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目的 探讨重复经颅磁刺激(rTMS)联合康复训练对运动发育迟缓患儿的影响.方法 将60例运动发育迟缓患儿按随机数字表法分为治疗组和对照组,每组30例,对照组采用康复训练治疗,治疗组采用rTMS联合康复训练治疗,均治疗3个疗程.治疗前后进行Gesell发育量表、粗大运动功能评定(GMFM)量表评定.结果 两组患儿均未出现头疼、头晕及异常病理反应.对照组和治疗组治疗后Gesell发育量表动作能发育商评分较治疗前明显提高[(64.37±16.37)分比(62.37±14.21)分和(74.50±13.32)分比(61.90±13.76)分],而且治疗组明显高于对照组,差异有统计学意义(P<0.05);对照组治疗后言语能发育商评分与治疗前比较差异无统计学意义[(79.57±5.93)分比(79.07±5.75)分,P>0.05],治疗组治疗后言语能发育商评分较治疗前明显提高[(80.70±5.38)分比(78.57±5.72)分],差异有统计学意义(P<0.05).对照组和治疗组治疗后GMFM量表A区、B区、C区和D区评分均较治疗前明显提高[对照组:(76.43±19.18)%比(75.40±19.38)%、(50.53±27.63)%比(49.60±28.22)%、(31.07±24.93)%比(28.40±23.70)%和(1.60±1.33)%比(0.89±0.37)%;治疗组:(85.80±13.73)%比(79.13±16.87)%、(65.77±26.27)%比(49.37±29.67)%、(49.60±28.22)%比(28.83±23.19)%和(2.10±1.60)%比(1.07±0.43)%],差异有统计学意义(P<0.05);治疗组治疗后A区、B区和C区评分明显高于对照组,差异有统计学意义(P<0.05),而两组治疗后D区评分比较差异无统计学意义(P>0.05).结论 rTMS联合康复训练比单独康复训练对运动发育迟缓患儿的粗大运动改善更佳,rTMS除了能提高患儿运动功能,对患儿语言能力也有改善作用.

Objective To observe the effects of repetitive transcranial magnetic stimulation (rTMS) combined with rehabilitation training on motor cortex in children with motor retardation. Methods Sixty children with motor retardation were divided into treatment group and control group by random digits table method with 30 cases each. The children in control group were treated with rehabilitation training, and the children in treatment group were treated with rTMS combined with rehabilitation training. Two groups were treated for 3 courses. The Gesell pediatric neuropsychological scale and gross motor function measure (GMFM) scale before and after treatment were evaluated. Results There was no headache, dizziness and abnormal pathological reaction in the 2 groups. The motor behavior development quotient scores of Gesell pediatric neuropsychological scale after treatment in control group and treatment group were significantly higher than those before treatment: (64.37 ± 16.37) scores vs. (62.37 ± 14.21) scores and (74.50 ± 13.32) scores vs. (61.90 ± 13.76) scores, but the score in treatment was significantly higher than that in control group, and there were statistical differences (P<0.05). There was no statistical difference in language behavior development quotient score between after treatment and before treatment in control group: (79.57 ± 5.93) scores vs. (79.07 ± 5.75) scores, P>0.05. The language behavior development quotient after treatment in treatment group was significantly higher than that before treatment:(80.70 ± 5.38) scores vs. (78.57 ± 5.72) scores, and there was statistical difference (P<0.05). The A, B, C and D area scores of GMFM scale after treatment in control group and treatment group were significantly higher than before treatment, which in control group were (76.43 ± 19.18)% vs. (75.40 ± 19.38)%, (50.53 ± 27.63)%vs. (49.60 ± 28.22)%, (31.07 ± 24.93)%vs. (28.40 ± 23.70)%and (1.60 ± 1.33)%vs. (0.89 ± 0.37)%, and in treatment group were (85.80 ± 13.73)%vs. (79.13 ± 16.87)%, (65.77 ± 26.27)%vs. (49.37 ± 29.67)%, (49.60 ± 28.22)%vs. (28.83 ± 23.19)%and (2.10 ± 1.60)%vs. (1.07 ± 0.43)%, and there were statistical differences (P<0.05); the A, B and C area scores after treatment in treatment group were significantly higher than those in control group, and there were statistical differences (P<0.05); but there was no statistical difference in D area score after treatment between 2 groups (P>0.05). Conclusions The rTMS combined with rehabilitation training is better in gross movement than the single rehabilitation training for children with motor retardation. The rTMS can improve the motor function and language ability of children.