高低频重复经颅磁刺激联合Rood技术对脑卒中患者下肢肌力及步行功能的影响研究

Effect of high- and low-frequency repetitive transcranial magnetic stimulation combined with Rood’s approach on lower limb muscle strength and walking function in stroke patients

摘要:

目的 探究高低频重复经颅磁刺激（rTMS）联合Rood技术对脑卒中患者下肢肌力及步行功能的影响。方法 选取2020年2月—2023年2月常州市武进中医医院收治的100例脑卒中患者，按信封抽签法随机分为单一组和联合组，每组50例。单一组给予Rood技术治疗，联合组给予高低频rTMS联合Rood技术治疗。比较两组治疗前后的生活质量、神经功能、下肢肌力、步行功能、神经电生理指标。结果 联合组治疗前后精力评分、家庭角色评分、思维能力评分和社会角色评分的差值均高于单一组（P <0.05）。两组患者治疗前及治疗2、4和6周NIHSS评分比较，结果 ①不同时间点NIHSS评分比较，差异有统计学意义（P <0.05）；②两组患者NIHSS评分比较，差异有统计学意义（P <0.05）；③两组患者NIHSS评分变化趋势比较，差异有统计学意义（P <0.05）。联合组治疗前后伸肌峰力矩体重比、屈肌峰力矩体重比的差值均高于单一组（P <0.05）。联合组治疗前后BBS评分、HFAC评分、TGA评分的差值均高于单一组（P <0.05）。联合组治疗前后MEP、CMCT的差值均高于单一组（P <0.05）。结论 rTMS联合Rood技术对脑卒中患者下肢肌力及步行功能的影响较为显著。

Abstract:

Objective To explore the effects of high- and low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with Rood’s approach on the lower limb muscle strength and walking function of stroke patients.Methods From February 2020 to February 2023, the 100 stroke patients admitted to Changzhou Wujin Hospital of Traditional Chinese Medicine were selected and randomly divided into the monotherapy group and the combined group using the envelope method, with 50 cases in each group. The monotherapy group was treated with the Rood’s approach, and the combined group was treated with both rTMS and the Rood’s approach. The quality of life, neurological function, lower limb muscle strength, walking function, and neurophysiological indicators before and after treatment were compared between the two groups.Results The differences of SS-QOL scores in terms of energy, family roles, thinking, and social roles before and after treatment in the combination group were higher than those in the monotherapy group (P < 0.05). Comparison of the National Institutes of Health Stroke Scale (NIHSS) scores at 2, 4, and 6 weeks between the combination and monotherapy groups using repeated measures ANOVA revealed that there was a statistically significant difference in NIHSS scores among different time points (P < 0.05) and between the combination and monotherapy groups, and that the change trend of NIHSS scores was different between the combination group and the monotherapy group (P < 0.05). The differences of the ratio of the peak torque of extensors to body weight and the ratio of the peak torque of flexors to body weight before and after treatment in the combination group were higher than those in the monotherapy group (P < 0.05). The differences of Berg Balance Scale (BBS) scores, Holden Functional Ambulation Categories (HFAC) scores, and Tinetti Gait Assessment (TGA) scores before and after treatment in the combination group were all higher than those in the monotherapy group (P < 0.05). The differences of motor evoked potential (MEP) amplitude and central motor conduction time (CMCT) before and after treatment in the combination group were higher than those in the monotherapy group (P < 0.05).Conclusions The combination of rTMS with Rood's approach significantly impacts the lower limb muscle strength and walking function of stroke patients.