目的:观察针刺配合低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对脑卒中后肩关节疼痛治疗的影响.方法:采用随机数字表法将脑卒中后肩关节疼痛患者分为联合组、rTMS组以及针刺组(n=20).针刺组给予针刺配合常规康复治疗,rTMS组给予常规康复和rTMS刺激治疗,联合组在针刺组治疗的基础上辅以rTMS刺激治疗,rTMS刺激部位为健侧半球的M1区(大脑运动皮质的上肢运动功能代表区),刺激频率为1.0 Hz.于治疗前、治疗4周后采用简易Fugl-Meyer运动功能量表(Fugl-Meyer Assessment,FMA)(上肢部分)、视觉类比评分法(VisualAnalogue Scale,VAS)评定患者上肢运动功能和疼痛情况.结果:rTMS刺激组治疗前后FMA和VAS评分分别为4.55±0.83,7.90±0.79和6.90±0.91,4.45±0.51;针刺组治疗前后FMA和VAS评分分别为4.50±0.76,11.60±1.27和6.80±0.95,3.20±0.52;联合组治疗前后FMA和VAS评分分别为4.70±0.80,18.0±1.45和6.85±0.99,1.75±0.45.3组治疗后FMA评分均有提高,VAS评分均有降低,差异均具有统计学意义(P<0.05);组间对比发现,治疗后,联合组及针刺组FMA,VAS评分均优于rTMS刺激组,联合组FMA,VAS评分优于针刺组,组间差异具均有统计学意义(P<0.05).结论:针刺配合1 Hz的rTMS可显著减轻脑卒中后肩关节疼痛.%Objective: To investigate the effects of the low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with acupuncture in the treatment of shoulder joint pain on patients after stroke. Methods: Sixty patients suffering from shoulder joint pain were selected to conduct the research and were randomly divided into three groups, an acupuncture group, a rTMS group and a combined therapy group, patients from the acupuncture group were given acupuncture with conventional rehabilitation. Specifically, the rTMS group in the contralateral hemisphere upper limb motor area were given 1 Hz rTMS, where M1 area (upper extremity motor function of cerebral motor cortex) of contralateral hemisphere is simulated, the combined therapy group were given 1 Hz rTMS on the basis of the treatment. The scores of simple Fugl-Meyer Assessment (FMA) and Visual Analogue Scale (VAS) before the treatment, 4 weeks after the treatment were used to evaluate the upper limb movement function recovery. Results: The upper limb FMA score and VAS score in the rTMS group were 4.55±0.83,7.90±0.79 and 6.90±0.91, 4.45±0.51 respectively; in the acupuncture group patients the scores were 4.50±0.76,11.60±1.27 and 6.80±0.95, 3.20±0.52 respectively; and in the combined therapy group were 4.70±0.80, 18.0±1.45 and 6.85±0.99, 1.75±0.45 respectively; the FMA scores of the groups increased after treatment, meanwhile the scores of VAS reduced, and the difference was statistically significant. Comparison between groups, the scores of FMA and VAS of the combined group and the acupuncture group were superior to the group of rTMS, and the scores of combined groups were superior to the groups of acupuncture, and the difference was statistically significant. Conclusion: Acupuncture with 1 Hz transcranial magnetic stimulation can significantly reduce the shoulder joint pain after stroke.
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