重复经颅磁刺激在不完全性脊髓损伤患者康复中的应用价值

Application value of repetitive transcranial magnetic stimulation in rehabilitation of incomplete spinal cord injury

中文关键词:  不完全性脊髓损伤  重复经颅磁刺激  疼痛  运功功能  生活质量

英文关键词:Incomplete spinal cord injury  Repetitive transcranial magnetic stimulation  Pain  Motor function  Quality of life

中文摘要:

  【摘要】 目的：探讨重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）治疗不完全性脊髓损伤的疗效。方法：前瞻性纳入2015年3月~2021年3月我院诊治的美国脊髓损伤协会（American Spinal Injury Association，ASIA）分级为C~D级、病程＜6个月且认知功能无异常的178例不完全性脊髓损伤患者。采用随机数字表法，将患者分为观察组和对照组各89例。两组年龄、性别、病程、ASIA分级、损伤平面等均无统计学差异（P＞0.05）。对照组给予常规康复干预，观察组在对照组基础上进行rTMS干预（每日治疗1次，每周5次，连续治疗10周）。分别于干预前和干预6、10周时，采用简化的McGill疼痛问卷（short-form of McGill pain questionnaire，SF-MPQ）测定疼痛评级指数（pain rating index，PRI）、视觉模拟评分（visual analogue scale，VAS）、现实疼痛指数（present pain index，PPI），其中PRI包含感觉类（PRI-sensory，PRI-S）和情感类（PRI-affective，PRI-A）；采用改良Ashworth量表（modified Ashworth scale，MAS）、脊髓损伤步行指数Ⅱ（walking index for spinal cord injury Ⅱ，WISCI Ⅱ）、脊髓功能独立性评分（spinal cord independence measure，SCIM）评定肌张力和下肢功能；采用汉密尔顿焦虑量表（Hamilton anxiety scale，HAMA）、汉密尔顿抑郁量表（Hamilton depression scale，HAMD）评定焦虑、抑郁；采用简明健康状况量表（36-item short-form health survey，SF-36）评定生活质量；采用磁刺激仪测定运动诱发电位（motor evoked potential，MEP）波幅、静息运动阈值（resting motor threshold，RMT）。结果：两组干预前PRI-S、PRI-A、VAS、PPI评分无显著性差异（P＞0.05），两组干预6、10周时均低于干预前（P＜0.05），且观察组低于对照组（P＜0.05）。两组干预前MAS、WISCI Ⅱ、SCIM评分无显著性差异（P＞0.05），两组干预6、10周时MAS评分均低于干预前（P＜0.05），WISCI Ⅱ、SCIM评分高于干预前（P＜0.05），且观察组干预6、10周时MAS评分均低于对照组，WISCI Ⅱ、SCIM评分高于对照组（P＜0.05）。两组干预前HAMA、HAMD、SF-36评分均无显著性差异（P＞0.05），两组干预6、10周时HAMA、HAMD评分均低于干预前（P＜0.05），SF-36评分高于干预前（P＜0.05），且观察组6、10周时HAMA、HAMD评分均低于对照组，SF-36评分高于对照组（P＜0.05）。两组干预前MEP波幅、RMT无显著性差异（P＞0.05），观察组干预6、10周时MEP波幅高于对照组（P＜0.05），RMT低于对照组（P＜0.05）。结论：rTMS可减轻不完全性脊髓损伤患者神经病理性疼痛，提高大脑皮质兴奋性、下肢运动功能和生活质量，减轻焦虑和抑郁，有助于患者康复。

英文摘要:

  【Abstract】 Objectives: To investigate the efficacy of repetitive transcranial magnetic stimulation(rTMS) in the treatment of incomplete spinal cord injury. Methods: 178 patients with incomplete spinal cord injury who were diagnosed and treated in our hospital from March 2015 to March 2021 with grade C-D of American Spinal Injury Association(ASIA), disease courses of less than 6 months, and no abnormal cognitive functions were prospectively enrolled. Using the random number table method, the patients were divided into observation group and control group with 89 cases each. There was no statistical difference in age, gender, course of disease, ASIA grade, and injury level between the two groups(P>0.05). The control group was given routine rehabilitation intervention, while the observation group was given rTMS(once a day, 5 times a week, continuous treatment for 10 weeks) on the intervention basis of the control group. Before the intervention and at 6 and 10 weeks of the intervention, the pain rating index(PRI), visual analogue scale(VAS) and present pain index(PPI) were measured using the short-form of McGill pain questionnaire(SF-MPQ). Among them, the PRI includes the PRI-sensory(PRI-S) and the PRI-affective(PRI-A). Modified Ashworth scale(MAS), walking index for spinal cord injury Ⅱ(WISCI Ⅱ), and spinal cord independence measure(SCIM) were used to assess the muscle tone and lower extremity function; Hamilton anxiety scale(HAMA) and Hamilton depression scale(HAMD) were used to assess anxiety and depression; 36-item short-form health survey(SF-36) was applied to evaluate the quality of life; and the magnetic stimulator was used to measure motor evoked potential(MEP) and resting motor threshold(RMT). Results: There was no significant difference in PRI-S, PRI-A, VAS and PPI scores between the two groups before intervention(P>0.05), while those values of both groups at 6 and 10 weeks after intervention were lower than before intervention(P<0.05), and the observation group was lower than the control group(P<0.05). The MAS, WISCI Ⅱ and SCIM scores between the two groups before intervention showed no significant difference(P>0.05). The MAS scores of both groups at 6 and 10 weeks after intervention were lower than those before intervention, while the WISCI Ⅱ and SCIM scores were higher than before intervention(P<0.05). The MAS scores of the observation group at 6 and 10 weeks of intervention were lower than those of the control group, while the WISCI Ⅱ and SCIM scores were higher than those of the control group(P<0.05). There was no significant difference in HAMA, HAMD and SF-36 scores between the two groups before intervention(P>0.05). The HAMA and HAMD scores of both groups at 6 and 10 weeks after intervention were lower than those before intervention(P<0.05), while the SF-36 scores were higher than before intervention(P<0.05). The HAMA and HAMD scores of the observation group at 6 and 10 weeks were lower than those of the control group, and the SF-36 score was higher than that of the control group(P<0.05). There was no significant difference in MEP amplitude and RMT between the two groups before intervention(P>0.05). The MEP amplitude in the observation group was higher than that in the control group at 6 and 10 weeks after intervention(P<0.05), and the RMT was lower than that in the control group(P<0.05). Conclusions: rTMS can reduce neuropathic pain in patients with incomplete spinal cord injury, improve cortical excitability, lower limb motor function and quality of life, reduce anxiety and depression, and help patients recover.