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

doi:10.3969/j.issn.1006-9771.2026.05.008

《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

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 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 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/Abstract

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

中图分类号:

R743.3

李欣源, 郑洁皎, 吴雪娇, 段林茹, 高羽飞. 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[J]. 《中国康复理论与实践》, 2026, 32(5): 577-587.

LI Xinyuan, ZHENG Jiejiao, WU Xuejiao, DUAN Linru, GAO Yufei. Effect of cerebellar intermittent theta-burst stimulation on postural control and fall risk in patients with stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(5): 577-587.

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组别	n	性别(男/女)/n	年龄/岁	病程/月	卒中类型(缺血/出血)/n	偏瘫侧(右/左)/n
对照组	15	11/4	67.00±4.19	2(1,4)	12/3	8/7
A组	15	13/2	65.93±10.71	3(1,4)	10/5	9/6
B组	15	12/3	64.07±10.74	2(1,4)	13/2	9/6
χ²/F/H值		0.890	0.489	0.385	1.721	0.182
P值		0.894	0.614	0.825	0.550	0.913

变量	组别	n	干预前		干预后
变量	组别	n	均值	标准差	均值	标准差
OSI	对照组	15	1.70	0.29	1.53	0.34
	A组	15	1.77	0.27	1.24	0.23
	B组	15	1.76	0.39	0.95	0.26
APSI	对照组	15	1.37	0.30	1.21	0.32
	A组	15	1.35	0.24	0.94	0.23
	B组	15	1.39	0.35	0.73	0.17
MLSI	对照组	15	1.28	0.21	1.13	0.25
	A组	15	1.30	0.24	0.90	0.24
	B组	15	1.27	0.29	0.69	0.18

变量	效应	平方和	自由度	均方	F值	η²_P	P值
OSI	组内	5.670	1	5.670	318.766	0.884	<0.001
	组间	1.046	2	0.523	3.242	0.134	0.049
	组内×组间	1.511	2	0.755	42.473	0.669	<0.001
APSI	组内	3.588	1	3.588	176.488	0.808	<0.001
	组间	0.811	2	0.406	3.180	0.131	0.052
	组内×组间	0.955	2	0.477	23.487	0.528	<0.001
MLSI	组内	3.249	1	3.249	349.249	0.893	<0.001
	组间	0.782	2	0.391	3.969	0.159	0.026
	组内×组间	0.680	2	0.340	36.532	0.635	<0.001

变量	组别	干预前后平均差值	干预前后平均差值标准差	P值	95%CI
变量	组别	干预前后平均差值	干预前后平均差值标准差	P值	下限	上限
OSI	对照组	-0.176	0.093	0.001	-0.274	-0.078
	A组	-0.520	0.162	<0.001	-0.618	-0.422
	B组	-0.810	0.268	<0.001	-0.908	-0.712
APSI	对照组	-0.155	0.100	0.005	-0.260	-0.050
	A组	-0.385	0.122	<0.001	-0.490	-0.280
	B组	-0.659	0.312	<0.001	-0.764	-0.554
MLSI	对照组	-0.157	0.097	<0.001	-0.228	-0.086
	A组	-0.403	0.137	<0.001	-0.474	-0.332
	B组	-0.581	0.166	<0.001	-0.652	-0.510

变量	组别		平均值差	P值	95%CI
变量	组别		平均值差	P值	下限	上限
OSI	B组	A组	-0.297	0.021	-0.533	-0.033
	B组	对照组	-0.580	<0.001	-0.830	-0.330
	A组	对照组	-0.283	0.015	-0.547	-0.047
APSI	B组	A组	-0.239	0.029	-0.453	-0.019
	B组	对照组	-0.484	<0.001	-0.703	-0.265
	A组	对照组	-0.245	0.024	-0.465	-0.026
MLSI	B组	A组	-0.213	0.037	-0.415	-0.010
	B组	对照组	-0.440	<0.001	-0.642	-0.238
	A组	对照组	-0.227	0.023	-0.430	-0.025

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

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

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变量	效应	平方和	自由度	均方	F值	η²_P	P值
OSI	组内	5.903	1	5.903	240.365	0.851	<0.001
	组间	1.384	2	0.692	3.890	0.156	0.028
	组内×组间	1.521	2	0.761	30.966	0.596	<0.001
APSI	组内	4.024	1	4.024	278.717	0.869	<0.001
	组间	0.821	2	0.411	2.912	0.122	0.065
	组内×组间	0.969	2	0.485	33.567	0.615	<0.001
MLSI	组内	3.234	1	3.234	826.009	0.958	<0.001
	组间	0.735	2	0.368	2.858	0.137	0.070
	组内×组间	1.037	2	0.519	131.783	0.880	<0.001

