应用高频重复经颅磁刺激（rTMS）治疗缺血性脑卒中患者运动功能障碍，运用弥散张量成像（DTI）评估rTMS治疗效果，探讨高频rTMS治疗运动功能障碍的神经机制。

纳入包头市中心医院神经内科、脑科中心及神经康复中心自2023年10月至2024年12月收治的40例缺血性脑卒中患者为研究对象，按照随机数字表法分为治疗组和对照组，每组20例。2组患者均给予基础药物治疗和常规康复治疗。治疗组在此基础上进行高频（10 Hz）rTMS治疗，连续治疗4周，每周5次，每次15 min；对照组给予10 Hz伪刺激治疗。所有患者在首次和末次治疗当天进行DTI检查并评定康复量表[包括美国国立卫生研究院卒中量表（NIHSS）、Fugl-Meyer运动功能评定量表（FMA）、改良Barthel指数（MBI）]，评估患者神经功能损伤严重程度、肢体运动功能障碍程度及日常生活活动能力。DTI感兴趣区（ROI）选择为放射冠区及内囊后肢，记录各个ROI的各向异性分数（FA），计算相对FA（rFA）。比较2组患者治疗前后的康复量表评分及DTI变化。

治疗4周后，2组患者的NIHSS评分均较治疗前下降，且治疗组下降更明显，差异有统计学意义（P<0.05）；FMA和MBI评分均较治疗前升高，且治疗组升高更明显，差异有统计学意义（P<0.05）。治疗组患者的放射冠区及内囊后肢的FA和rFA值较治疗前升高，差异有统计学意义（P<0.05）；而对照组患者治疗前后的FA和rFA值相比，差异无统计学意义（P>0.05）。

高频rTMS联合常规康复治疗可显著改善缺血性脑卒中患者的运动功能障碍，提高患侧皮质脊髓束完整性，这可能是高频rTMS治疗运动功能障碍的神经机制。

To assess the therapeutic effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on motor dysfunction in patients with ischemic stroke using diffusion tensor imaging (DTI), and to explore the underlying neural mechanism of high-frequency rTMS for motor dysfunction.

Forty patients with ischemic stroke admitted to Neurology Department, Brain Center and Neurorehabilitation Center of Baotou Central Hospital from October 2023 to December 2024 were collected, and divided into treatment group and control group by the random number table method, with 20 cases in each group. Both groups received basic pharmacotherapy and conventional rehabilitation. On this basis, the treatment group underwent high-frequency (10 Hz) rTMS for 4 weeks, 5 times a week, 15 min each time. The control group received 10 Hz sham stimulation. DTI examinations and functional assessments using the National Institutes of Health stroke scale (NIHSS), Fugl-Meyer assessment (FMA), and modified Barthel index (MBI) were performed on the day of the first and last treatment sessions to evaluate neurological deficit severity, limb motor impairment, and activities of daily living. Regions of interest (ROIs) for DTI were placed in the corona radiata and posterior limb of the internal capsule. Fractional anisotropy (FA) values in each ROI were recorded, and relative FA (rFA) was calculated. Rehabilitation scale scores and DTI metrics before and after treatment were compared between the two groups.

After 4 weeks of treatment, the NIHSS scores of both groups decreased compared to those before treatment, with a more significant decrease in the treatment group, and the differences were statistically significant (P<0.05). Both FMA and MBI scores increased compared to those before treatment, with a more significant increase in the treatment group, and the differences were statistically significant (P<0.05). The FA and rFA values of the radiating coronary region and posterior limb of the internal capsule in the treatment group increased compared to those before treatment, and the differences were statistically significant (P<0.05). However, there was no statistically significant difference in the FA and rFA values between the control group before and after treatment (P>0.05).

High-frequency rTMS combined with conventional rehabilitation therapy can significantly improve motor dysfunction in patients with ischemic stroke and improve the integrity of the corticospinal tract on the affected side, which may represent the neural mechanism underlying the therapeutic effect of high-frequency rTMS on post-stroke motor dysfunction.