低频重复经颅磁刺激联合躯干稳定性训练对脑卒中偏瘫患者神经和平衡及步行功能的影响

Effect of low frequency repetitive transcranial magnetic stimulation combined with trunk stability training on nerve,balance,and walking function of stroke patients with hemiplegia

目的探讨低频重复经颅磁刺激(rTMS)联合躯干稳定性训练对脑卒中偏瘫患者神经、平衡及步行功能的影响。方法前瞻性选取2018年3月至2021年3月威海市中心医院收治的103例脑卒中偏瘫患者作为本次研究对象,按照简单随机数字表法分为对照组(52例)和观察组(51例)。对照组男32例,女20例,年龄(60.28±12.45)岁;观察组男29例,女22例,年龄(60.71±12.52)岁。两组患者均给予临床常规康复治疗,在此基础上对照组给予躯干稳定性训练,观察组给予rTMS联合躯干稳定性训练。采用美国国立卫生研究院卒中量表(NIHSS)评估患者治疗前后的神经功能,采用感觉统和测试(SOT)、运动控制测试(MCT)、Brunel平衡量表(BBS)评估患者治疗前后的平衡功能,采用步态分析仪评估患者治疗前后的步行功能。统计方法采用独立样本t检验、配对t检验及四格表χ^(2)检验。结果治疗后两组NIHSS评分均降低,且观察组NIHSS评分低于对照组[(9.13±1.72)分比(12.36±2.14)分],两组比较差异有统计学意义(t=8.433,P<0.001)。治疗后两组SOT、BBS评分升高,MCT评分降低,且观察组的SOT、BBS评分均明显高于对照组[(78.72±6.96)分比(70.26±7.63)分、(47.29±4.95)分比(39.64±4.65)分],MCT评分低于对照组[(113.42±4.01)分比(131.28±6.71)分],两组比较差异均有统计学意义(t=5.876、8.102、16.357,均P<0.001)。治疗后两组步行速度、患侧步幅、患侧下肢摆动百分比、患侧髋关节关节活动范围(ROM)、膝关节ROM、踝关节ROM均明显升高,患侧下肢支撑期降低,差异均有统计学意义(均P<0.05);且观察组步行速度、患侧步幅、患侧下肢摆动百分比、患侧髋关节ROM、膝关节ROM、踝关节ROM均明显高于对照组,患侧下肢支撑期低于对照组,差异均有统计学意义(均P<0.05)。结论对脑卒中偏瘫患者应用rTMS联合躯干稳定性训练能够明显改善的神经功能、平衡功能和步行功能,具有一定的临床推广价值。

Objective To investigate the effect of low frequency repetitive transcranial magnetic stimulation(rTMS)combined with trunk stability training on nerve,balance,and walking function of stroke patients with hemiplegia.Methods A total of 103 patients with stroke hemiplegia treated in Weihai Central Hospital from March 2018 to March 2021 were prospectively selected as the research objects.They were divided into a control group(52 cases)and an observation group(51 cases)by the random number table method.The control group had 32 males and 20 females,and they were(60.28±12.45)years old.The observation group had 29 males and 21 females,and they were(60.71±12.52)years old.Both groups were given clinical routine rehabilitation treatment.On this basis,the control group was given trunk stability training,and the observation group rTMS combined trunk stability training.The National Institutes of Health Stroke Scale(NIHSS)was used to assess the patients'neurological function before and after the treatment.The sensory integration test(SOT),motor control test(MCT),and Brunel Balance Scale(BBS)were used to assess the patients'balance function before and after the treatment.The state analyzer was used to evaluate the patients'walking function before and after the treatment.The independent-sample t test,paired t test,and four grid tableχ^(2) test were used.Results After the treatment,the neurological function scores of the two groups were reduced,and the neurological function score in the observation group was lower than that in the control group[(9.13±1.72)vs.(12.36±2.14)],with a statistical difference(t=8.433,P<0.001).After the treatment,the scores of SOT and BBS increased and the MCT score decreased in the two groups;and the scores of SOT and BBS were significantly higher and the MCT score was lower in the observation group than in the control group[(78.72±6.96)vs.(70.26±7.63),(47.29±4.95)vs.(39.64±4.65),and(113.42±4.01)vs.(131.28±6.71)],with statistical differences(t=5.876,8.102,and 16.357;all P<0.001).After the treatment,the walking speed,ipsilateral stride,ipsilateral lower limb swing percentage,ipsilateral hip joint range of motion(ROM),knee joint ROM,and ankle joint ROM significantly increased and the support period of the affected leg decreased in the two groups(all P<0.05);and the walking speed,ipsilateral stride,ipsilateral lower limb swing percentage,ipsilateral hip joint ROM,knee joint ROM,and ankle joint ROM were significantly higher and the support period of the affected leg was lower in the observation group than in the control group,with statistical differences(all P<0.05).Conclusion The application of rTMS combined with trunk stability training can significantly improve the nerve,balance and walking function of stroke patients with hemiplegia,so it has certain clinical promotion value.