目的:探讨经颅磁刺激联合下肢康复机器人对脑卒中患者下肢功能的康复效果。方法:收集 2021 年 1 月—2023 年 6 月首都医科大学附属北京康复医院收治的 100 例脑卒中患者作为研究对象,随机将其分成治疗组(50 例)和对照组(50 例)。对照组采用常规康复训练联合下肢康复机器人治疗,治疗组在对照组的基础上增加经颅磁 刺激治疗。观察两组患者临床疗效、关节活动度指标、Fugl-Meyer 量表、Berg 平衡量表、ADLs 和 WHOQOL-100 评分。 结果:治疗前,两组患者关节活动度指标、Fugl-Meyer 量表、Berg 平衡量表、ADLs 和 WHOQOL-100 评分比较,差 异均无统计学意义(P>0.05)。治疗后,两组患者各项指标均得到显著改善,且治疗组均优于对照组,差异有统计 学意义(P<0.05)。结论:经颅磁刺激联合下肢康复机器人对脑卒中患者治疗能够有效促进下肢功能的康复,增强 患者髋关节、膝关节的灵活度,促进身体平衡的建立,进一步强化患者运动功能的恢复,提升患者日常生活的活动 能力并有助于为其培养积极的生活预期。
Objective: To analyze the rehabilitation effect of lower limb rehabilitation robot combined with transcranial magnetic stimulation (TMS) on lower limb function of stroke patients. Methods: 100 stroke patients who were treated in Beijing Rehabilitation Hospital affiliated to Capital Medical University from January 2021 to June 2023 were selected. The selected patients were divided into the control group and the treatment group randomly, with 50 cases in each group. The control group was treated with conventional rehabilitation training combined with lower limb rehabilitation robot. The treatment group was treated with TMS combined with lower limb rehabilitation robot. The joint mobility index, Fugl-Meyer assessment, Berg balance scale, activities of daily living (ADLs) and WHOQOL-100 scores, and clinical efficacy of patients in the two groups before and after treatment were observed and compared. Results: Before treatment, there was no significant difference in joint mobility index, Fugl-Meyer assessment, Berg balance scale, ADLs and WHOQOL-100 scores between the two groups (P>0.05). After treatment, the above indexes of the two groups were significantly improved, and those indexes in the treatment group was better than those in the control group, and the differences were statistically significant (P<0.05). Conclusion: TMS combined with rehabilitation robot could effectively promote the rehabilitation of lower limb function of stroke patients, enhance the flexibility of hip and knee joints, improve the establishment of body balance. Meanwhile, it could further strengthen the recovery of motor function, improve the ADLs ability and cultivate positive life expectations of stroke patients.
收稿日期:2024-03-07 录用日期:2024-04-24
Received Date: 2024-03-07 Accepted Date: 2024-04-24
基金项目:2022 年沧州市科技计划项目(222106061)
Foundation Item: 2022 Cangzhou Science and Technology Plan Project (222106061)
通讯作者:赵殿兰,Email:15610509736@163.com
Corresponding Author: ZHAO Dianlan, Email: 15610509736@163.com
引用格式:刘翠,甄巧霞,王平,等 . 经颅磁刺激联合下肢康复机器人对脑卒中患者下肢功能康复的效果观察 [J]. 机器人外科学杂 志(中英文),2024,5(4):542-547.
Citation: LIU C, ZHEN Q X, WANG P, et al. Effect of lower limb rehabilitation robot combined with transcranial magnetic stimulation on lower limb function of stroke patients[J]. Chinese Journal of Robotic Surgery, 2024, 5(4): 542-547.
[1] 宋剑英 , 李季 , 李聪 , 等 . 羚角钩藤汤合温胆汤加减配合针灸对 痰热内闭证中风偏瘫疗效及对中医症状、下肢功能和足底压力 的影响 [J]. 中华中医药学刊 , 2022, 40(2): 86-89.
[2] ZONG X M, LI Y Y, LIU C, et al. Theta-burst transcranial magnetic stimulation promotes stroke recovery by vascular protection and neovascularization[J]. Theranostics, 2020, 10(26): 12090-12110.
[3] 袁野 , 张姗姗 , 李沿江 , 等 . 电针针刺痉挛拮抗肌穴位对中风 偏瘫患者下肢功能障碍的疗效观察 [J]. 中国中医急症 , 2022, 31(4): 638-640, 647.
[4] Bai Z F, Zhang J Q, Fong K N K. Effects of transcranial magnetic stimulation in modulating cortical excitability in patients with stroke: a systematic review and meta-analysis[J]. J Neuroeng Rehabil, 2022, 19(1): 24.
[5] 杨勇 , 邢英茹 , 田飞 , 等 . 温针灸配合股直肌神经入肌点推拿点 按疗法对中风偏瘫患者下肢运动功能障碍和生活质量的影响[J]. 临床医学研究与实践 , 2022, 7(13): 82-86.
