《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (5): 577-587.doi: 10.3969/j.issn.1006-9771.2026.05.008

• 应用研究 • 上一篇    下一篇

小脑间歇性θ脉冲刺激对脑卒中患者姿势控制和跌倒风险的效果

李欣源1, 郑洁皎1,2(), 吴雪娇3, 段林茹2, 高羽飞1   

  1. 1 上海中医药大学康复医学院, 上海市 201203
    2 复旦大学附属华东医院, 上海市 200040
    3 上海市第一康复医院, 上海市 200082
  • 收稿日期:2025-10-28 修回日期:2026-02-27 出版日期:2026-05-25 发布日期:2026-05-26
  • 通讯作者: 郑洁皎,E-mail:zjjcss@163.com
  • 作者简介:李欣源(2000-),女,汉族,云南陆良县人,硕士研究生,主要研究方向:老年康复、神经康复。
    郑洁皎(1953-),女,汉族,上海市人,主任医师、教授,主要研究方向:老年康复、康复管理。
  • 基金资助:
    上海市科委"科技创新行动计划"医学创新研究专项重大疑难疾病诊疗方案(策略)临床研究项目(22Y31900200)

Effect of cerebellar intermittent theta-burst stimulation on postural control and fall risk in patients with stroke

LI Xinyuan1, ZHENG Jiejiao1,2(), WU Xuejiao3, DUAN Linru2, GAO Yufei1   

  1. 1 School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
    2 Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
    3 The First Rehabilitation Hospital in Shanghai, Shanghai 200082, China
  • Received:2025-10-28 Revised:2026-02-27 Published:2026-05-25 Online:2026-05-26
  • Contact: ZHENG Jiejiao, E-mail: zjjcss@163.com
  • Supported by:
    Shanghai Science and Technology Commission Science and Technology Innovation Action Plan Clinical Research on Diagnosis and Treatment Plan (Strategy) for Major Difficult Diseases(22Y31900200)

摘要:

目的 探讨间歇性θ脉冲刺激(iTBS)作用于小脑对脑卒中患者姿势控制和跌倒风险的疗效。
方法 2024年10月至2025年8月,在复旦大学附属华东医院招募脑卒中患者45例,随机分为对照组、A组和B组,每组15例。3组均接受常规药物治疗和康复,A组加用病灶侧初级运动皮质(M1) iTBS,B组加用病灶对侧小脑iTBS,共3周。干预前后,采用Biodex Balance System平衡测试仪测量各组睁/闭眼姿势稳定指数、稳定极限范围、方向控制分数和反应时,采用Berg平衡量表(BBS)、计时-起立行走测试(TUGT)和10米步行测试(10MWT)进行评定。
结果 干预后,睁/闭眼姿势稳定指数、稳定极限范围、方向控制分数、反应时、BBS评分、TUGT和10MWT的组内-组间交互效应均显著(F>23.487, P <0.001),3组干预后均明显优于干预前(P <0.01)。睁眼/闭眼姿势稳定指数、稳定极限范围、方向控制分数和反应时均为B组最优,A组次之,对照组最差(P <0.05);BBS、TUGT和10MWT均为A/B组优于对照组(P <0.05)。
结论 小脑iTBS可有效改善脑卒中患者姿势控制障碍,降低跌倒风险,可能优于M1 iTBS。

关键词: 脑卒中, 间歇性θ脉冲刺激, 小脑, 初级运动皮质, 平衡, 姿势控制, 跌倒

Abstract:

Objective To investigate the effect of cerebellar intermittent theta-burst stimulation (iTBS) on postural control and fall risk in stroke patients.
Methods From October, 2024 to August, 2025, 45 stroke patients were recruited from Huadong Hospital Affiliated to Fudan University. They were randomly divided into control group (n=15), group A (n=15) and group B (n=15). All the groups received conventional medication and rehabilitation. Group A was additionally administered iTBS over the ipsilesional primary motor cortex (M1), while group B received iTBS over the contralesional cerebellum, for three weeks. Before and after intervention, postural stability indexes (eyes open/closed), limits of stability, directional control score and reaction time were measured using Biodex Balance System, and they were assessed with Berg Balance Scale (BBS), Timed Up & Go Test (TUGT) and 10-meter walk test (10MWT).
Results After intervention, significant group-time interaction effects were observed for eyes open/closed postural stability indexes, limits of stability, directional control score, reaction time, BBS score, TUGT and 10MWT (F>23.487, P<0.001). All the groups improved in all the indexes after intervention (P<0.01). The eyes open/closed postural stability indexes, limits of stability, directional control score and reaction time were the best in group B, followed by group A, and the worst in the control group (P<0.05), while BBS, TUGT and 10MWT were better in groups A and B than in the control group (P<0.05).
Conclusion Cerebellar iTBS can effectively improve postural control disorders and reduce fall risk in stroke patients, and may be superior to M1 iTBS.

Key words: stroke, intermittent theta-burst stimulation, cerebellum, primary motor cortex, balance, postural control, fall

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