目的:探讨间歇性θ爆发刺激(iTBS)双靶点刺激对不完全性脊髓损伤(iSCI)患者下肢功能的影响。
方法:随机,单盲,本研究采用假对照试验.将30例符合纳入标准的下肢功能障碍的iSCI患者随机分为假手术组和iTBS组,每组15例。iTBS组采用常规康复治疗联合iTBS双靶点刺激治疗中央脑沟和脊髓损伤节段神经根。假手术组采用常规康复治疗联合iTBS双靶点假刺激治疗。治疗前对所有患者进行综合功能评估,在治疗的第3天和第21天。主要评价指标为:双下肢胫前肌运动诱发电位(MEP)的波幅和潜伏期,感觉诱发电位(SEP)的两个下肢的潜伏期,膝关节屈肌强度和膝关节伸肌强度,下肢运动评分(LEMS),下肢感觉评分(LESS),脊髓独立性测量(SCIM)评分和步态参数(步速,步频,步幅长度,地面反作用力)。
结果:在治疗的第21天,在iTBS组中,胫骨前肌的MEP幅度增加,MEP的延迟缩短,膝关节屈肌强度和膝关节伸肌强度增加,下肢运动评分和双下肢SCIM评分均升高。此外,膝关节屈曲肌的肌力差异有统计学意义,膝关节伸肌,MEP振幅,LEMS和SCIM两组间比较(p<0.05)。在10位可以使用助行器行走的患者中,治疗后iTBS组的步长和步频均较Sham组增加(p<0.01),地面反作用力(GRF)增加(p<0.05)。两组下肢LESS无明显差别(p>0.05)。
结论:ITBS双靶点刺激能显著改善iSCI患者的双下肢运动功能,但对双下肢感觉功能无明显改善。因此,这种治疗模式可能参与iSCI患者部分神经回路的重建和修复。此外,iTBS双靶点刺激可以提高iSCI患者的日常生活能力。
OBJECTIVE: To explore the influence of intermittent theta burst stimulation (iTBS) dual-target stimulation on lower limb function in patients with incomplete spinal cord injury (iSCI).
METHODS: A randomized, single -blind,sham-controlled trial was used in this study. Thirty iSCI patients with lower limb dysfunction meeting the inclusion criteria were randomly divided into a sham group and an iTBS group, with 15 cases in each group. The iTBS group received conventional rehabilitation therapy combined with iTBS dual-target stimulation on the central cerebral sulcus and the nerve root of the spinal cord injury segment. The sham group was treated with conventional rehabilitation therapy combined with iTBS dual-target sham stimulation therapy. Comprehensive functional assessment was performed on all patients before treatment, on the Day 3 and Day 21 of treatment.The main evaluation indicators were as follows: amplitude and latency of motor-evoked potential (MEP) in the anterior tibial muscles of both lower limbs,latency of sensory-evoked potential (SEP) of both lower limbs, knee flexor strength and knee extensor strength, lower extremity motor score (LEMS), lower extremity sensory score (LESS), spinal cord independence measure (SCIM) score and gait parameters (stride speed, stride frequency, stride length, ground reaction force).
RESULTS: On day 21 of treatment, in the iTBS group, the MEP amplitude of the anterior tibial muscles increased, the latency of MEP shortened, knee flexor strength and knee extensor strength increased, and the lower extremity motor score and SCIM score of both lower limbs increased. In addition, there were statistically significant differences in the muscle strength of the knee flexion muscle, knee extensor muscle, MEP amplitude, LEMS and SCIM between the two groups (p<0.05). Among the 10 patients who could walk with an assisted walker, the step length and step frequency of the iTBS group were increased compared with the sham group after treatment (p<0.01), and the ground reaction force (GRF) was increased (p<0.05). There was no significant difference in the LESS of the lower limbs between the two groups (p > 0.05).
CONCLUSIONS: ITBS dual-target stimulation can significantly improve the motor function of both lower limbs in patients with iSCI but does not significantly improve the sensory function of both lower limbs. Therefore, this treatment mode may participate in the reconstruction and repair of some nerve circuits in patients with iSCI. In addition, iTBS dual-target stimulation can improve the ability of iSCI patients to perform daily living.