《中国康复理论与实践》

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (10): 1203-1214.doi: 10.3969/j.issn.1006-9771.2024.10.011

• 应用研究 • 上一篇    下一篇

镜像疗法对脑卒中后I型复杂区域性疼痛综合征患者上肢功能及大脑皮质活动效果的随机对照试验

文翠凤1,2, 娅茹1, 黄昊1, 廖雪梅1, 白玉龙3()   

  1. 1.上海中医药大学附属第三康复医院重症康复科，上海市 200436
    2.同济大学医学院，上海市 200065
    3.复旦大学附属华山医院康复医学科，上海市 200040
  • 收稿日期:2024-05-08 修回日期:2024-09-06 出版日期:2024-10-25 发布日期:2024-11-08
  • 通讯作者: 白玉龙(1966-)，男，博士，主任医师，博士研究生导师，主要研究方向：神经损伤和运动伤病的康复。E-mail： dr_baiyl@fudan.edu.cn
  • 作者简介:文翠凤(1985-)，女，汉族，上海市人，硕士研究生，主治医师，主要研究方向：神经康复。
  • 基金资助:
    上海市静安区医学科研项目(2017QT04);上海市静安区医学科研项目(2021MS18);静安区卫生系统重点学科建设项目(2021PY04)

Effect of mirror therapy on upper limb function and cerebral cortex activity in patients with type I complex regional pain syndrome after stroke: a randomized controlled trial

WEN Cuifeng1,2, YA Ru1, HUANG Hao1, LIAO Xuemei1, BAI Yulong3()   

  1. 1. Department of Critical Rehabilitation, the Third Rehabilitation Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200436, China
    2. Tongji University School of Medicine, Shanghai 200065, China
    3. Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:2024-05-08 Revised:2024-09-06 Published:2024-10-25 Online:2024-11-08
  • Contact: BAI Yulong, E-mail： dr_baiyl@fudan.edu.cn
  • Supported by:
    Medical Research Project of Jing'an District in Shanghai(2017QT04);Medical Research Project of Jing'an District in Shanghai(2021MS18);Key Discipline Construction Project of Jing'an District Health System(2021PY04)

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摘要：

目的 探讨镜像疗法对脑卒中后I型复杂区域性疼痛综合征(CRPS)上肢功能及大脑皮质活动的影响。

方法 2017年10月至2022年2月，在上海中医药大学附属第三康复医院招募脑卒中后I型CRPS患者72例，随机分为对照组(n = 36)和镜像组(n = 36)。对照组给予常规康复训练，镜像组在对照组基础上给予镜像疗法，共6周。治疗前、治疗3周后、治疗6周后分别对患者进行疼痛视觉模拟量表(VAS)、改良Barthel指数(MBI)、水肿容积和Brunnstrom分期评定。采用NirSmart 32通道功能性近红外光谱(fNIRS)采集静息态440 s。

结果 治疗后，两组VAS评分均明显改善，且治疗6周后明显优于治疗3周后(P < 0.01)；治疗6周后镜像组优于对照组(P < 0.05)。两组MBI评分均显著改善，且治疗6周后显著优于治疗3周后(P < 0.001)。两组水肿均显著改善(Z > 30.113, P < 0.001)，且治疗6周后镜像组明显优于对照组(Z = -3.347, P = 0.001)；镜像组患者的水肿容积在治疗3周后、6周后均明显减少(Z < -0.667, P < 0.01)，且治疗6周后效果更优(Z = -0.667, P = 0.005)。两组Brunnstrom分期均显著改善(Z > 29.714, P < 0.001)，治疗6周后镜像组优于对照组(Z = -2.046, P = 0.041)。治疗后对照组右侧M1与右侧初级体感皮质连接强度较强，镜像组左侧M1与右侧M1、右侧初级体感皮质、右侧皮质运动前区和辅助运动区连接强度较强。镜像组左右侧初级体感皮质、左侧皮质运动前区和辅助运动区与右侧M1区、右侧皮质运动前区和辅助运动区与左侧初级体感皮质、左侧M1区与左侧初级体感皮质、左侧初级体感皮质与右侧M1区的连接强度强于对照组(∣t∣ > 3.402, P < 0.01)。

结论 镜像疗法有助于改善脑卒中后I型CRPS患者患手的疼痛、水肿和上肢运动功能。镜像疗法可加强健侧感觉区与患侧感觉运动区的连接，促进感觉运动皮质重组。

关键词: 脑卒中, 复杂区域性疼痛综合征, 镜像疗法, 上肢, 大脑皮质, 随机对照试验

Abstract:

Objective To investigate the effect of mirror therapy on upper limb function and cortical activity in patients with type I complex regional pain syndrome (CRPS) after stroke.

Methods A total of 72 post-stroke patients with type I CRPS were recruited at the Third Rehabilitation Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from October, 2017 to February, 2022. They were randomly divided into control group (n = 36) and mirror therapy group (n = 36). The control group received conventional rehabilitation training, while the mirror therapy group received mirror therapy in addition. Before treatment, as well as at three and six weeks after treatment, they were evaluated using the Visual Analog Scale (VAS) for pain, modified Barthel Index (MBI), edema volume and Brunnstrom stage. Resting-state data were collected for 440 seconds using a 32-channel functional near-infrared spectroscopy (fNIRS) system.

Results After treatment, VAS scores significantly improved in each group, showing better after six weeks than after three weeks (P < 0.01). The mirror therapy group was better than the control group after six weeks (P < 0.05). MBI scores also significantly improved in each group, showing better after six weeks than after three weeks (P < 0.001). Edema volume significantly decreased in each group (Z > 30.113, P < 0.001), while the mirror therapy group was better than the control group after six weeks (Z = -3.347, P = 0.001). Edema volume in the mirror therapy group significantly reduced at both three and six weeks (Z < -0.667, P < 0.01), with a stronger effect observed after six weeks (Z = -0.667, P = 0.005). Brunnstrom stages improved significantly in each group (Z > 29.714, P < 0.001), while the mirror therapy group was better than the control group after six weeks (Z = -2.046, P = 0.041). After treatment, the control group showed strong connectivity between right M1 and right primary somatosensory cortex, while the mirror therapy group demonstrated stronger connectivity between left M1 and right M1, right primary somatosensory cortex, right pre-motor and supplementary motor cortex. Connectivity between left and right primary somatosensory cortex increased in mirror therapy group, as well as the connectivity between left pre-motor-supplementary motor cortex and right M1, right pre-motor-supplementary motor cortex and left primary somatosensory cortex, left M1 and left primary somatosensory cortex, and left primary somatosensory cortex and right M1 (∣t∣ > 3.402, P < 0.01).

Conclusion Mirror therapy may relieve pain and edema, and improve upper limb motor function in post-stroke patients with type I CRPS, which may associate with stonger connectivity between sensory regions on the unaffected side and sensory-motor regions on the affected side, promoting sensorimotor cortical reorganization.

Key words: stroke, complex regional pain syndrome, mirror therapy, upper limb, cerebral cortex, randomized controlled trial

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