低频rTMS联合肌电生物反馈疗法治疗偏瘫型脑瘫的疗效及对患儿神经、运动功能的影响

Curative effect low-frequency rTMS combined with electromyographic biofeedback therapy in the treatment of children with hemiplegic cerebral palsy and its effect on nerve and motor function.

目的观察低频重复经颅磁刺激(r TMS)联合肌电生物反馈疗法治疗偏瘫型脑瘫的疗效,并探讨其对患儿神经、运动功能的影响。方法回顾性分析2015年8月至2018年8月深圳市儿童医院康复医学科收治的90例偏瘫型脑瘫患儿的诊疗资料。按照康复训练措施不同分为观察组和对照组各45例。两组患儿均给予常规的基础康复训练,对照组在上述基础上使用肌电生物反馈疗法治疗,观察组在对照组治疗的基础上联合低频rTMS治疗,10 d治疗1次,10 d为一个疗程,均连续治疗5个疗程。比较两组患儿治疗后的临床疗效以及治疗前、治疗后的发育商(DQ)、粗大运动功能测量(GMFM)-88量表评分、精细运动能力(FMFM)量表评分,并记录两组患儿治疗后的不良反应情况。结果治疗后,观察组患儿的治疗总有效率为86.67%,明显高于对照组的66.67%,差异有统计学意义(P<0.05);治疗后观察组患儿的DQ值为(82.33±4.51)分,明显高于对照组的(78.05±3.07)分,差异有统计学意义(P<0.05);治疗后观察组患儿GMFM-88量表中D区、E区评分分别为(31.03±2.70)分、(50.04±4.43)分,明显高于对照组的(26.83±3.14)分、(42.83±4.61)分,差异均有统计学意义(P<0.05);治疗后观察组患儿FMFM量表中A区、B区、C区、D区、E区评分分别为(11.12±1.35)分、(19.53±1.65)分、(22.18±2.24)分、(28.95±2.06)分、(53.53±4.71)分,明显高于对照组的(9.74±1.19)分、(15.34±1.42)分、(18.03±1.75)分、(22.31±2.57)分、(45.29±3.46)分,差异均有统计学意义(P<0.05);两组患儿治疗过程中均无明显不良反应。结论低频r TMS联合肌电生物反馈疗法治疗偏瘫型脑瘫疗效显著,其可有效改善患儿的神经、运动功能,安全性高,值得临床推广应用。

Objective To observe the effect of low frequency repetitive transcranial magnetic stimulation(rTMS)combined with electromyographic biofeedback therapy in the treatment of hemiplegic cerebral palsy,and to explore its influence on nerve and motor function of children.Methods The diagnosis and treatment data of 90 children with hemiplegic cerebral palsy admitted to the Department of Rehabilitation Medicine,Shenzhen Children's Hospital from August 2015 to August 2018 were analyzed retrospectively.According to different rehabilitation training measures,they were divided into the observation group and control group,with 45 patients in each group.The two groups of children were given routine basic rehabilitation training.The control group was treated with electromyographic biofeedback therapy on the basis of the above,and the observation group was combined with low-frequency rTMS on the basis of the control group,once every 10 days,with 10 days as a course of treatment,for 5 courses.The clinical efficacy in two groups children at after treatment 5 courses,and the development quotient(DQ),gross motor function scale(GMFM)-88 scale,fine motor ability(FMFM)scale before treatment and after treatment and after treatment 5 courses were compared,and the adverse reactions after treatment was recorded.Results After treatment 5 courses,the total effective rate in the observation group children was 86.67%,which was significantly higher than 66.67%of the control group(P<0.05);DQ value in the observation group children was(82.33±4.51)points,which was significantly higher than(78.05±3.07)points of the control group(P<0.05);GMFM-88 scale D and E area scores in the observation group were(31.03±2.70)points,(50.04±4.43)points,respectively,which were significantly higher than corresponding(26.83±3.14)points and(42.83±4.61)points of the control group(P<0.05);FMFM scale A,B,C,D and E area scores in the observation group were(11.12±1.35)points,(19.53±1.65)points,(22.18±2.24)points,(28.95±2.06)points,(53.53±4.71)points,respectively,which were significantly higher than corresponding(9.74±1.19)points,(15.34±1.42)points,(18.03±1.75)points,(22.31±2.57)points,(45.29±3.46)points of the control group(all P<0.05);there were no significant adverse reactions in the two groups.Conclusion Low-frequency rTMS combined with electromyographic biofeedback therapy is well for children with hemiplegic cerebral palsy,which can effectively improve the children's nerve and motor functions,with high safety,which is worthy of clinical application.