1.徐州医科大学第二附属医院康复医学科，江苏 徐州 221000;2.徐州医科大学附属徐州康复医院，江苏 徐州 221006
周梦（1992—），女，江苏徐州人，本科，中级治疗师，研究方向为脑神经损伤康复，Email：1525310047@qq.com。
陈伟，女，医学硕士，主任医师，Email： chenwei2339@163.com。
1.Department of Rehabilitation Medicine， Second Affiliated Hospital of Xuzhou Medical University， Xuzhou， Jiangsu 221000， China;2.Xuzhou Rehabilitation Hospital of Xuzhou Medical University， Xuzhou， Jiangsu 221006， China
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目的 探讨神经松动术联合经颅磁刺激治疗脑梗死后偏瘫肩痛的效果及对神经营养因子、细胞因子水平的影响。方法 选取2019年2月—2021年3月徐州医科大学第二附属医院脑梗死后偏瘫肩痛患者114例，以随机数字表法分为观察组、对照组，各57例。对照组采取神经松动术，观察组采取神经松动术联合经颅磁刺激，均治疗2周。酶联免疫吸附法测定血清脑源性神经营养因子（BDNF）、促生长因子-1（IGF-1）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、一氧化氮（NO）水平。结果 观察组治疗2周后总有效率为94.74%，高于对照组的75.44%（P＜0.05）；观察组治疗1和2周后视觉模拟评分量表（VAS）评分均较对照组低，Fugl-Meyer运动功能评定量表（FMA）-上肢部分、日常生活活动能力量表（Barthel指数，BI）评分均较对照组高（P＜0.05）；观察组治疗1周、2周后肩关节外旋、内旋、外展、后伸、前屈活动度均较对照组高（P＜0.05）；观察组治疗1周、2周后血清BDNF、IGF-1水平均高于对照组，TNF-α、IL-6、NO水平均低于对照组（P＜0.05）。结论 应用神经松动术联合经颅磁刺激治疗脑梗死后偏瘫肩痛患者可降低疼痛程度，提升肩关节活动度、上肢功能、日常生活能力，调节血清神经营养因子、细胞因子表达，提升疗效。国际神经病学神经外科学杂志, 2022, 49(6): 54-58]
Objective To investigate the clinical effect of nerve mobilization combined with transcranial magnetic stimulation in the treatment of hemiplegic shoulder pain after cerebral infarction and its effect on the levels of neurotrophic factors and cytokines.Methods A total of 114 patients with hemiplegic shoulder pain after cerebral infarction who were treated in The Second Affiliated Hospital of Xuzhou Medical University from February 2019 to March 2021 were enrolled and divided into observation group and control group using a random number table， with 57 patients in each group. The patients in the control group received nerve mobilization， while those in the observation group received nerve mobilization combined with transcranial magnetic stimulation； the course of treatment was 2 weeks for both groups. ELISA was used to measure the serum levels of brain-derived neurotrophic factor （BDNF）， insulin-like growth factor-1 （IGF-1）， tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and nitric oxide （NO）.Results After 2 weeks of treatment， the observation group had a significantly higher overall response rate than the control group （94.74% vs 75.44%， P <0.05）. After 1 and 2 weeks of treatment， compared with the control group， the observation group had a significantly lower Visual Analogue Scale score and significantly higher scores of Fugl-Meyer Assessment-upper extremities and Activities of Daily Living （Barthel Index） （P <0.05）， a significantly greater range of motion in shoulder joint extorsion， intorsion， abduction， extension， and flexion （P <0.05）， and significantly higher serum levels of BDNF and IGF-1 and significantly lower levels of TNF-α， IL-6， and NO （P <0.05）.Conclusions In the treatment of hemiplegic shoulder pain after cerebral infarction， the application of nerve mobilization combined with transcranial magnetic stimulation can reduce the degree of pain， improve the range of motion of shoulder joint， the function of upper extremities， and the activities of daily living， and regulate the expression of serum neurotrophic factors and cytokines， thereby improving the treatment outcome of patients. ［Journal of International Neurology and Neurosurgery, 2022, 49(6): 54-58］
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周梦,王帅,张明,陈伟456.神经松动术联合经颅磁刺激治疗脑梗死后偏瘫肩痛的研究[J].国际神经病学神经外科学杂志,2022,49(6):54-58111ZHOU Meng, WANG Shuai, ZHANG Ming, CHEN Wei222. Clinical effect of nerve mobilization combined with transcranial magnetic stimulation in treatment of hemiplegic shoulder pain after cerebral infarction[J]. Journal of International Neurology and Neurosurgery,2022,49(6):54-58
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- 收稿日期:2021-09-18
- 最后修改日期:2022-08-16
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- 在线发布日期: 2023-02-01
