文章摘要
饶尧，张晶晶，张弢，李艳，肖仔仙，杨杨，丁浩.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[J].神经损伤功能重建,2025,(5):266-270
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 HemiplegicShoulder Pain and Somatosensory Evoked Potentials
  
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:上海市长宁区卫健 委 课 题 资 助 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）
作者单位
饶尧，张晶晶，张弢，李艳，肖仔仙，杨杨，丁浩 上海交通大学医学 院附属同仁医院康 复科 
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中文摘要:
      目的：观察重复外周磁刺激（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）。2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质高频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 皮质高频rTMS治疗。每天1次，每周5 d，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潜伏期和波幅差异无统计学意义（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（P＜0.05）。但对照组干预后N20潜伏期缩短差异无统计学意义（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:
      To observe the clinical efficacy of repetitive peripheral magnetic stimulation (rPMS) combined with repetitive transcranial magnetic stimulation (rTMS) on post-stroke hemiplegic shoulder pain (HSP) and its impact on the somatosensory evoked potentials (SEPs) of the median nerve in the affected upper limb. Methods: Forty patients with 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 training. In addition, the control group was treated with high-frequency rTMS over the primary motor cortex of the affected side, while the observation group was treated with high-frequency rPMS targeting the painful trigger points of the rotator cuff muscles of the affected shoulder, combined with high-frequency rTMS over the primary motor cortex of the affected side. Treatments were administered once daily, five days a week, for four weeks. Before and after the intervention, subjects were assessed using the Short-Form McGill Pain Questionnaire (SF-MPQ), passive joint range of motion (PROM) of the pain-free hemiplegic shoulder, Neer shoulder function score, Modified Barthel Index (MBI), and the latency and amplitude of the N20 component of the median nerve SEP in the affected upper limb. Results: Before the intervention, there were no significant differences in baseline characteristics, SF-MPQ scores, PROM, Neer shoulder function scores, MBI, or the latency and amplitude of the N20 component of the median nerve SEP between the two groups (P>0.05). After the intervention, both groups showed a significant decrease in SF-MPQ scores compared to baseline (P<0.01), with a more pronounced decrease observed in the observation group than in the control group (P<0.05). Both groups also demonstrated significant improvements in PROM, Neer shoulder function scores, MBI, and N20 amplitude compared to baseline (P<0.05), with more significant improvements observed in the observation group than in the control group (P<0.05). After the intervention, the N20 latency in the observation group was significantly shorter than before the intervention (P<0.05), and the difference in N20 latency before and after the intervention was more pronounced in the observation group than in the control group (P<0.05). However, no significant difference in N20 latency was observed in the control group after the intervention (P>0.05). Conclusion: Peripheral-central combined magnetic stimulation is significantly effective in improving shoulder pain, shoulder joint function, and activities of daily living in patients with HSP. It also has a beneficial effect on the latency and amplitude of the N20 component of the median nerve SEP, with superior outcomes compared to rTMS treatment alone.
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