《中国康复理论与实践》

《中国康复理论与实践》 ›› 2015, Vol. 21 ›› Issue (09): 1058-1063.

• 基础研究 • 上一篇    下一篇

脑卒中后上肢运动功能恢复大脑可塑性的磁共振弥散张量成像研究

凌晴 1a，林丽萍 1b，胡世红 1a，何嫱 1a，许佳 1a
  

  1. 作者单位：1.复旦大学附属上海市第五人民医院，a.康复医学科；b.放射科，上海市 200240。
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-09-25 发布日期:2015-09-25

Brain Plasticity of Upper Extremity Motor Function Recovery after Stroke: A Diffusion Tensor Imaging Study

LING Qing1a, LIN Li-ping1b, HU Shi-hong1a, HE Qiang1a, XU Jia1a
  

  1. 1. a. Department of Rehabilitation Medicine; b. Department of Radiology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, China
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-09-25 Online:2015-09-25

PDF (PC)

被引次数

11

摘要： 目的 应用磁共振弥散张量成像(DTI)分析脑卒中偏瘫患者康复后上肢功能恢复的大脑可塑性变化。方法 病程 4~8周、病变部位为内囊基底节区且皮质脊髓束受累的脑卒中偏瘫患者 25例，随机分为康复组(n=13)和对照组(n=12)，对照组予常规药物治疗，康复组在常规药物治疗的基础上增加综合康复治疗。两组分别于治疗前和治疗3个月后行DTI检查，依次从大脑脚、内囊后肢、放射冠区 3个层面，测量病变同侧皮质脊髓束和病变对侧相应脑组织的部分各向异性值(FA)，计算 FA比值(rFA)和 FA不对称性值(FAasy)；利用弥散张量纤维束成像技术重建双侧皮质脊髓束。对偏瘫侧上肢运动功能采用简式 Fugl-Meyer 评定(UE-FMA)进行评定。结果 治疗前两组UE-FMA评分无显著性差异，康复组治疗前后差值多于对照组(P<0.05)。康复组放射冠层面FA、rFA、FAasy治疗前后有显著性差异(P<0.05)，大脑脚和内囊层面无显著性差异(P>0.05)。对照组各层面FA、rFA、FAasy治疗前后均无显著性差异(P>0.05)。康复组治疗后病灶侧皮质脊髓束纤维较前致密，形态结构改善。结论 康复治疗可促进上肢运动功能改善和大脑可塑性变化，主要表现为放射冠层面皮质脊髓束的修复。

关键词: 脑卒中, 上肢, 运动功能, 弥散张量成像, 磁共振成像, 康复, 大脑可塑性

Abstract: Objective To explore brain plasticity of upper extremities motor function recovery after stroke with diffusion tensor imaging (DTI). Methods 25 stroke patients with internal capsule lesions and affected corticospinal tract (CST), 4-8 weeks after onset, were divided randomly into rehabilitation group (n=13) and control group (n=12). Both groups received routine medication and the rehabilitation group also received rehabilitation. All the patients were scanned with DTI and assessed with upper extremity Fugl-Myer Assessment (UE-FMA) before and 3 months after treatment. The fractional anisotropy (FA), FA ratio (rFA) and FA asymmetry (FAasy) in cerebral peduncle, posterior limb of internal capsule (PLIC) and corona radiate were obtained. The bilateral corticospinal tracts were reconstructed with diffusion tensor tractography. Results The scores of UE-FMA increased in both groups after treatment (P<0.05), and increased more in the rehabilitation group than in the control group (P<0.05). There was significant difference in FA, rFA and FAasy in the corona radiate section of CST after treatment in the rehabilitation group (P<0.05), but was not in the cerebral peduncle and PLIC section. However, there was no significant differences in FA, rFA and FAasy in the control group. The ipsilesional CST fibers were more compact after treatment in the rehabilitation group. Conclusion Rehabilitation can improve the upper extremities function recovery after stroke, which may associated with the repairment of CST in the corona radiate section.

Key words: stroke, upper extremities, motor function, diffusion tensor imaging, magnetic resonance imaging, rehabilitation, brain plasticity