重复外周磁刺激作用于上肢不同位置对亚急性期脑卒中患者腕关节运动功能的影响：一项随机对照试验

doi:10.12114/j.issn.1007-9572.2024.0081

中国全科医学 ›› 2024, Vol. 27 ›› Issue (23): 2846-2852.DOI: 10.12114/j.issn.1007-9572.2024.0081

• 论著·专病研究·脑卒中康复 • 上一篇下一篇

重复外周磁刺激作用于上肢不同位置对亚急性期脑卒中患者腕关节运动功能的影响：一项随机对照试验

谢勇¹^,², 林嘉莉¹, 刘燕平², 蔡扬帆², 连晓文², 丁铃⁴, 贾杰¹^,³^,⁵^,^*()

1．350005　福建省福州市，福建医科大学附属第一医院
2．350003　福建省福州市，福建中医药大学附属康复医院
3．200040　上海市，复旦大学附属华山医院康复医学科
4．201399　上海市浦东医院康复医学科
5．350200　福建省福州市，国家区域医疗中心　复旦大学附属华山医院福建医院　福建医科大学附属第一医院（滨海院区）

收稿日期:2024-03-01 修回日期:2024-04-12 出版日期:2024-08-15 发布日期:2024-05-08
通讯作者: 贾杰
作者贡献：
谢勇提出研究构思，负责试验实施，观察指标的测量与数据收集；林嘉莉、刘燕平、蔡扬帆、连晓文负责试验实施与评估；谢勇、丁铃负责论文撰写与统计学处理；贾杰负责文章的质量控制及审校，对文章整体进行监督管理；所有作者确认了论文终稿。
基金资助:
福建省科技创新联合资金项目(2021Y9130); 国家自然科学基金资助项目(91948302，82021002); 国家重点研发计划项目(2018YFC2002300，2018YFC2002301)

Effect of Repeated Peripheral Magnetic Stimulations at Different Sites of Upper Limbs on Wrist Motor Function in Subacute Stroke Patients: a Randomized Controlled Trial

XIE Yong¹^,², LIN Jiali¹, LIU Yanping², CAI Yangfan², LIAN Xiaowen², DING Ling⁴, JIA Jie¹^,³^,⁵^,^*()

1. The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
2. Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350003, China
3. Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai 200040, China
4. Department of Rehabilitation Medicine, Shanghai Pudong Hospital, Shanghai 201399, China
5. National Regional Medical Center/Huashan Hospital Affiliated to Fudan University (Fujian Branch) /the First Affiliated Hospital of Fujian Medical University (Binhai Branch), Fuzhou 350200, China

Received:2024-03-01 Revised:2024-04-12 Published:2024-08-15 Online:2024-05-08
Contact: JIA Jie

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摘要/Abstract

摘要： 背景腕关节运动功能障碍是脑卒中后常见遗留症，而腕关节在提高手部实用性方面具有重要作用。因此，提高患者的腕关节运动能力可以有效地促进其日常生活参与度，尽管重复外周磁刺激（rPMS）已被证明对改善该问题具有显著效果，但针对不同位点的治疗效果仍需深入探究。目的探索rPMS分别作用于伸腕肌、桡神经时对亚急性期脑卒中患者腕关节运动功能的影响。方法选取2022年10月—2023年10月在福建中医药大学附属康复医院住院治疗且存在腕关节运动功能障碍的亚急性期脑卒中患者60例作为研究对象。采用随机数字表法将患者分为对照组（20例）、肌肉刺激组（20例）和神经刺激组（20例），对照组接受常规的康复训练，肌肉刺激组和神经刺激组分别在对照组的治疗方案上增加rPMS，且分别作用于伸腕肌和桡神经上，于干预前、后（10次治疗）分别采集伸腕肌表面肌电的积分肌电值（iEMG）、均方根植（RMS）和中位频率（MF），Fugl-Meyer评定量表上肢部分（FMA-UE）、手臂动作调查测试（ARAT）、改良Barthel指数（MBI）进行患侧上肢功能评估。结果干预期间由于主动要求退出试验、被迫终止试验等原因导致数据丢失2例，最终纳入对照组20例、肌肉刺激组19例、神经刺激组19例。治疗前三组患者伸腕肌表面肌电的iEMG、RMS、MF比较，差异无统计学意义（P>0.05）。治疗后肌肉刺激组、神经刺激组患者伸腕肌表面肌电的iEMG、RMS、MF高于对照组（P<0.05）；神经刺激组患者伸腕肌表面肌电的iEMG、RMS、MF高于肌肉刺激组（P<0.05）。三组患者治疗后伸腕肌表面肌电的iEMG、RMS、MF均高于组内治疗前（P<0.05）。治疗前三组患者FMA-UE、ARAT、MBI评分比较，差异无统计学意义（P>0.05）；治疗后肌肉刺激组、神经刺激组患者FMA-UE、ARAT、MBI评分高于对照组（P<0.05）；神经刺激组患者FMA-UE、ARAT、MBI评分高于肌肉刺激组（P<0.05）。三组患者治疗后FMA-UE、ARAT、MBI评分均高于组内治疗前（P<0.05）。结论 rPMS分别作用于伸腕肌、桡神经，对脑卒中后腕关节运动功能障碍均有改善，且作用于桡神经较伸腕肌疗效更显著。

