脑梗死康复治疗前、后手运动功能BOLD—fMRI定量分析  

Changes in the hand motor cortex after cerebral infarction and during rehabilitation

作　　者：周福玲[1] 元小冬[1] 赵丽君[2] 崔艳[1] 王守红[2] 

机构地区：[1]华北煤炭医学院附属开滦医院神经内科,唐山063000 [2]华北煤炭医学院附属开滦医院核磁共振室,唐山063000

出　　处：《中华物理医学与康复杂志》2008年第8期537-541,共5页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的利用血氧水平依赖性功能磁共振成像（BOLD—fMRI）技术研究急性期脑梗死患者短期康复治疗前、后的手运动中枢激活体积的变化，比较常规治疗者和康复治疗者中枢激活体积的变化规律，探讨脑梗死患者急性期手运动功能康复的机制。方法选择脑梗死急性期患者16例作为患者组，随机分为康复治疗组8例，常规治疗组8例，分别于人院当日及治疗第14天进行fMRI检查，并采用Fugl—Meyer运动功能评分法（FMA）评定其手运动功能，记录并比较常规治疗组和康复治疗组治疗前、后的中枢激活体积；另选10名健康志愿者行单次fMRI检查，测定相同运动任务刺激后的脑功能区位置和激活体积，并与患者组进行比较。结果16例脑梗死患者经治疗后，对侧感觉运动皮质（SMC）激活体积及FMA评分均大于治疗前（P〈0．05）；康复治疗组治疗前、后患手运动激活对侧SMC的体积以及FMA评分的变化均较常规治疗组明显（P〈0．05）。结论脑梗死急性期采取临床短期康复治疗可引起患侧SMC区的相应变化，促进患肢功能的恢复。Objective To observe any change in the active volume of the hand motor cortex during rehabili- tation therapy after acute cerebral infarction and analyze the mechanisms involved in motor function rehabilitation. Methods Of 16 patients with acute brain infarction, 8 were administered routine internal medicine treatment only, while and the other 8 received rehabilitation therapy in addition. Before treatment and after 14 days, the patients were assessed with functional magnetic resonance imaging （ fMRI ） and the Fugl-Meyer assessment of motor function （ FMA）. The active volume of the motor cortex was compared between the two groups of patients. Ten healthy volun- teers were examined with fMRI to confirm the location and the volume of the active area when performing the same ex- ercises. Results After treatment, all the 16 patients showed increased motor cortex active volume, and their FMA scores also increased. Those receiving rehabilitation therapy improved to a significantly greater extent than those trea- ted with internal medicine treatment alone. Conclusion Rehabilitation of patients with acute infarction can activate a greater volume of the motor cortex and promote functional recovery.

关 键 词：血氧水平依赖性 功能磁共振成像 脑梗死 手运动 康复 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]