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| 外周-中枢联合磁刺激对脑卒中后偏瘫肩痛及体感诱发电位的影响 |
| The impact of peripheral-central combined magnetic stimulation on post-stroke hemiplegic shoulder pain and somatosensory evoked potentials |
| 投稿时间：2025-04-15 修订日期：2025-04-15 |
| DOI： |
| 中文关键词: 脑卒中 重复经颅磁刺激 重复外周磁刺激 偏瘫肩痛 体感诱发电位 |
| 英文关键词: stroke repetitive transcranial magnetic stimulation repetitive peripheral magnetic stimulation hemiplegic shoulder pain somatosensory evoked potential |
| 基金项目:《基于EEG分析探讨rTMS对轻度认知障碍患者大脑皮层功能代偿及脑网络重组机制的研究》(No.20214Y005) |
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| 中文摘要: |
| 目的：观察对比重复外周磁刺激(repetitive peripheral magnetic stimulation ,rPMS)联合重复经颅磁刺激(repetitive transcranial magnetic stimulation ,rTMS)对卒中后偏瘫肩痛的临床疗效及患侧上肢正中神经体感诱发电位(somatosensory evoked potentials ,SEP)的影响。方法：用随机数字表法将40例偏瘫肩痛(hemiplegic shoulder pain ,HSP)患者随机分为观察组（20例）和对照组（20例）。两组均接受常规康复训练，此外，对照组患者予以患侧初级运动皮层高频rTMS治疗，观察组患者予以患侧肩袖肌群痛点高频rPMS联合初级运动皮层高频rTMS治疗。每天1次，每周5天，治疗4周。在干预前、干预结束后对受试者进行简版麦吉尔疼痛问卷(short-form McGill pain questionnaire ,SF-MPQ)、偏瘫肩无痛被动活动范围(passive joint range of motion ,PROM)、Neer肩关节功能评分、改良Barthel指数(modified Barthel index ,MBI)评定和患侧上肢正中神经SEP N20潜伏期和波幅测定。结果：干预前2组患者的基本资料及SF-MPQ、PROM、Neer肩关节功能评分、MBI、患侧正中神经N20潜伏期和波幅无显著差异（P＞0.05）。干预后2组患者SF-MPQ评分均较干预前显著降低（P＜0.01），且观察组比对照组降低更为显著（P＜0.05）。干预后2组患者PROM、Neer肩关节功能评分、MBI、N20波幅均较干预前显著提高（P＜0.05），且观察组比对照组提高更为显著（P＜0.05）。干预后观察组患者N20潜伏期较干预前有显著缩短（P＜0.05），且观察组干预前后N20潜伏期差值比对照组缩短更为显著，差异具有统计学意义（P＜0.05）。但对照组干预后N20潜伏期缩短不显著（P＞0.05）。结论：外周-中枢联合磁刺激对HSP患者的肩痛、肩关节功能活动以及日常生活能力改善均有显著疗效，且对正中神经SEP N20潜伏期和波幅有改善作用，效果优于单纯rTMS治疗。 |
| 英文摘要: |
| Objective: To observe and compare the clinical effect of repetitive peripheral magnetic stimulation (rPMS) combined with repetitive transcranial magnetic stimulation (rTMS) on shoulder pain in hemiplegia after stroke, and the somatosensory evoked potentials (SEP) impact of the affected upper limb. Methods: Forty individuals diagnosed with hemiplegic shoulder pain (HSP) were randomly divided into an observation group (20 cases) and a control group (20 cases) using a random number table method. Both groups received conventional rehabilitation therapy. On this basis, patients in the control group received high-frequency rTMS therapy on the primary motor cortex of the affected side, while patients in the observation group received high-frequency rPMS therapy on the pain points of the rotator cuff muscle group of the affected side in combination with high-frequency rTMS therapy on the primary motor cortex. once a day, 5 days a week, for 4 weeks. Before and after the intervention, the subjects were evaluated using the short-form McGill pain questionnaire (SF-MPQ), passive joint range of motion (PROM) of the hemiplegic shoulder, Neer shoulder joint function score, modified Barthel index (MBI), and the latency and amplitude of N20 of the median nerve SEP in the affected upper limb. Results: Before intervention, there were no significant differences in general information, SF-MPQ, PROM, Neer shoulder function score, MBI, N20 latency and amplitude of the affected median nerve between the two groups (P>0.05).The SF-MPQ scores of both groups after the intervention decreased significantly compared with those before intervention (P<0.01), and the reduction observed in the observation group was statistically more pronounced compared to the control group (P<0.05). After intervention, the PROM, Neer shoulder joint function score, MBI, and in both groups,the N20 amplitude were significantly improved than before (P<0.05), and the observation group exhibited a more notable enhancement compared to the control group (P<0.05). tPost-intervention, the N20 latency in the observation group underwent a significant shortening relative to its pre-intervention state (P<0.05), and the difference in N20 latency between the observation group before and after intervention was more significant than the control group, which shows a significant difference (P<0.05). However, the N20 latency in the control group did not significantly shorten after intervention (P>0.05). Conclusion: Peripheral-central combined magnetic stimulation has significant therapeutic effects on shoulder pain, shoulder joint function, and improvement of daily living ability in patients with HSP, and it also has an improvement effect on the latency and amplitude of N20 of the median nerve SEP, which is superior to that of simple rTMS treatment. |
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