关键词: 卒中, 重复外周磁刺激, 伸腕肌, 桡神经, 腕关节运动功能障碍, 随机对照试验

Abstract:

Background

Wrist motor dysfunction is a common sequela at post-stroke, and the wrist has an important role in improving hand practicality. Therefore, improving the range of motion of the wrist can effectively promote the activities of daily life in post-stroke patients. Although repetitive peripheral magnetic stimulations (rPMS) have been shown to have a significant effect on improving the range of motion of the wrist, the therapeutic effect of different stimulation sites still needs to be further explored.

Objective

To investigate the effect of rPMS on wrist extensor muscle and radial nerve for the motor function of wrist of subacute stroke patients.

Methods

A total of 60 subacute stroke patients with wrist motor dysfunction admitted to Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine from October 2022 to October 2023 were selected as the study subjects. The included patients were randomly divided into control group (20 cases), muscle stimulation group (20 cases) and nerve stimulation group (20 cases) by simple randomized grouping method using a random number table. Patients in all the three groups received routine rehabilitation training, and those in the muscle stimulation group and nerve stimulation group were additionally managed by rPMS on the wrist extensor muscle and the radial nerve, respectively. Before and after the interventions for 10 times of rPMS, integrated electromyography (iEMG), root mean square (RMS) and median frequency (MF) on the surface of the wrist extensor muscle, the Fugl-Meyer Assessment for upper extremity (FMA-UE), the Action Research Arm Test (ARAT) and the modified Barthel Index (MBI) were measured to assess the upper limb function of the affected side.

Results

During the intervention period, there were 2 cases of data loss due to voluntary withdrawal or forced termination of the trial, and finally 20 cases were included in the control group, 19 cases in the muscle stimulation group, and 19 cases in the nerve stimulation group. There were no significant differences in iEMG, RMS and MF of wrist extensor muscle among three groups before treatment (P>0.05). After treatment, iEMG, RMS and MF of wrist extensor muscle in muscle stimulation group and nerve stimulation group were significantly higher than those of control group (P<0.05). The iEMG, RMS and MF of wrist extensor muscle in nerve stimulation group were significantly higher than those of muscle stimulation group (P<0.05). The iEMG, RMS and MF of the wrist extensor muscle after treatment were higher than those before treatment in the three groups (P<0.05). There were no significant differences in FMA-UE, ARAT and MBI scores among the three groups before treatment (P>0.05). After treatment, FMA-UE, ARAT and MBI scores in muscle stimulation group and nerve stimulation group were significantly higher than those of control group (P<0.05). The scores of FMA-UE, ARAT and MBI in nerve stimulation group were significantly higher than those in muscle stimulation group (P<0.05). The scores of FMA-UE, ARAT and MBI in three groups were significantly higher after treatment than before treatment (P<0.05) .

Conclusion

rPMS on the wrist extensor muscle and the radial nerve can improve the wrist motor dysfunction after stroke, and the effect on the radial nerve is more significant than that on the wrist extensor muscle.

Key words: Stroke, Repetitive peripheral magnetic stimulation, Wrist extensor muscle, Radial nerve, Wrist motor dysfunction, Randomized controlled trial

谢勇,林嘉莉,刘燕平,等. 重复外周磁刺激作用于上肢不同位置对亚急性期脑卒中患者腕关节运动功能的影响：一项随机对照试验[J]. 中国全科医学, 2024, 27(23): 2846-2852. DOI: 10.12114/j.issn.1007-9572.2024.0081.
XIE Yong,LIN Jiali,LIU Yanping, et al. Effect of Repeated Peripheral Magnetic Stimulations at Different Sites of Upper Limbs on Wrist Motor Function in Subacute Stroke Patients: a Randomized Controlled Trial[J]. Chinese General Practice, 2024, 27(23): 2846-2852. DOI: 10.12114/j.issn.1007-9572.2024.0081.

