文章摘要
孙剑渊,顾琦,吴勤峰,施加加.重复经颅磁刺激对不完全性脊髓损伤患者的临床疗效观察[J].中国康复,2019,34(6):303-306
重复经颅磁刺激对不完全性脊髓损伤患者的临床疗效观察
Efficacy of repetitive transcranial magnetic stimulation in the treatment of segment incomplete spinal cord injury
  
DOI:
中文关键词: 脊髓损伤  重复经颅磁刺激  神经性疼痛
英文关键词: Spinal cord injury  Repetitive transcranial magnetic stimulation  Neuropathic pain
基金项目:苏州市科技计划项目(SYS201785);昆山市社会发展科技计划项目(KS1771)
作者单位
孙剑渊 昆山市康复医院江苏 苏州 215300 
顾琦 南通大学附属医院江苏 南通 226000 
吴勤峰 苏州科技城医院/南京医科大学附属苏州医院江苏 苏州 215000 
施加加 昆山市康复医院江苏 苏州 215300 
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中文摘要:
      目的:观察重复经颅磁刺激(rTMS)治疗C4~T12平面不完全性脊髓损伤患者神经性疼痛和脊髓功能独立性的疗效。方法:招募C4~T12平面脊髓损伤(ASIA C/D级)患者48例,对入选患者随机区组法分为观察组和对照组,每组各24例。对照组患者在常规康复的基础上辅以安慰剂治疗(极低阈强度的经颅磁刺激治疗),观察组在常规康复的基础上辅以80%阈强度的经颅磁刺激治疗,分别于治疗前和治疗6个月后评估2组患者的脑皮质运动诱发电位(MEP)和静息运动阈值(RMT)、疼痛简化McGill疼痛问卷(SF MPQ)和脊髓功能独立性评估量表Ⅲ (SCIM Ⅲ)。结果:治疗6个月后,观察组MEP波幅较治疗前及对照组明显提高(P<0.05),RMT较治疗前及对照组明显下降(P<0.05);对照组MEP波幅和RMT治疗前后比较差异无统计学意义。治疗后,观察组患者SF MPQ各项评分均较治疗前明显下降(均P<0.05),其中PRI S、PRI T及VAS评分更低于对照组 (均P<0.05),PRI A和PPI评分与对照组比较差异无统计学意义;对照组治疗前后SF MPQ各项评分比较差异无统计学意义。治疗后,观察组患者SCIM Ⅲ评分明显高于治疗前及对照组(均P<0.05),对照组治疗前后比较差异无统计学意义。结论:在常规康复的基础上辅以重复经颅磁刺激可明显改善C4~T12节段不完全性脊髓损伤患者的神经性疼痛,提高患者运动功能独立性。
英文摘要:
      Objective: To observe the effect of repetitive transcranial magnetic stimulation (rTMS) on the spinal cord independence and the neuropathic pain in patients with spinal cord injury (C4-T12 incomplete injury). Methods: Forty-eight patients with C4-T12 spinal cord injury (Asia C/D grade) were enrolled, and were randomly divided into two groups, 24 in each group. The control group was treated with placebo (transcranial magnetic stimulation with extremely low threshold intensity) on the basis of routine rehabilitation, and the observation group was given repetitive transcranial magnetic stimulation (80% threshold intensity) on the basis of routine rehabilitation. Motor evoked potential (MEP), rest motor threshold (RMT), Short form McGillPain Questionnaire (SF-MPQ) and Spinal Cord Independence Measure Ⅲ (SCIM-Ⅲ) were assessed before and 6 months after treatment. Results: After 6 months of treatment, MEP in observation group was significantly higher than that before treatment and control group (P<0.05), and RMT was significantly lower than that before treatment and control group (P<0.05). There was no significant difference in the MEP and RMT in the control group before and after treatment (P>0.05). After 6 months of treatment, the scores of SF-MPQ in the observation group were significantly lower than those before treatment (all P<0.05), the scores of PRI-S, PRI-T and VAS in the observation group were lower than those in the control group (all P<0.05), but there was no significant difference in the scores of PRI-A and PPI in two groups; there was no significant difference in the scores of SF-MPQ in the control group before and after treatment (P>0.05). After 6 months of treatment, the SCIM-Ⅲ score in the observation group was significantly higher than that in the control group (P<0.05). Conclusion: Adding rMTS on the basis of routine rehabilitation can significantly improve the spinal cord independence and the neuropathic pain in patients with spinal cord injury (C4-T12 incomplete injury).
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