重复性经颅磁刺激联合局部振动治疗偏瘫型脑性瘫痪儿童疗效研究

Therapeutic Effect of Repetitive Transcranial Magnetic Stimulation Combined with Local Vibration Therapy on Children with Hemiplegic Cerebral Palsy

目的:探讨重复性经颅磁刺激(rTMS)联合局部振动(LVB)治疗对偏瘫型脑性瘫痪(HCP)儿童下肢痉挛、平衡功能和步态功能的影响。方法:选择2022年1—12月苏州大学附属儿童医院收治的HCP儿童66例,采用随机数字表法分为对照组、rTMS组和rTMS联合LVB组(联合组),每组22例。对照组接受常规康复治疗(包括物理因子治疗、痉挛肌牵伸训练、体位转移训练、站立平衡训练和步态训练等),30 min/次,1次/d,5 d/周,持续治疗12周。rTMS组在此基础上接受低频rTMS治疗,频率5 Hz、强度35%运动阈值(MT)、刺激时间10 s、序列间隔20 s,20 min/次,1次/d,5 d/周,持续治疗12周。联合组在rTMS组基础上接受LVB,振动频率15~20 Hz,位移<7 mm,10 min/次,1次/d,5 d/周,持续治疗12周。分别于治疗前后采用改良Ash⁃worth痉挛评定量表(MAS)评估患儿小腿三头肌的痉挛程度;采用Fugl-Meyer平衡功能评定量表(FM-B)评估患儿平衡功能;采用Gait Watch三维步态分析系统评估患儿三维步态参数(步速、患侧步长、患侧髋关节屈曲、患侧膝关节屈曲和患侧踝关节屈曲)。结果:与治疗前比较,rTMS组和联合组治疗后MAS评分均明显降低,FM-B评分和步态参数(步速、患侧步长、患侧髋关节屈曲、患侧膝关节屈曲、患侧踝关节屈曲)均明显升高,差异有统计学意义(P<0.05)。与对照组比较,rTMS组和联合组治疗后MAS评分均明显降低,FM-B评分、患侧步长和步速评分均明显升高(P<0.05);与rTMS组比较,联合组治疗后MAS评分明显降低,FM-B评分和步态参数(步速、患侧步长、患侧髋关节屈曲、患侧膝关节屈曲、患侧踝关节屈曲)均明显升高,差异有统计学意义(P<0.05)。结论:rTMS联合LVB可有效改善HCP儿童下肢痉挛、平衡功能和步态功能,值得临床推广。

Objective:To observe the effect of repetitive transcranial magnetic stimulation(rTMS)combined with local vibration(LVB)therapy on lower limb spasticity,balance function and gait function in children with hemiplegic cerebral palsy(HCP).Methods:A total of 66 children with HCP,who were treated in the Children's Hospital of Soochow University from January 2022 to December 2022 were randomly divided into control group,rTMS group and combined group,with 22 cases in each group.The control group received routine rehabilitation training(physical modality therapy,spasmodic muscle stretching training,postural transfer training,standing blance training and gait training,etc),30 minutes a time,once a day,five days a week,lasting for twelve weeks.The rTMS group received low-frequency rTMS treatment additionally,with a frequency of five Hz and a stimulation intensity of 35%motor threshold(MT),the stimulation time of 10 s,and the interval of 20 s,20 minutes a time,once a day,five days a week,lasting for 12 weeks.The combined group received LVB therapy in addition to the treatment of the rTMS group,and the vibration frequency was set to 15-20 Hz,within seven mm displacement,10 minutes a time,once a day,five days a week,lasting for 12 weeks.Before and after treatment,the modified Ashworth scale(MAS)was used to evaluate the muscle tone;the balance subscale of Fugl-Meyer test(FM-B)was used to evaluate the balance function,and the Gait Watch three-dimensional gait analysis system was used to evaluate the three-dimensional gait parameters(stride speed,stride length,hip flexion,knee flexion and ankle flexion of the affected side).Results:Compared with that before treatment,MAS scores of the rTMS group and the combined group after treatment decreased significantly,the FM-B scores and gait parameters(stride speed,stride length,hip flexion,knee flexion and ankle flexion of the affected side)increased significantly,and the differences were statistically significant(P<0.05).Compared with the control group,MAS scores of the rTMS group and the combined group after treatment decreased significantly,FM-B score,stride length and stride speed increased significantly(P<0.05);compared with the rTMS group,MAS score of the combined group after treatment decreased significantly,FM-B score and gait parameters(stride speed,stride length,hip flexion,knee flexion and ankle flexion of the affected side)increased significantly,and the differences were statistically significant(P<0.05).Conclusion:The rTMS combined with LVB therapy can effectively improve the lower limb spasticity,balance function and gait function of children with HCP,which is recommended for clinical application.