变量	效应	平方和	自由度	均方	F值	η²_P	P值
稳定极限范围	组内	1438.782	1	1438.782	240.482	0.870	<0.001
	组间	518.487	2	259.244	2.922	0.140	0.067
	组内×组间	410.333	2	205.167	34.292	0.656	<0.001
方向控制分数	组内	667.785	1	667.785	521.232	0.934	<0.001
	组间	362.474	2	181.237	3.668	0.165	0.035
	组内×组间	229.639	2	114.819	89.621	0.829	<0.001
反应时	组内	1236.825	1	1236.825	826.009	0.958	<0.001
	组间	334.527	2	167.264	2.858	0.137	0.070
	组内×组间	394.650	2	197.325	131.783	0.880	<0.001

变量	效应	平方和	自由度	均方	F值	η²_P	P值
BBS	组内	877.344	1	877.344	964.620	0.958	<0.001
	组间	323.089	2	161.544	2.431	0.104	0.100
	组内×组间	290.956	2	159.949	159.949	0.884	<0.001
TUGT	组内	386.801	1	386.801	353.913	0.894	<0.001
	组间	249.949	2	124.974	2.518	0.107	0.093
	组内×组间	99.483	2	49.741	45.512	0.684	<0.001
10MWT	组内	496.038	1	496.038	237.637	0.850	<0.001
	组间	217.971	2	108.985	2.050	0.089	0.141
	组内×组间	145.453	2	72.727	34.841	0.624	<0.001

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变量	组别	n	干预前		干预后
变量	组别	n	均值	标准差	均值	标准差
稳定极限范围/%	对照组	15	52.77	7.89	55.85	6.70
	A组	15	53.54	7.14	61.92	4.72
	B组	15	53.46	8.46	67.77	5.31
方向控制分数/%	对照组	15	32.37	4.79	34.39	4.56
	A组	15	33.68	4.49	38.81	3.27
	B组	15	33.45	6.91	43.65	5.51
反应时/s	对照组	15	57.38	7.05	54.38	6.44
	A组	15	56.08	4.92	49.08	5.09
	B组	15	57.85	5.15	43.95	3.50

变量	组别	干预前后平均差值	干预前后平均差值标准差	P值	95%CI
变量	组别	干预前后平均差值	干预前后平均差值标准差	P值	下限	上限
稳定极限范围	对照组	3.077	1.321	0.003	1.131	5.023
	A组	8.385	3.820	<0.001	6.439	10.330
	B组	14.308	4.423	<0.001	12.362	16.253
方向控制分数	对照组	2.007	0.725	<0.001	1.140	2.874
	A组	5.131	1.740	<0.001	4.231	6.030
	B组	10.208	2.074	<0.001	9.308	11.107
反应时	对照组	-3.000	1.154	<0.001	-3.973	-2.027
	A组	-7.000	1.154	<0.001	-7.973	-6.027
	B组	-13.892	2.523	<0.001	-14.866	-12.919

变量	组别	n	干预前		干预后
变量	组别	n	均值	标准差	均值	标准差
BBS	对照组	15	33.67	4.04	35.67	4.47
	A组	15	34.07	7.15	40.87	6.23
	B组	15	34.13	5.99	44.67	5.83
TUGT/s	对照组	15	30.56	5.11	29.19	5.06
	A组	15	29.14	4.61	24.52	4.04
	B组	15	29.22	5.98	22.77	5.19
10MWT/s	对照组	15	25.29	5.52	23.94	5.93
	A组	15	24.76	5.69	19.56	4.13
	B组	15	24.62	5.95	17.11	3.92

变量	组别	干预前后平均差值	干预前后平均差值标准差	P值	95%CI
变量	组别	干预前后平均差值	干预前后平均差值标准差	P值	下限	上限
BBS	对照组	2.000	0.655	<0.001	1.031	2.436
	A组	6.800	1.698	<0.001	5.764	7.169
	B组	10.533	1.187	<0.001	9.831	11.236
TUGT	对照组	-1.369	1.243	0.001	-2.140	-5.990
	A组	-4.613	1.259	<0.001	-5.384	-3.843
	B组	-6.456	1.851	<0.001	-7.226	-5.686
10MWT	对照组	-1.357	0.818	0.014	-2.422	-0.293
	A组	-5.207	1.911	<0.001	-6.271	-4.142
	B组	-7.522	2.864	<0.001	-8.587	-6.453