| 摘要: |
| ［摘要］ 目的 探讨重复经颅磁刺激（rTMS）联合脑机接口（BCI）调控股直肌表面肌电图（sEMG）均方根（RMS）值与不完全性脊髓损伤（iSCI）患者下肢运动功能的相关性。方法 纳入2023年6月至2025年8月连云港市第一人民医院收治的150例iSCI患者，分为联合组（接受rTMS+BCI+常规康复）、rTMS组（接受rTMS+假性BCI+常规康复）和常规组（接受假性rTMS+假性BCI+常规康复），每组50例。测定股直肌不同收缩状态下RMS值，评估皮质脊髓束兴奋性，同步检测股直肌运动单位电位（MUPs）及下肢神经传导速度。以美国脊髓损伤协会（ASIA）下肢运动评分、Fugl-Meyer下肢运动功能评定量表（FMA-LE）评分、Berg平衡量表（BBS）评分评估下肢运动功能，并以随访3个月时FMA-LE评分提升≥50%为运动功能恢复良好。通过Pearson相关分析、受试者工作特征（ROC）曲线分析，明确股直肌RMS值的预测效能。结果 干预4周、8周及随访3个月时，联合组各角度主动收缩态股直肌RMS值、FMA-LE评分、ASIA下肢运动评分、BBS评分显著高于rTMS组和常规组（P<0.05），rTMS组显著高于常规组（P<0.05）。干预4周、8周及随访3个月时，联合组静息运动阈值（RMT）、运动诱发电位（MEP）波幅、MEP潜伏期、坐骨神经的运动神经传导速度（MCV）、腓总神经的感觉神经传导速度（SCV）及股直肌MUPs幅值显著优于rTMS组和常规组（P<0.05），rTMS组显著优于常规组（P<0.05）。随访3个月时，联合组运动功能恢复良好率显著高于rTMS组和常规组（P<0.05），rTMS组显著高于常规组（P<0.05）。Pearson相关分析结果显示，主动收缩态股直肌RMS值与ASIA下肢运动评分、FMA-LE评分、BBS评分及MEP波幅呈正相关（P<0.05），与RMT呈负相关（P<0.05）。ROC曲线分析结果显示，干预8周时股直肌RMS值预测下肢运动功能恢复良好的曲线下面积（AUC）为0.896，联合MEP波幅后AUC升至0.943。结论 iSCI患者股直肌RMS值与下肢运动功能恢复呈显著相关，膝关节伸直60°主动收缩态RMS值为核心电生理评估指标，联合MEP波幅检测对下肢运动功能恢复的预测价值较高。 |
| 关键词: 重复经颅磁刺激 脑机接口 不完全性脊髓损伤 股直肌 表面肌电图 |
| DOI：10.3969/j.issn.1674-3806.2026.04.03 |
| 分类号:R 744 |
| 基金项目:国家自然科学基金项目（编号：82272594）；苏州市科技计划项目（编号：SZM2023004） |
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| Analysis on the correlation between repetitive transcranial magnetic stimulation combined with brain-computer interface to regulate RMS values of rectus femoris muscle and lower limb motor function in patients with incomplete spinal cord injury |
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XIAO Guihua1,2,3, REN Xuyan1,2, FAN Yingjie1,2, SU Min1,2
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1.Department of Rehabilitation Medicine, the Fourth Affiliated Hospital of Soochow University(Suzhou Dushu Lake Hospital), Suzhou 215124, China; 2.Rehabilitation Research Institute, Soochow University, Suzhou 215124, China; 3.Department of Comprehensive Rehabilitation, the First People′s Hospital of Lianyungang, Lianyungang 222000, China
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| Abstract: |
| ［Abstract］ Objective To explore the correlation between repetitive transcranial magnetic stimulation(rTMS) combined with brain-computer interface(BCI) to regulate root-mean-square(RMS) value of surface electromyography(sEMG) of the rectus femoris muscle and lower limb motor function in patients with incomplete spinal cord injury(iSCI). Methods A total of 150 patients with iSCI who were admitted to the First People′s Hospital of Lianyungang from June 2023 to August 2025 were included and divided into the combined group(receiving rTMS+BCI+conventional rehabilitation), the rTMS group(receiving rTMS+ sham BCI+conventional rehabilitation), and the conventional group(receiving sham rTMS+sham BCI+conventional rehabilitation), with 50 patients in each group. The RMS values of the rectus femoris muscle in different contraction states were measured, and the excitability of the corticospinal tract was assessed. The motor unit potentials(MUPs) of the rectus femoris muscle and lower limb nerve conduction velocities(NCVs) were simultaneously recorded. Lower limb motor function was assessed using the American Spinal Injury Association(ASIA) Lower Extremity Motor scores, the Fugl-Meyer Assessment for the Lower Extremity(FMA-LE) scores, and the Berg Balance Scale(BBS) scores. A good recovery of motor function was considered when the increase in FMA-LE scores was ≥50% at the 3-month follow-up. The predictive efficacy of the RMS values of the rectus femoris muscle was clarified through Pearson correlation analysis and receiver operating characteristic(ROC) curve analysis. Results At 4 and 8 weeks of intervention and 3 months of follow-up, the RMS values of the rectus femoris muscle in active contraction state at each angle, FMA-LE scores, ASIA Lower Extremity Motor scores and BBS scores in the combined group were significantly higher than those in the rTMS group and the conventional group(P<0.05), and these indicators in the rTMS group were significantly higher than those in the conventional group(P<0.05). At 4 and 8 weeks of intervention and 3 months of follow-up, the resting motor threshold(RMT), motor evoked potential(MEP) amplitude, MEP latency, motor nerve conduction velocity(MCV) of the sciatic nerve, sensory nerve conduction velocity(SCV) of the common peroneal nerve and the MUPs amplitude of the rectus femoris muscle in the combined group were significantly better than those in the rTMS group and the conventional group(P<0.05), and these indicators in the rTMS group were significantly better than those in the conventional group(P<0.05). At the 3-month follow-up, the good recovery rate of motor function in the combined group was significantly higher than that in the rTMS group and the conventional group(P<0.05), and the good recovery rate of motor function in the rTMS group was significantly higher than that in the conventional group(P<0.05). The results of Pearson correlation analysis showed that the RMS values of the rectus femoris muscle in active contraction state were positively correlated with the ASIA Lower Extremity Motor scores, FMA-LE scores, BBS scores and MEP amplitude(P<0.05), and were negatively correlated with RMT(P<0.05). The ROC curve analysis indicated that the area under the curve(AUC) for the RMS values of the rectus femoris muscle in predicting good recovery of lower limb motor function was 0.896 at 8 weeks of intervention, and the AUC increased to 0.943 when combining with MEP amplitude. Conclusion There is a significant correlation between the RMS values of the rectus femoris muscle and the recovery of lower limb motor function in iSCI patients. The RMS value of the rectus femoris muscle in active contraction state with the knee joint extended at 60° serves as a key electrophysiological assessment indicator, and its predictive value for the recovery of lower limb motor function is higher when combining it with MEP amplitude detection. |
| Key words: Repetitive transcranial magnetic stimulation(rTMS) Brain-computer interface(BCI) Incomplete spinal cord injury(iSCI) Rectus femoris muscle Surface electromyography(sEMG) |
