连续θ爆发经颅磁刺激对侧运动前区对脑卒中重度偏瘫患者痉挛步态的影响

Effect of cTBS magnetic stimulation over contralateral premotor areas on post-stroke spastic gait in severe hemiplegia patients

目的 探索连续θ爆发经颅磁刺激对侧运动前区对脑卒中重度偏瘫患者痉挛步态的影响。方法 前瞻性选取2019年1月至2024年1月于南阳医学高等专科学校第一附属医院神经内科住院的脑卒中重度偏瘫患者186例,根据随机数字表法分为对照组93例和观察组93例。对照组采用常规康复训练,观察组采用连续θ爆发经颅磁刺激,治疗4周后比较步态参数、Fugl-Meyer运动功能量表(Fugl-Meyer assessment of lower extremity, FMA-LE)评分、Berg平衡量表(Berg balance scale, BSS)评分、临床痉挛指数(clinic spasticity index, CSI)评分、下肢感觉、痉挛程度改善情况以及总有效率。结果 2组治疗后屈髋峰、屈膝峰、步幅、步频、步速、FMA-LE评分、BSS评分、CSI评分、H波潜伏期明显高于治疗前,两点辨别觉、H/M比值明显低于治疗前,差异有统计学意义(P<0.01)。观察组治疗后屈髋峰、屈膝峰、步幅、步频、步速、FMA-LE评分、BSS评分、CSI评分、H波潜伏期明显高于对照组,两点辨别觉、H/M比值明显低于对照组,差异有统计学意义(P<0.01)。观察组1级、1+级、2级、3级、4级痉挛程度改善情况分别为1例(1.1%)、11例(11.8%)、48例(51.6%)、31例(33.3%)、2例(2.2%),对照组分别为0例、7例(7.5%)、29例(31.2%)、44例(47.3%)、13例(14.0%),2组痉挛程度改善情况比较,差异有统计学意义(P<0.01)。观察组总有效率明显高于对照组(96.8%vs 77.4%,χ^(2)=15.500,P<0.01)。结论 脑卒中重度偏瘫患者进行连续θ爆发经颅磁刺激可改善肌肉痉挛,恢复步态,针对对侧运动前区,更好改善下肢感觉、运动功能。

Objective To determine the effects of continuous θ burst stimulation of contralateral premotor areas on post-stroke spasticity gait in patients with severe hemiplegia.Methods A prospective trial was conducted on 186 stroke patients with severe hemiplegia admitted to our department from January 2019 to January 2024.They were randomly into control group(93 cases, conventional rehabilitation training) and observation group(93 cases, continuous θ burst transcranial stimulation).In 4 weeks after treatment, gait parameters, Fugl-Meyer assessment of lower extremity(FMA-LE) score, Berg balance scale(BSS) score, clinic spasticity index(CSI) score, lower limb sensation, spasticity improvement, and total effective rate were compared between the two groups.Results After treatment, both the 2 groups had significantly higher hip flexion, knee flexion, stride length, step frequency, step speed, FMA-LE score, BSS score, CSI score, and H wave latency, and lower two-point discrimination perception and H/M ratio when compared with the levels before treatment(P<0.01).What's more, all above indicators were obviously better in the observation group than the control group(P<0.01).The observation group had 1(1.1%),11(11.8%),48(51.6%),31(33.3%) and 2 cases(2.2%),respectively, of spasticity improvement grades 1,1+,2,3,and 4,and the control group had 0,7(7.5%),29(31.2%),44(47.3%),and 13 cases(14.0%),respectively, with statistical differences between the two group(P<0.01).The total effective rate was notably higher in the observation group than the control group(96.8% vs 77.4%,χ^(2)=15.500,P<0.01).Conclusion For severe hemiplegia patients, continuous θ burst stimulation can improve muscle spasm, restore gait, and better improve lower limb sensory and motor function.