摘要目的:探讨重复经颅磁刺激联合强制性诱导疗法对偏瘫型脑瘫患儿上肢功能的影响。方法:纳入符合条件的2～3岁偏瘫型脑瘫患儿60例，采用随机数字表法分为对照组和观察组，每组30例，2组患儿均行常规康复治疗，对照组辅以强制性诱导疗法，用限制性手托在患儿清醒状态下对健侧上肢持续固定3 h，期间对患侧手进行一对一强化训练，每次30 min，每日1次，每周5次，连续4周；观察组在强制性诱导疗法的基础上对患儿健侧大脑皮质运动区给予1.0 Hz的低频重复经颅磁刺激治疗，每次20 min，每日1次，每周5次，连续4周。分别于治疗前及治疗4周后(治疗后)，用Peabody精细发育量表(PDMS-2 FM)和Carroll上肢功能测试量表(UEFT)对患儿手的抓握、对捏和整个上肢功能进行评估。结果:治疗后，2组患儿的PDMS-2 FM评分[对照组(72.23±8.55)分、观察组(77.41±9.44)分]和UEFT评分[对照组(24.67±5.14)分、观察组(29.78±6.28)分]均较组内治疗前[对照组(65.57±9.14)和(13.22±5.21)分；观察组(65.62±9.16)和(13.06±6.09)分]有显著提高( P<0.01)，且观察组的PDMS-2 FM和UEFT评分较对照组提高更为明显，组间差异均有统计学意义( P<0.05)。 结论:重复经颅磁刺激联合强制性诱导疗法能有效改善偏瘫型脑瘫患儿的上肢运动功能，促进精细运动发育。

abstractsObjective:To explore the effect of combining repetitive transcranial magnetic stimulation (rTMS) with constraint-induced movement therapy (CIMT) in rehabilitating the upper limb functioning of children with hemiplegic cerebral palsy.Methods:Sixty children with hemiplegic cerebral palsy were recruited and randomly divided into a control group ( n=30) and an experimental group ( n=30). Both groups were given conventional rehabilitation therapy and intensive one-to-one CIMT of the affected hand for 30 minutes 5 times a week for 4 successive weeks. The healthy hand was immobilized in a hand cushion for 3 hours. The experimental group was additionally provided with 20 minutes of rTMS at 1.0Hz, 5 times a week for the same 4 weeks. Before and after the treatment, both groups were evaluated using the Peabody Developmental Motor Scales (PDMS-2 FM) and an upper extremities function test (UEFT). Results:After 4 weeks of treatment there was significant improvement in both groups with regard to the average PDMS-2 FM and UEFT scores. The improvement in the experimental group was significantly better.Conclusions:rTMS combined with CIMT can effectively improve upper limb motor function and promote the fine motor development of children with hemiplegic cerebral palsy.