目的 探讨低频重复经颅磁刺激(LF-rTMS)联合悬吊训练(SET)对痉挛型偏瘫脑瘫患儿的影响,为痉挛型偏瘫脑瘫患儿的康复治疗提供参考依据。 方法 选取2024年1—11月在青岛大学附属妇女儿童医院治疗的60例痉挛型偏瘫脑瘫患儿,按随机数字表法分为对照组、SET组和联合组,每组各20例。对照组接受常规康复治疗,SET组在对照组基础上接受SET,联合组在SET组基础上接受LF-rTMS,三组均治疗4周。治疗前、治疗4周后,采用粗大运动功能测试量表(GMFM-88)D区(站立)、E区(走、跑和跳)、Peabody精细运动发育量表2(PDMS-2 FM)、Berg平衡量表(BBS) 对三组患儿进行评定,同时采用肱二头肌、肱三头肌、股直肌、胫骨前肌及腹横肌的均方根值(RMS)为表面肌电的主要观察指标。 结果 治疗4周后,三组患儿GMFM-88 D区、E区,BBS评分及各靶肌肉RMS均较治疗前显著改善(P＜0.01),联合组与SET组PDMS-2 FM评分高于治疗前(P＜0.01);组间比较,联合组GMFM-88 D区和E区评分(F=9.124、9.422)、PDMS-2 FM评分(F=9.835)、BBS评分(F=9.019)优于对照组和SET组(P＜0.05),肱二头肌、肱三头肌、股直肌、胫骨前肌的表面肌电RMS(F=10.855、11.341、29.272、27.940)改善均显著优于对照组和SET组(P＜0.05),联合组和SET组腹横肌的表面肌电RMS改善显著优于对照组(F=43.100, P＜0.01)。 结论 LF-rTMS联合SET能有效提高痉挛型偏瘫脑瘫患儿的粗大运动功能和精细运动功能、改善平衡功能,可尝试在临床推广。
Abstract
Objective To investigate the therapeutic effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with suspension exercise therapy (SET) in children with spastic hemiplegic cerebral palsy (CP), in order to provide evidence for rehabilitation strategies. Methods Sixty children with spastic hemiplegic CP treated at Women′s and Children′s Hospital, Qingdao University between January and November 2024 were enrolled in this study, and were randomly assigned to control group (conventional rehabilitation, n=20), SET group (control treatment+SET, n=20), or combined group (SET treatment+LF-rTMS, n=20).All groups received 4 weeks of intervention.Outcomes were assessed pre- and post-treatment using Gross Motor Function Measure-88 (GMFM-88) domains D (standing) and E (walking/running/jumping), Peabody Developmental Motor Scales-2 Fine Motor (PDMS-2 FM), Berg Balance Scale (BBS).Besides, the root mean square value (RMS) of the biceps brachii, triceps brachii, rectus femoris, tibialis anterior and transversus abdominis muscles was used as the main observation index of surface electromyography (sEMG). Results After 4 weeks, all groups showed significant improvements inGMFM-88 domain D and E, BBS scores, and RMS of all target muscles (P<0.01), the PDMS-2 FM scores in the combined group and the SET group were higher than those before treatment (P<0.01).Comparisons between groups revealed that the combined group had superior GMFM-88 domain D (F=9.124) and E (F=9.422) scores, PDMS-2 FM (F=9.835), and BBS (F=9.019) compared to both other groups (P<0.05), significantly greater RMS improvements in biceps (F=10.855), triceps (F=11.341), rectus femoris (F=29.272), and tibialis anterior (F=27.940) versus controls and SET group (P<0.05), and the combined group and SET group had greater improvements in transversus abdominis RMS (F=43.100) versus controls (P<0.01). Conclusion LF-rTMS combined with SET can effectively improve the gross motor function and fine motor function, and balance function of children with spastic hemiplegic cerebral palsy, and try to promote in clinical practice.
关键词
低频重复经颅磁刺激 /
悬吊训练 /
痉挛型偏瘫 /
脑瘫
Key words
low-frequency repetitive transcranial magnetic stimulation /
sling exercise therapy /
hemiplegia spasticity /
cerebral palsy
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基金
2025—2027年青岛市医疗卫生重点学科建设项目(青卫科教字[2024]3-49)
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