应用功能磁共振对臂丛神经损伤健侧颈7移位术后肢体功能康复与大脑皮质激活区的研究  

Study on the limb functional rehabilitation and the activating region of cevebral cortex after contralateral C7 nerve root transfer for brachial plexus injury with functional magnetic resonance imaging

作　　者：孙贵新[1] 孙华平[2] 冯晓源[2] 高歌军[2] 顾玉东[1] 

机构地区：[1]复旦大学附属华山医院手外科,上海市200040 [2]复旦大学附属华山医院磁共振室,上海市200040

出　　处：《中国临床康复》2005年第45期6-8,i0005,共4页Chinese Journal of Clinical Rehabilitation

基　　金：国家自然科学基金资助项目(30371435)~~

摘　　要：目的:通过对左侧全臂丛根性撕脱伤患者健侧颈7(C7)神经移位后与健康对照组的上肢运动比较,探讨其功能康复与大脑可塑性的关系。方法:选择2001-09/2003-06在华山医院手外科手术或复诊的左侧全臂丛根性撕脱伤患者8例。同期选取健康自愿者8例为对照组。均为右利手。采用1.5T超导磁共振仪检查肢体对应的大脑运动皮层激活的变化。结果:16例患者均进入结果分析。①对照组受检者单侧肢体运动均可在对侧大脑半球初级运动皮质观察到兴奋区,其最大信号像素时间-信号强度曲线与BLOCK模式运动时相一致。②治疗组所有患者健侧上肢运动时,均可在对侧初级运动皮质观察到激活区,出现部位和形态与正常人大致相仿。健侧C7神经移位后,患侧屈腕屈指运动时,对侧皮质运动区M1区的激活体积较正常对照组平均值小。但随着术后功能的恢复,患肢对侧初级运动皮质激活区呈现逐渐增大趋势。功能恢复好,对侧运动皮质激活区区域则大,功能恢复差,对侧运动皮质激活区区域则小。结论:功能性磁共振可描绘出臂丛神经损伤健侧C7神经移位患者的大脑初级运动皮质的改变,术后积极进行损伤肢体的主动锻炼,可加速大脑可塑性的转化,有利于功能康复。AIM：To investigate the relation between the functional rehabilitation and the brain plasticity by comparing movements of the upper extremity in patients with braehial plexus avulsion at the left side after C7 nerve transfer at the uninjured side and persons in the healthy control group. METHODS：Eight patients with braehial plexus avulsion at the left side, who were made operation at Department of Hand Surgery or return visit in the Huashan Hospital from September 2001 to June 2003,and eight healthy volunteers were seleeted as control group.They were all right handedness. Changes of the corresponding primary motor cortex of limb were detected with superconduct 1.5 T magnetic resonance scanner. RESULTS：Totally 16 patients were involved in the result analysis. ①Signal changes were observed within contralateral primary motor cortex in subjects of control group.The maximal signal pixel time-signal curve was the same to the movement of BLOCK model.②All the patients in the treatment group when performing upper limb movement,activating area could be found at contralateral primary motor cortex where was similar as normal persons with similar form.After the C7 nerve transfer at the uninjured side and when perfoming counting wrist and finger,the mean volume of activation at the MI region of contralateral cortical motor area was smaller than that in the normal control group.But with the recovery of operation function,it enlarged at the activation region of contralateral primary motor cortex at the injured side gradually,lf the function recovered better,the region of activation of contralateral motor cortex became larger;if the function recovered worse, the region would be smaller. CONCLUSION：Functional magnetic resonance can show the changes of the primary motor cortex in patients with brachial plexus avulsion after C7 nerve transfer at uninjured side.The aetive exercise with injured extremity after operation can accelerate the conversion of cerebral compliance and is helpful for functional recovery.

关 键 词：臂丛/损伤 神经移位 磁共振成像 大脑可塑性 

分 类 号：R651.3[医药卫生—外科学]