rTMS联合臀中肌促通对老年脑卒中后偏瘫患者步态、平衡能力和肢体功能的影响

Effects of rTMS combined with gluteus medius muscle facilitation on gait,balance ability and limb function in elderly patients with post-stroke hemiplegia

中文关键词: 老年, 脑卒中, 偏瘫, 重复经颅磁刺激, 臀中肌促通, 步态恢复, 肢体功能

英文关键词: elderly  stroke  hemiplegia  repetitive transcranial magnetic stimulation  gluteus medius muscle facilita-tion  gait recovery  limb function

中文摘要:

      目的 探究重复经颅磁刺激(rTMS)与臀中肌促通联合治疗老年脑卒中后偏瘫的效果,分析对步态、平衡能力和肢体功能的影响,为治疗该病症提供方法.方法 选择2022年10月-2024年3月南京医科大学附属淮安第一医院收治的102例老年脑卒中患者,根据不同的治疗方法分为rTMS组和促通组,每组51例.2组均给予常规药物支持治疗与康复训练,rTMS组给予rTMS治疗,促通组在rTMS组治疗基础上加用臀中肌反复促通.比较2组治疗前后步态、躯干能力[采用中文版躯干损伤量表(TIS)评估]、肢体功能[采用Fugl-Meyer评估表(FMA)评估]、平衡能力[采用Tinetti平衡与步态量表、伯格平衡量表(BBS)评估及坐位与站立位平衡功能]和血流动力学指标[收缩最大血流速度(PSV)、血流量(BF)].结果 治疗后,2组步速、步频、患肢健肢步长比和患肢健肢支撑时间比同组治疗前增加(P＜0.05),步态周期时间和步宽较治疗前减少(P＜0.05),促通组和rTMS组差异均有统计学意义(P＜0.05).2组TIS各分量表评分及总分、FMA中上肢运动和下肢运动和总评分、Tinetti评分、BBS评分及患侧上肢肱静脉PSV、BF和下肢股总静脉PSV、BF较同组治疗前增加(P＜0.05),重心摆动平均速度、重心移动轨迹和重心单位面积移动轨迹长度较同组治疗前降低(P＜0.05),促通组和rTMS组差异有统计学意义(P＜0.05).结论 rTMS联合臀中肌促通可明显改善老年脑卒中后偏瘫患者步态与平衡能力,增加下肢静脉血流,促进躯干与肢体功能恢复.

英文摘要:

      Objective To explore the effects of repetitive transcranial magnetic stimulation(rTMS)combined with glu-teus medius muscle facilitation in the treatment of post-stroke hemiplegia in the elderly,analyze its effects on gait,balance abil-ity and limb function,and provide a method for the treatment of this disease.Methods 102 elderly stroke patients admitted to Huai'an First People's Hospital Affiliated to Nanjing Medical University from October 2022 to March 2024 were selected and di-vided into rTMS group and facilitation group according to different treatment methods,with 51 cases in each group.Both groups received conventional drug support treatment and rehabilitation training.The rTMS group received rTMS treatment,while the facilitation group received repeated facilitation of the gluteus medius muscle in addition to rTMS treatment.The gait,trunk ability[Chinese version of Trunk Injury Scale(TIS)],limb function[Fugl-Meyer assessment scale(FMA)],balance ability[Tinetti Balance and Gait Scale,Berg Balance Scale(BBS)and sitting and standing balance function]and the hemody-namic indicators[peak systolic velocity(PSV),blood flow(BF)]were compared between the two groups before and after treatment.Results After treatment,the step speed,step frequency,step length ratio of affected limb to healthy limb and sup-port time of affected limb and healthy limb in the two groups were quicker or larger than those of the same group before treat-ment(P＜0.05),while the gait cycle time and step width were shorter than those of the same group before treatment(P＜0.05).The differences between the two group were statistically significant(P＜0.05).The scores of subscales and total score of TIS,scores of upper limb movement and lower limb movement and total score of FMA,Tinetti score and BBS score and the PSV and BF of the brachial vein of the affected upper limb and PSV and BF of the common femoral vein of the affected lower limb increased in both groups compared with those in the same group before treatment(P＜0.05),while the average speed of the center of gravity swing,the trajectory of the center of gravity movement,and the length of the trajectory of the center of gravity movement per unit area decreased compared with those in the same group before treatment(P＜0.05),The differences between the two group were statistically significant(P＜0.05).Conclusion The combination of rTMS and gluteus medius muscle facilitation can significantly improve the gait and balance ability of elderly patients with post-stroke hemiplegia,increase the venous blood flow of lower limbs,and promote the recovery of trunk and limb function.