摘要
Abstract
Objective To observe the effects of virtual reality(VR)combined with repetitive transcranial magnetic stimulation(rTMS)on neuropathic pain,motor function and negative emotions in patients with spinal cord injury(SCI).Methods A total of 90 patients with SCI complicated by neuropathic pain who were hospitalized in the Department of Rehabilitation Medicine of Kaifeng Central Hospital from November 2023 to November 2024 were selected.All patients were randomly divided into an observation group and a control group based on the random number table method,with 45 cases in each group.The control group received conventional rehabilitation therapy,while the observation group received VR training and rTMS in addition to the conventional rehabilitation therapy.The treatment duration was 8 weeks for both groups.The clinical efficacy,pain status,lower limb motor function,negative emotions,and serological indicators were compared between the two groups.Adverse reactions during treatment and the Visual Analogue Scale(VAS)score at the 6-month follow-up were recorded.Results The total effective rate in the observation group was 91.11%,which was higher than that in the control group(68.89%;χ2=6.944,P<0.05).After treatment,the VAS score,the anxiety and depression scores of the Hospital Anxiety and Depression Scale(HADS)-Anxiety(HADS-A)and serum interleukin-6(IL-6)level in the observation group were lower lower than the control group[(2.61±1.03)points vs.(4.28±1.16)points,(7.18±2.31)points vs.(9.93±2.57)points,(7.44±2.25)points vs.(10.38±2.49)points,(4.38±1.47)pg/mL vs.(6.21±1.62)pg/mL;t=7.222,5.338,5.877,5.612,P<0.001].While,the Fugl-Meyer Assessment of Lower Extremity Motor Function(FMA-LE)score,Lower Extremity Motor Score(LEMS)and serum brain-derived neurotrophic factor(BDNF)level in the observation group were higher than those in the control group[(22.46±3.81)points vs.(17.18±3.55)points,(28.14±5.29)points vs.(21.73±5.02)points,(31.24±5.08)pg/mL vs.(23.59±4.67)pg/mL;t=6.802,5.896,7.437,P<0.001].During the treatment period,there was no statistically significant difference in the incidence of adverse reactions between the two groups(χ2=0.714,P=0.399).At 6 months after the end of treatment,a total of 85 patients were successfully followed up,(42 in the observation group and 43 in the control group).The follow-up results showed that the VAS score in the observation group was lower than that in the control group[(3.15±1.18)points vs.(4.95±1.24)points;t=6.853,P<0.001].Conclusions VR combined with rTMS is safe and effective,helping to alleviate neuropathic pain,improve lower extremity motor function,and reduce anxiety and depression in SCI patients.The mechanism may be related to upregulation of serum BDNF levels and downregulation of IL-6 levels.关键词
脊髓损伤/神经病理性疼痛/虚拟现实技术/重复经颅磁刺激/运动功能/焦虑/抑郁Key words
spinal cord injury/neuropathic pain/virtual reality/repetitive transcranial magnetic stimulation/motor function/anxiety/depression
