重复经颅磁刺激结合穴位肌电生物反馈治疗对脑卒中患者胫骨前肌形态结构与肌力的影响

Effects of repeated transcranial magnetic stimulation combined with acupoint myoelectric biofeedback on morphology and muscle strength of tibialis anterior muscle in patients with cerebral apoplexy

目的探讨重复经颅磁刺激(rTMS)结合穴位肌电生物反馈治疗(EMGBF)对脑卒中患者胫骨前肌形态结构与肌力的影响。方法选取2019-06—2022-06收治于儋州市人民医院的180例脑卒中患者为研究对象,以随机数字表法将其分为常规组(CON组)、rTMS组、EMGBF组、r TMS+EMGBF组,每组45例。比较4组患者治疗前一般资料,采用超声技术测量并记录4组患者治疗前和治疗后(治疗4周后)的踝背屈肌力参数,静息和最大等长收缩状态时下胫骨前肌结构羽状角(PA)、肌肉厚度(MT)、肌纤维长度(FL);采用FMA量表下肢(FMA-LE)评分、Berg平衡量表(BBS)和改良Barthel指数(MBI)评分评估患者治疗后的效果。随机行走模型比较4组患者上述指标的改善程度。记录患者治疗过程中不良反应发生情况。结果治疗后CON组、rTMS组、EMGBF组和rTMS+EMGBF组患者踝背屈肌力、FMA-LE评分、BBS评分、MBI评分较治疗前均有明显改善(P<0.001);静息和最大等长收缩状态下r TMS组、EMGBF组和rTMS+EMGBF组患者的PA、MT较治疗前均有明显改善(P<0.05);rTMS+EMGBF组患者治疗后踝背屈肌力(31.43±5.07)N,静息状态和最大等长收缩状态下PA(11.32±1.02、11.42±1.05)°、MT(11.18±1.02、11.50±0.98)mm,FMA-LE评分(28.65±8.02)分,BBS评分(38.67±8.02)分、MBI评分(66.34±7.34)分较治疗前的改善程度明显优于其他3组(P<0.05);随机行走模型评价各指标改善程度依次为rTMS+EMGBF组,rTMS组和EMGBF组,CON组。4组患者治疗期间均未出现明显的不良反应。结论rTMS联合EMGBF治疗对脑卒中患者胫骨前肌和肌力的恢复具有显著疗效。

Objective To investigate the effects of repeated transcranial magnetic stimulation(rTMS)combined with electromyographic biofeedback(EMGBF)on the morphology and muscle strength of tibialis anterior muscle in stroke patients.Methods A total of 180 stroke patients admitted to our hospital from June 2019 to June 2022 were selected as the study subjects,and they were divided into conventional group(CON group),rTMS group,EMGBF group and rTMS+EMGBF group by random number table method,with 45 patients in each group.The general data of four groups before treatment were compared.Before and after treatment(4 weeks after treatment),the muscle strength parameters of the dorsiflexor of the four groups were measured and recorded by ultrasonic technology,The structure feathery Angle(PA),muscle thickness(MT)and muscle fiber length(FL)of the tibialis anterior muscle at rest and maximum isometric contraction state were measured and recorded.FMA lower extremity(FMA-LE)score,Berg balance scale(BBS)and modified Barthel index(MBI)score were used to evaluate the outcomes of patients after treatment.Random walking model was used to compare the improvement degree of above indicators in four groups.The occurrence of adverse reactions during treatment was recorded.Results After treatment,ankle dorsiflexion strength,FMA-LE score,BBS score and MBI score of patients in CON group,rTMS group,EMGBF group and rTMS+EMGBF group were significantly improved compared with those before treatment(P<0.001).PA and MT of patients in rTMS group,EMGBF group and rTMS+EMGBF group at rest and under maximal isometric contraction were significantly improved compared with those before treatment(P<0.05).In rTMS+EMGBF group,dorsal flexion strength was(31.43±5.07)N,PA was(11.32±1.02)°,MT was(11.18±1.02)mm,MT was(11.50±0.98)in resting state and maximal isometric contraction state.The FMA-LE score(28.65±8.02),BBS score(38.67±8.02)and MBI score(66.34±7.34)were significantly improved compared with the other three groups(P<0.05).The improvement degree of each index evaluated by random walk model was rTMS+EMGBF group,rTMS group and EMGBF group,CON group in order.There were no obvious adverse reactions in the 4 groups during treatment.Conclusion rTMS combined with EMGBF has a significant effect on the recovery of tibialis anterior muscle and muscle strength in stroke patients.