| 徐 榕,朱光跃,王 勇,孙婷婷,许东升.外周磁刺激结合经颅磁刺激对脑卒中后上肢痉挛的影响[J].中国康复医学杂志,2021,(8):943~948 |
| 外周磁刺激结合经颅磁刺激对脑卒中后上肢痉挛的影响 点此下载全文 |
| 徐 榕 朱光跃 王 勇 孙婷婷 许东升 |
上海市养志康复医院(上海市阳光康复中心)
，上海市，201603 |
| 基金项目：国家重点研发计划（2020YFC2004202）；上海市养志康复医院院级科研培育项目（YZ2020-017） |
| DOI：10.3969/j.issn.1001-1242.2021.08.007 |
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| 摘要： |
| 摘要
目的：观察外周结合经颅磁刺激对脑卒中后上肢痉挛的影响。
方法：将30例脑卒中后上肢痉挛的患者随机分为治疗组和对照组，每组15例。使用“8”字形磁刺激线圈给予治疗组患者非受累侧皮层M1区强度为80%静息运动阈值，频率1Hz共1200个脉冲磁刺激，随后给予患侧上肢Erb's点iTBS模式刺激共600个脉冲，刺激强度为能引起患侧拇短屈肌肉眼可见细微收缩最小强度。对照组给予假刺激，治疗组和对照组均接受相同的常规康复治疗。治疗共持续5周，每周治疗5天，每天治疗1次。观察其对患者患侧上肢改良Ashworth评分、Tardieu评分的影响，同时观察治疗前后患侧上肢正中神经腕水平H反射潜伏期及Hmax/Mmax肌电生理指标的变化，与对照组做比较。
结果：治疗组偏瘫侧上肢MAS评分治疗前后分值差：肘屈曲、肘伸展、屈指间关节、伸指间关节与对照组差值比较具有显著性差异（P<0.05）。Tardieu评分治疗前后分值差：肩水平内收、肘屈曲（肩内收位）、肘伸展（肩外展位）和对照组比较有显著性差异（P<0.05）。但肩前屈、肩外展、肘伸展、腕屈曲、伸腕MAS评分、肩内旋、前臂旋前（肩内收位）、前臂旋后（肩内收位）Tardieu评分差值两组比较无显著性差异（P>0.05），治疗组偏瘫侧上肢正中神经H反射潜伏期、Hmax/Mmax治疗前后差值和对照组比较有显著性差异（P<0.05）。
结论：外周磁刺激结合经颅磁刺激治疗可能有助于缓解脑卒中后上肢痉挛患者的痉挛状态。 |
| 关键词：脑卒中 痉挛 磁刺激 H反射 Hmax/Mmax |
| The effect of peripheral magnetic stimulation combined with transcranial magnetic stimulation on upper limb spasm after stroke Download Fulltext |
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| Shanghai Yangzhi Rehabilitation Hospital，Shanghai，201603 |
| Fund Project: |
| Abstract: |
| Abstract
Objective：To observe the effects of combined peripheral and transcranial magnetic stimulation on upper limb spasticity in patients with chronic stroke.
Method：Thirty chronic patients were randomly divided into combined magnetic stimulation group， sham stimulation group(n=15 in each group). The combined magnetic stimulation group was treated with 1Hz 1200 pulses transcranial magnetic stimulation over contralesional M1 and 600 pulses peripheral magnetic stimulation (intermittent theta burst stimulation, iTBS) over iplesional Erb’s point by “8” shaped coil. The intensity of transcranial stimulation was 80% resting motor threshold(rMT) and the intensity of peripheral stimulation was adjusted to induce the muscle contraction in abductor Digiti Minimi (ADM) muscle that can be just visible. The control group received sham stimulation. All patients were treated with real stimulation or sham stimulation once a day， 5 days a week for 5 weeks. Both groups were assessed before and after treatment. The upper limb modified Ashworth scale(MAS) and Tardieu scale were used to assess degree of spasticity. We also evaluated median nerve H reflex latency and the ratio of the maximum amplitude of H reflex and maximum amplitude of M wave (Hmax/Mmax) before and after treatment.
Result：There were significant improvements in Tardieu score of shoulder horizontal abductors， elbow flexors， elbow extensors and MAS score of elbow flexion，elbow extension， interphalangeal joint flexion， interphalangeal joint extention. There were significant differences of H reflex latency and Hmax/Mmax of median nerve. There were no significant differences in the MAS score of shoulder flexion， shoulder abduction， wrist flexion， wrist extensors and Tardieu score of shoulder internal rotators， elbow pronators and elbow supinators.
Conclusion： Combined magnetic stimulation can improve upper limb spasticity in patients with chronic stroke， and it is also worth to be studied further. |
| Keywords:stroke spasticity magnetic stimulation H reflex Hmax/Mmax |
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