CAJ | 학술논문

目的：观察重复经颅磁刺激（rTMS）联合康复训练治疗对促进脑瘫患儿运动功能发育与智力提高的作用。方法75例痉挛型脑瘫患儿随机分为治疗组38例和对照组37例，对照组采用康复训练治疗，治疗组在对照组基础上联合r T‐MS治疗，治疗前与治疗1、3个月末，采用Ashworth痉挛量表评定小腿三头肌痉挛情况，采用88项粗大运动功能量表（GM‐FM‐88）及FM EM量表分别进行粗大运动功能及精细运动功能评定；采用小儿神经心理发育检查量表（DQ ）评定小儿发育商。结果治疗组治疗后Ashworth痉挛评级较治疗前及对照组有所改善，但差异无统计学意义（P＞0.05）。GMFM‐88评分结果显示，治疗3个月后，治疗组A区卧位翻身、B区坐位、C区爬跪、D区站立得分均显著高于治疗前及对照组同期得分（P＜0.05）。FMEM量表评分结果显示，治疗组患儿FMEM 5个能区得分均较治疗前有所提高，尤其在B区上肢关节活动能力、C区抓握能力及D区操作能力得分显著高于治疗前及对照组同期（P＜0.05）。治疗组治疗后DQ评分显著高于对照组（P＜0.05）。结论 rTMS联合康复训练治疗对促进脑瘫患儿运动功能发育与智力提高具有显著效果，对改善患儿生活质量具有重大意义，且简单易行，易于推广。
목적：관찰중복경로자자격（rTMS）연합강복훈련치료대촉진뇌탄환인운동공능발육여지력제고적작용。방법75례경련형뇌탄환인수궤분위치료조38례화대조조37례，대조조채용강복훈련치료，치료조재대조조기출상연합r T‐MS치료，치료전여치료1、3개월말，채용Ashworth경련량표평정소퇴삼두기경련정황，채용88항조대운동공능량표（GM‐FM‐88）급FM EM량표분별진행조대운동공능급정세운동공능평정；채용소인신경심리발육검사량표（DQ ）평정소인발육상。결과치료조치료후Ashworth경련평급교치료전급대조조유소개선，단차이무통계학의의（P＞0.05）。GMFM‐88평분결과현시，치료3개월후，치료조A구와위번신、B구좌위、C구파궤、D구참립득분균현저고우치료전급대조조동기득분（P＜0.05）。FMEM량표평분결과현시，치료조환인FMEM 5개능구득분균교치료전유소제고，우기재B구상지관절활동능력、C구조악능력급D구조작능력득분현저고우치료전급대조조동기（P＜0.05）。치료조치료후DQ평분현저고우대조조（P＜0.05）。결론 rTMS연합강복훈련치료대촉진뇌탄환인운동공능발육여지력제고구유현저효과，대개선환인생활질량구유중대의의，차간단역행，역우추엄。
Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) combined with reha‐bilitation training on motor function of cerebral palsy.Methods Seventy‐five children with spastic cerebral palsy were randomly divided into treatment group of 38 cases and control group of 37 cases. The control group received rehabilitation training ,and treatment group was given rTMS treatment based on the control group.Before treatment and 1st ,3rd month after treatment , Ashworth spasm scale was used to assess the spasm of triceps muscle;GMFM‐88 and FMEM scale were used to assess the gross motor function and fine motor function;children neuropsychological development checklist (DQ) was used to assess the children developmental quotient.Results The Ashworth spasm scale in treatment group was improved after treatment than be‐fore treatment and control group ,but the difference was not statistically significant (P>0.05).GMFM‐88 score showed that , after 3 months of treatment ,the scores of A supine stand area ,sitting area B ,C zone climb kneeling ,D district stood in treat‐ment group were significantly higher than those before treatment and the same period of control group (P<0.05).FMEM scale scores showed that the scores of 5 energy regions of FMEM in treatment group improved than those of before treatment ,espe‐cially the scores of upper limb joint activity in B area ,the grasping ability in C area and operation ability in D area were signifi‐cantly higher than those of before treatment and the control group (P<0.05). After treatment ,DQ score of treatment group was significantly higher than that of control group(P<0.05).Conclusion rTMS combined with rehabilitation training has a significant effect on motor function and intellectual development in cerebral palsy ,and can improve the life quality of children. It is simple and easy to promote.