[6] Radiansyah R S, Hadi D W. Repetitive transcranial magnetic stimulation in central post-stroke pain: current status and future perspective[J]. Korean J Pain, 2023, 36(4): 408-424.
[7] 陈立霞 , 李承家 , 王亭亭 , 等 . 头针配合镜像疗法对中风后下肢 功能障碍患者运动功能及生活能力的影响 [J]. 上海针灸杂志 , 2021, 40(3): 279-283.
[8] HONG Y, LIU Q, PENG M N, et al. High-frequency repetitive transcranial magnetic stimulation improves functional recovery by inhibiting neurotoxic polarization of astrocytes in ischemic rats[J]. J Neuroinflammation, 2020, 17(1): 150.
[9] 危虹 , 陈水金 , 何志雄 . 下肢智能反馈训练系统对早期中风患者 下肢运动功能的影响 [J]. 按摩与康复医学 , 2021, 12(6): 41-43.
[10] 赵雅娴 , 唐芷晴 , 孙新亭 , 等 . 不同强度穿戴式下肢康复机器 人训练对脑卒中后下肢功能的效果 [J]. 中国康复理论与实践 , 2023, 29(5): 497-503.
[11] Starosta M, Cichoń N, Saluk-Bijak J, et al. Benefits from Repetitive Transcranial Magnetic Stimulation in Post-Stroke Rehabilitation[J]. J Clin Med, 2022, 11(8): 2149.
[12] 曲斯伟 , 朱琳 , 钱龙 , 等 . 镜像视觉反馈训练联合下肢康复机器 人对脑卒中患者下肢运动功能的影响 [J]. 中华物理医学与康复 杂志 , 2022, 44(1): 30-34.
[13] Calabrò R S, Billeri L, Manuli A, et al. Applications of transcranial magnetic stimulation in migraine: evidence from a scoping review[J]. J Integr Neurosci, 2022, 21(4): 110.
[14] 史轲 , 闻新丽 , 任省民 . 滋阴通络汤阿司匹林对中风患者下肢 深静脉血栓形成及凝血功能的影响 [J]. 血栓与止血学 , 2020, 26(3): 390-391.
[15] Horimoto Y, Sato C, Inagaki A, et al. Effects of repetitive transcranial magnetic stimulation on cerebral glucose metabolism[J]. Neurol Sci, 2022, 43(3): 1879-1883.
[16] 李希 , 王秉翔 , 李娜 , 等 . 下肢外骨骼机器人康复训练对脑卒 中偏瘫患者下肢运动的影响 [J]. 山东大学学报 ( 医学版 ), 2023, 61(3): 121-126, 133.
[17] XING Y, ZHANG Y Q, LI C Q, et al. Repetitive Transcranial magnetic stimulation of the brain after ischemic stroke: mechanisms from animal models[J]. Cell Mol Neurobiol, 2023, 43(4): 1487-1497.
[18] 刘勇涛 , 谢丽娟 , 刘晓鑫 , 等 . 经颅磁刺激联合温针灸对中风后 肢体运动功能障碍患者肢体功能恢复的影响 [J]. 西部中医药 , 2023, 36(5): 120-123.
[19] Einstein E H, Dadario N B, Khilji H, et al. Transcranial magnetic stimulation for post-operative neurorehabilitation in neuro-oncology: a review of the literature and future directions[J]. J Neurooncol, 2022, 157(3): 435-443.
[20] 曾梅芳 , 刘芬 , 刘琼姿 . 醒脑灵肢丸联合高频重复经颅磁刺激 治疗中风恢复期气虚血瘀型运动障碍的临床效果 [J]. 临床合理 用药 , 2023, 16(20): 55-57.
[21] 何婧柳 , 李培真 , 徐晓萌 . 通任调督针法联合低频重复经颅磁 刺激治疗中风后睡眠障碍患者的近期随访研究 [J]. 中国疗养医 学 , 2022, 31(4): 381-383.
[22] Hara T, Abo M. New Treatment Strategy Using Repetitive Transcranial Magnetic Stimulation for Post-Stroke Aphasia[J]. Diagnostics (Basel), 2021, 11(10): 1853.
[23] 李雨源 , 程剑利 , 徐慧敏 , 等 . 针刺通督醒神穴联合重复经颅磁 刺激治疗中风后意识障碍的交互作用研究 [J]. 现代中西医结合 杂志 , 2021, 30(15): 1601-1605.
[24] 张伟 , 陈颖萍 , 杨斌 , 等 . 健脑中风灵联合经颅磁刺激治疗瘀血 阻络型缺血性卒中的临床研究 [J]. 中外医疗 , 2021, 40(23): 5-9.