目的：观察针刺配合低频重复经颅磁刺激(low frequency repetitive transcranial magnetic stimulation，LF-rTMS)对脑卒中后上肢运动功能障碍的影响。方法：采用随机数字表法将脑卒中后上肢运动功能障碍的患者分为联合组、rTMS组以及针刺组每组20例。针刺组给予针刺配合常规康复治疗，rTMS组给予常规康复和LF-rTMS治疗，联合组在针刺组治疗的基础上辅以LF-rTMS治疗，刺激部位为健侧半球的M1区(大脑运动皮质的上肢运动功能代表区)，刺激频率为1.0 Hz。于治疗前、治疗4周后采用简易Fugl-Meyer运动功能量表(Fugl-Meyer Assessment，FMA)(上肢部分)、Wolf运动功能测试量表(Wolf Motor Function Test，WMFT)评分评价疗效。结果：rTMS组治疗前后FMA评分和WMFT评分分别为4.65±1.66，7.45±2.63和0.85±1.57，10.05±4.02，针刺组分别为4.45±0.89，5.80±1.74和0.6±1.23，6.75±2.07，联合组分别为4.60±0.75，13.55±2.56和0.95±2.06，8.95±3.90。3组治疗前后FMA评分和WMFT评分均有提高，差异均具有统计学意义(P<0.05)；组间对比发现，治疗后rTMS组WMFT评分优于针刺组，FMA评分不优于针刺组；联合组FMA评分和WMFT评分均优于针刺组和rTMS组，组间差异具均有统计学意义(P<0.05)。结论：针刺配合1 Hz rTMS可显著促进脑卒中后偏瘫上肢运动功能的恢复。
Effect of acupuncture combined with low-frequency repetitive transcranial magnetic stimulation on the upper limb dysfunction after stroke
Objective: To investigate the effects of the low frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with acupuncture on upper limb dysfunction of patients after stroke. Methods: Sixty patients suffering from upper limb dysfunction were randomly divided into 3 groups, including an acupuncture group, a rTMS group and a combined therapy group. The acupuncture group were given acupuncture with conventional rehabilitation. Specifically, rTMS group in the contralateral hemisphere upper limb motor area were given 1hz rTMS treatment, where M1 area (upper extremity motor function of cerebral motor cortex) of contralateral hemisphere was simulated, the combined therapy group were given 1 Hz rTMS treatment on the basis of the treatment. The scores of simple Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) before and 4 weeks after the treatment were used to evaluate the upper limb movement function recovery. Results: The upper limb FMA score and WMFT score in the rTMS group were 4.65±1.66, 7.45±2.63 and 0.85±1.57, 10.05±4.02 respectively; in the acupuncture group patients the scores were 4.45±0.89, 5.80±1.74 and 0.6±1.23, 6.75±2.07 respectively; and in the combined therapy group were 4.60±0.75, 13.55±2.56 and 0.95±2.06, 8.95±3.90, respectively. The FMA and WMFT score of the three groups all increased, and the difference was statistically significant. The WMFT score rTMS were significantly higher than that in the acupuncture group after the treatment. However, FMA score were not better than that in the acupuncture group. The FMA score and WMFT score in the combined therapy group were significantly greater than that in the acupuncture group and rTMS group, and the difference was statistically significant. Conclusion: Acupuncture with 1 Hz TMS can significantly improve the upper limb movement function on the hemiplegic side after stroke.