图/表 4

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组别	例数	性别（男/女）	年龄（±s，岁）	病程（±s，d）	瘫痪侧别（左/右）	脑卒中类型（脑梗死/脑出血）
对照组	20	14/6	64.0±9.9	30.25±13.47	10/10	11/9
肌肉刺激组	19	14/5	62.6±10.2	37.79±15.16	8/11	15/4
神经刺激组	19	15/4	61.6±8.3	33.05±14.19	5/14	16/3
F（χ²）值		0.470^a	0.397	1.380	2.360^a	4.770^a
P值		0.930	0.674	0.259	0.308	0.109

组别	例数	性别（男/女）	年龄（±s，岁）	病程（±s，d）	瘫痪侧别（左/右）	脑卒中类型（脑梗死/脑出血）
对照组	20	14/6	64.0±9.9	30.25±13.47	10/10	11/9
肌肉刺激组	19	14/5	62.6±10.2	37.79±15.16	8/11	15/4
神经刺激组	19	15/4	61.6±8.3	33.05±14.19	5/14	16/3
F（χ²）值		0.470^a	0.397	1.380	2.360^a	4.770^a
P值		0.930	0.674	0.259	0.308	0.109

组别	例数	iEMG				RMS				MF
组别	例数	治疗前	治疗后	t_配对值	P值	治疗前	治疗后	t_配对值	P值	治疗前	治疗后	t_配对值	P值
对照组	20	124.02±26.27	155.35±22.98	-10.690	<0.001	30.81±14.08	36.51±13.98	-7.786	<0.001	107.12±24.91	116.89±24.51	-6.588	<0.001
肌肉刺激组	19	123.33±30.08	175.43±32.70^a	-12.585	<0.001	24.38±13.89	47.13±14.02^a	-21.292	<0.001	105.19±20.06	133.86±23.92^a	-15.750	<0.001
神经刺激组	19	126.99±23.27	199.51±28.69^ab	-15.373	<0.001	28.72±14.32	57.53±17.44^ab	-21.699	<0.001	105.70±23.31	150.37±25.93^ab	-19.530	<0.001
F值		0.101	11.865			1.049	9.305			0.037	8.885
P值		0.904	<0.001			0.357	<0.001			0.963	<0.001

组别	例数	iEMG				RMS				MF
组别	例数	治疗前	治疗后	t_配对值	P值	治疗前	治疗后	t_配对值	P值	治疗前	治疗后	t_配对值	P值
对照组	20	124.02±26.27	155.35±22.98	-10.690	<0.001	30.81±14.08	36.51±13.98	-7.786	<0.001	107.12±24.91	116.89±24.51	-6.588	<0.001
肌肉刺激组	19	123.33±30.08	175.43±32.70^a	-12.585	<0.001	24.38±13.89	47.13±14.02^a	-21.292	<0.001	105.19±20.06	133.86±23.92^a	-15.750	<0.001
神经刺激组	19	126.99±23.27	199.51±28.69^ab	-15.373	<0.001	28.72±14.32	57.53±17.44^ab	-21.699	<0.001	105.70±23.31	150.37±25.93^ab	-19.530	<0.001
F值		0.101	11.865			1.049	9.305			0.037	8.885
P值		0.904	<0.001			0.357	<0.001			0.963	<0.001

组别	例数	FMA-UE评分				ARAT评分
组别	例数	治疗前	治疗后	t_配对值	P值	治疗前	治疗后	t_配对值	P值
对照组	20	32.05±13.03	38.40±12.61	-8.261	<0.001	22.45±8.04	28.70±8.28	-7.709	<0.001
肌肉刺激组	19	32.26±13.46	46.26±12.97^a	-12.544	<0.001	23.68±8.86	35.16±9.84^a	-10.495	<0.001
神经刺激组	19	34.10±10.72	54.47±8.55^ab	-15.662	<0.001	22.74±9.28	41.48±8.00^ab	-19.884	<0.001
F值		0.158	9.399			0.106	10.421
P值		0.854	<0.001			0.900	<0.001

重复外周磁刺激作用于上肢不同位置对亚急性期脑卒中患者腕关节运动功能的影响：一项随机对照试验

Effect of Repeated Peripheral Magnetic Stimulations at Different Sites of Upper Limbs on Wrist Motor Function in Subacute Stroke Patients: a Randomized Controlled Trial

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组别	例数	治疗前	治疗后	t_配对值	P值
对照组	20	50.60±18.57	56.80±17.96	-7.366	<0.001
肌肉刺激组	19	52.16±19.22	68.21±18.82^a	-11.393	<0.001
神经刺激组	19	54.21±17.03	79.58±14.24^ab	-21.272	<0.001
F值		0.190	8.608
P值		0.827	<0.001

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