小针刀联合经颅磁刺激治疗脑梗死后遗症期上肢痉挛的疗效观察

Therapeutic Efficacy of Small Needle Knife Combined with Transcranial Magnetic Stimulationin the Treatment of Upper Limb Spasticity in the Postcerebral Infarction Period

目的:研究小针刀联合经颅磁刺激(Transcranial Magnetic Stimulation.TMS)在改善脑梗死后遗症期患者上肢痉挛症状中的临床疗效。方法:选取2021年6月~2023年6月在本院就诊的80例脑梗死后遗症期上肢轻至中度痉挛患者,随机将其分为小针刀组(n=26)、TMS组(n=27)、联合组(n=27)。所有患者在常规康复训练基础上,小针刀组进行小针刀治疗,TMS组进行经颅磁治疗,联合组进行联合治疗。治疗前后评估患者的Fugl-Meyer量表分数、临床痉挛指数分数,运动诱发电位,和静息运动阈值。结果:三组患者治疗后Fugl-Meyer评分均提高,临床痉挛指数评分均下降(P<0.01),其中联合治疗组的FuglMeyer评分高于单一治疗组,临床痉挛指数评分低于单一治疗组(P<0.01):三组患者治疗后运动诱发电位潜伏期均缩短,波幅增高(P<0.01),其中联合治疗组的运动诱发电位潜伏期短于单一治疗组,波幅高于单一治疗组(P<0.01):三组患者治疗后静息运动阈值均下降(P<0.01),其中联合治疗组的静息运动阈值低于单一治疗组(P<0.01)。结论:小针刀联合经颅磁刺激治疗能有效缓解脑梗死后上肢功能痉挛患者的上肢痉挛、中枢神经系统功能及大脑皮层兴奋性,疗效优于单一治疗方法。

Objective:To study the clinical efficacy of small needle knife therapy combined with Transcranial Magnetic Stimulation(TMS)in improving the symptoms of upper limb spasticity in patients with cerebral infarction sequelae.Methods:Eighty patients with mild to moderate spasticity of the upper limbs in the sequelae stage of cerebral infarction who attended our hospital from June 2021 to June 2023 were selected,and all of them were randomly divided into the small-needle knife group(n=26),the TMS group(n=27),and the combined group(n=27).On the basis of conventional rehabilitation training,the small-needle knife group was treated with small-needle knife,the TMS group was treated with transcranial magnetic therapy,and the combined group was treated with combined therapy.Patients'clinic spasticity index scores,motor-evoked potentials,and resting motor thresholds were assessed be-fore and after treatment.Results:The Fugl-Meyer scores of the three groups of patients improved after treatment,the clinic spasticity index scores decreased after treatment(P<0.01),with the Fugl-Meyer scores of the combined treatment group being higher than that of the single treatment group,and the clinic spasticity index scores lower than that of the single treatment group(P<0.01);the la-tency of motor-evoked potentials was shortened and wave amplitude increased after treatment among three groups(P<0.01),with the latency period of the motor-evoked potentials of the combined treatment group being shorter than that of the single treatment group,and the wave amplitude higher than that of the single treatment group(P<0.01);and the resting motor threshold of the three groups of patients decreased after treatment(P<0.01),with the combined treatment group having shorter resting motor thresholds than the single treatment group(P<0.01).Conclusion:Small needle knife combined with transcranial magnetic stimulation treatment can effectively relieve upper limb spastic state,central nervous system function and cerebral cortex excitability of patients with up-per limb functional spasms after cerebral infarction,and the therapeutic efficacy is better than that of single treatment method.