摘要
目的 探讨机器人辅助步态训练结合重复经颅磁刺激(rTMS)对创伤性不完全性脊髓损伤(ISCI)患者下肢功能的影响.方法 选择2020年1月至2023年10月在该院就诊的腰椎创伤性ISCI患者46例作为研究对象,采用随机数字表法将患者分为对照组和观察组各23例.对照组采用机器人辅助步态训练,观察组在对照组的基础上给予rTMS治疗.观察并比较两组患者下肢运动评分(lower extremity functional scale,LEFS)、10 m 步行测试、SCI-Ⅱ 步行指数(WISCI-Ⅱ)、改良 Ashworth量表(MAS)、步态测量的改善情况.结果 治疗后,两组患者LEFS评分均较治疗前显著升高(P＜0.05),且观察组患者治疗后LEFS评分显著高于对照组(P＜0.05).治疗后,两组患者10 m步行试验时间较治疗前显著降低,WISCI-Ⅱ较治疗前显著升高,差异均有统计学意义(P＜0.05);治疗后,两组患者10 m步行试验和WISCI-Ⅱ相比较,差异无统计学意义(P＞0.05).治疗后,两组患者膝伸肌、髋内收肌、踝跖屈肌MAS与治疗前差异无统计学意义(P＞0.05);治疗后两组患者上述指标差异无统计学意义(P＞0.05).治疗后,两组患者步速均较治疗前显著升高(P＜0.05),但两组患者治疗后步速差异均无统计学意义(P＞0.05);治疗前,两组患者步频、单支撑时间、双支撑时间、步长等差异均无统计学意义(P＞0.05),且治疗后两组患者步频、单支撑时间、双支撑时间、步长等差异均无统计学意义(P＞0.05).结论 rTMS可改善慢性创伤性ISCI患者的下肢运动功能,但对步态特征、支撑依赖程度和痉挛水平的影响不显著.
Abstract
Objective To investigate the effect of robot-assisted gait training combined with repetitive transcranial magnetic stimu-lation(rTMS)on lower limb function in patients with traumatic incomplete spinal cord injury(ISCI).Method Forty-six patients with traumatic ISCI in our hospital from January 2020 to October 2023 were selected as the study objects.The patients were randomly divided into a control group and an observation group using a random number table method,with 23 cases in each group.The improve-ment of lower extremity functional scale(LEFS),10-meter walking test,SCI-Ⅱ walking index(WISCI-Ⅱ),modified Ashworth scale(MAS)and gait measurement were observed and compared between the two groups.Results After treatment,the LEFS of both groups of patients significantly increased compared to before treatment(P＜0.05),and the LEFS of the observation group was signifi-cantly higher than that of the control group after treatment(P＜0.05).After treatment,the 10 meter walking test of the two groups significantly decreased compared to before treatment,and the WISCI significantly increased compared to before treatment,with statisti-cal significance(P＜0.05).There was no statistically significant difference between the 10 meter walk test and WISCI between the two groups after treatment(P＞0.05).After treatment,there was no statistically significant difference in the MAS of knee extensor mus-cle,hip adductor muscle,and ankle plantar flexor muscle between the two groups compared to before treatment(P＞0.05),and there was no statistically significant difference in the above indicators between the two groups after treatment(P＞0.05).After treatment,the walking speed of both groups significantly increased compared to before treatment(P＜0.05),but there was no statistically signifi-cant difference in walking speed between the two groups after treatment(P＞0.05).There was no statistically significant difference in step frequency,single support time,double support time,and step length between the two groups before and after treatment(P＞0.05),and there was no statistically significant difference in step frequency,single support time,double support time,and step length between the two groups after treatment(P＞0.05).Conclusion rTMS can improve lower limb motor function in patients with chronic traumatic ISC1,but has no significant effect on gait characteristics,support dependence degree and spasticity level.
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