rTMS与FES治疗卒中后复杂区域性疼痛综合征的效果比较

Effect of repetitive transcranial magnetic stimulation versus functional electrical stimulation on post-stroke complex regional pain syndrome

目的比较重复经颅磁刺激(rTMS)与功能性电刺激(FES)治疗卒中后复杂区域性疼痛综合征的临床效果。方法选取温州市中医院2021年7月至2023年2月收治的卒中后复杂区域性疼痛综合征患者60例进行随机对照研究,采用随机数字表法将患者分为rTMS组30例和FES组30例。rTMS组给予rTMS治疗,FES组给予FES治疗,均每天1次,持续治疗8周。比较两组临床疗效、手指总活动度(TAM)、Fugl-Meyer评定量表(FMA)评分、日常生活活动能力评定量表(ADL)评分和改良Barthel指数量表(MBI)评分、肩关节活动度及安全性。结果FES组总有效率为86.7%(26/30),高于rTMS组的83.3%(25/30),但差异无统计学意义(Z=0.09,P=0.930)。治疗后,两组TAM评分、FMA评分差异均无统计学意义(P=0.244、0.262),两组MBI评分、ADL评分差异均无统计学意义(均P>0.05),两组肩关节活动度差异均无统计学意义(均P>0.05)。结论rTMS、FES治疗卒中后复杂区域性疼痛综合征均有显著的效果,均可改善患者上肢活动功能,提高患者日常生活活动能力,帮助重塑脑神经功能。

Objective To investigate the clinical efficacy of repetitive transcranial magnetic stimulation(rTMS)versus functional electrical stimulation(FES)in the treatment of post-stroke complex regional pain syndrome.Methods The randomized controlled study included 60 patients with post-stroke complex regional pain syndrome who received treatment at the Wenzhou TCM Hospital of Zhejiang Chinese Medical University from July 2021 to February 2023.These patients were divided into an rTMS group(n=30)and an FES group(n=30)using a random number table method.Patients in the rTMS group were treated with rTMS,while those in the FES group were treated with FES.All treatments were performed once daily for 8 consecutive weeks.The clinical efficacy,total active movement score of the fingers,Fugl-Meyer assessment scale score,Activity of Daily Living score,modified Barthel Index score,shoulder joint range of motion,and safety were compared between the two groups.Results The total response rate in the FES group was 86.7%(26/30),which was significantly higher than 83.3%(25/30)in the rTMS group(Z=0.09,P=0.93).After treatment,there were no significant differences between the two groups in terms of total active movement score of the fingers and Fugl-Meyer assessment scale score(P=0.244,0.262).No significant differences were found between the two groups in MBI score and ADL score(both P>0.05).There was also no significant difference in shoulder joint range of motion between the two groups(P>0.05).Conclusion Both rTMS and FES are highly effective for post-stroke complex regional pain syndrome.They can improve upper limb function,enhance daily living abilities,and remodel neurological functions of the brain.