗组采用传统康复治疗+经颅磁刺激神经调控治疗,对照组采用传统康复治疗。比较两组患儿康复治疗前后Gesell发育诊断量表发育商和关节活动度。结果康复治疗前,治疗组患儿股角大于对照组(P<0.05);两组患儿动作能发育商、应物能发育商、言语能发育商、应人能发育商、腘窝角、足背屈角比较,差异无统计学意义(P>0.05)。康复治疗1个月后,治疗组患儿动作能发育商大于对照组,腘窝角和股角小于对照组(P<0.05);两组患儿应物能发育商、言语能发育商、应人能发育商、足背屈角比较,差异无统计学意义(P>0.05)。康复治疗2个月后,治疗组患儿动作能发育商大于对照组,言语能发育商、腘窝角和股角小于对照组(P<0.05);两组患儿应物能发育商、应人能发育商、足背屈角比较,差异无统计学意义(P>0.05)。治疗组患儿康复治疗3个月后言语能发育商、应人能发育商较康复治疗2个月后升高(P<0.05)。结论经颅磁刺激神经调控治疗在肌张力低下型脑性瘫痪患儿的康复治疗中起到一定的作用,这种康复作用在经颅磁刺激神经调控治疗2个月时最明显。

Objective To investigate the effect of the nerve regulation therapy by transcranial magnetic stimulation on the rehabilitation of children with hypotonia and cerebral palsy, Methods Enrolled 57 children with hypotonia and cerebral palsy who were admitted into Xuzhou Children＇s Hospital from June 2014 to March 2015. Using convenience number table method, the subjects were divided into treatment group （n = 27 ） and control group （n = 30 ） . Treatment group was administrated with traditional rehabilitation treatment ＋ nerve regulation therapy by transcranial magnetic stimulation, and control group was administrated with conventional rehabilitation therapy. The two groups were compared in the development quotient of Gesell development diagnosis scale and joint movement degree before and after treatment. Results Before rehabilitation therapy, treatment group has bigger patellofemoral angle than control group （P 〈 0. 05） ; the two groups were not significantly different in popliteal fossa angle, foot dorsiflexion angle and the development quotients of motor ability, adaptability to objects, adaptability to people and speech ability （ P 〉 0. 05） . One month after rehabilitation therapy, treatment group has higher development quotient of motor ability and smaller popliteal fossa angle and patellofemoral angle than control group （ P 〈 0. 05 ） ; the two groups were not significantly different in the development quotients of adaptability to objects, speech ability and adaptability to people and foot dorsiflexion angle （P 〉 0.05） . After two - month rehabilitation therapy, treatment group was higher in the developmentquotient of motor ability and was lower in the development quotient of speech ability, patellofemoral angle and patellofemoral angle than control group （ P 〈 0. 05 ） ; the two groups were not significantly different in the development quotients of adaptability to objects and adaptability to people and foot dorsiflexion angle （P 〉 0. 05 ） . After three - month rehabilitation therapy, treatment group saw increase in the development quotients of speech ability and adaptability to people than those after two - month rehabilitation therapy （ P 〈 0.05 ） . Conclusion Nerve regulation therapy by transcranial magnetic stimulation has efficacy to some extent in the rehabilitation therapy of children with hypotonia and cerebral palsy, and it is most effective after two - month treatment.