重复经颅磁刺激调控初级感觉区改善皮质下脑梗死后平衡功能及步态的有效性研究

关键词：皮质下脑梗死  重复经颅磁刺激  初级感觉区  平衡功能  步态

Keywords:subcortical cerebral infarction  repetitive transcranial magnetic stimulation  primary sensory cortex  balance function  gait

摘要：

      摘要 目的：探讨重复经颅磁刺激（repeated transcranial magnetic stimulation， rTMS）调控初级感觉皮层对皮质下脑梗死后平衡功能和步行功能恢复的影响。 方法：本研究采用随机对照设计，共纳入了40例符合入组标准的研究对象，通过随机数字法将其随机分成对照组和试验组。试验组患者接受健侧初级感觉皮层高频rTMS刺激后立即进行常规康复治疗，对照组患者接受假刺激治疗和常规康复治疗，均为1次/天，共治疗3周。治疗前后给予下肢Fugl-Meyer评分、10m步行测试（10-meter walking test， 10MWT）、Berg平衡量表（Berg balance scale， BBS）、平衡功能测试压力中心（centre of pressure， COP）椭圆面积和压力轨迹长度、步态时空参数以及COP参数，并进行组内和组间对比分析结果。 结果：两组患者一般资料及平衡和步态参数无显著性差异。经过3周治疗后，两组患者下肢Fugl-Meyer评分、10MWT、BBS、压力重心面积、步幅、步宽、步速、患侧支撑相占比和COP前后支撑线较治疗前显著提高（P＜0.05），试验组患者站位COP压力轨迹、步行COP左右对称也较治疗前显著改善（P＜0.05）。而对照组患者站位COP压力轨迹、左右对称较治疗前无显著差异（P＞0.05）。试验组患者步宽、步速、支撑相比值、COP面积、压力轨迹长度和左右对称较对照组显著提高（P＜0.05），下肢Fugl-Meyer评分、10MWT、BBS、步幅、患侧摆动相比值和COP前后支撑线较对照组无显著差异（P＞0.05）。 结论：rTMS通过兴奋健侧初级感觉皮层能够促进感觉运动通路功能重组，从而有效改善皮质下脑梗死患者的平衡功能与步行能力。

Abstract:

      Abstract Objective： To investigate the effects of repetitive transcranial magnetic stimulation （rTMS） targeting contralesional primary somatosensory cortex on balance and gait recovery in patients with subcortical cerebral infarction. Method： This randomized controlled trial enrolled 40 patients who met the inclusion criteria and randomly assigned them to a control group and an experimental group. The experimental group received high-frequency rTMS stimulation over the contralesional primary somatosensory cortex followed immediately by conventional rehabilitation therapy, while the control group received sham stimulation combined with conventional rehabilitation therapy. Interventions were administered once daily for 3 weeks. Outcome measures assessed before and after treatment included the Fugl-Meyer Assessment for lower extremity（FMA-LE）， 10-Meter Walking Test （10MWT）， Berg Balance Scale （BBS）， and Centre of Pressure test（COP） ellipse area and pressure trajectory length， gait spatiotemporal parameters and COP parameters. Within-group and between-group comparisons were conducted. Result： No significant differences were observed in baseline demographic characteristics or balance and gait parameters between two groups. After 3 weeks of intervention， both groups demonstrated significant improvements in FMA-LE scores， 10MWT performance， BBS scores， COP area， stride length， step width， walking speed， percentage of stance phase on the affected side， and anterior-posterior COP stability line （all P<0.05）. Additionally， the experimental group showed significant improvements in standing COP trajectory and left-right COP symmetry during walking compared to baseline （P<0.05）. In contrast， no significant changes were observed in these two parameters in the control group after treatment （P>0.05）. Post-treatment intergroup comparisons revealed that the experimental group exhibited significantly greater improvements in step width， walking speed， percentage of stance phase， COP area， COP trajectory length， and left-right COP symmetry （P<0.05）. However， no statistically significant differences were found for FMA-LE scores， 10MWT performance， BBS scores， stride length， swing phase ratio on the affected side， or anterior-posterior COP stability line between the two groups（P>0.05）. Conclusion： High-frequency rTMS targeting the contralateral primary somatosensory cortex facilitates sensorimotor pathway reorganization and effectively improves balance function and gait performance in patients with subcortical cerebral infarction.