健侧颈7移位正中神经后的脑功能重组改变  

Functional reorganization in the brain after contralateral C7 transfer to the median nerve

作　　者：华续赟[1] 左传涛[2] 徐文东[1] 徐建光[1] 顾玉东[1] 

机构地区：[1]复旦大学附属华山医院手外科, 上海200040 [2]复旦大学附属华山医院PET中心, 上海200040

出　　处：《中华手外科杂志》2009年第2期103-106,共4页Chinese Journal of Hand Surgery

基　　金：卫生部临床学科重点项目（2007-66）

摘　　要：目的探讨健侧颈，移位术后脑功能区变化的现象和可能的机制，为临床促进健侧颈，移位后功能的恢复提供理论依据。方法损伤组：左侧全臂丛神经根性撕脱伤后行健侧颈，移位术后成年男性患者6例，在健侧肩内收带动下患侧屈腕、屈指肌力恢复至地或以上者。对照组：健康成年男性6例，运动模式为健侧（右侧）肩内收。应用正电子发射计算机断层扫描（positron emission tomography，PET）技术，对头部图像进行分析。结果PET显示，对照组右侧肩内收时以左侧半球兴奋为主，而损伤组右侧肩内收时除左侧半球兴奋外，右侧半球额、顶叶皮质区有兴奋，包括SMI和SMA，同时皮质下区域也有兴奋。结论发现成人大脑存在跨两半球功能重组的脑功能显像证据，并定位了参与功能重组的区域，提出了神经移位术后大脑试图利用原功能区来恢复对患肢控制的假设。Objective To investigate changes in brain function zones following contralateral C7 transfer and its possible mechanisms, and provide scientific bases for clinical measurements to improve functional recovery after such nerve transfer. Methods Experiment al group： 6 adult male patients with left brachial plexus total avulsions who underwent contralateral C7 transfer and had recovered M3 or above muscle power of wrist flexors and finger flexors on the injured side under volitional vigorous healthy shoulder （right side） adduction. Control group： 6 healthy male adults whose motor task was to adduct the right shoulder. Positron Emission tomography （PET） techniques were applied to acquire scans of the brain for analysis. Results PEr scans showed excitation mainly in the left hemisphere upon right shoulder adduction in the control group. In the experimental group, in addition to excitation in the left hemisphere, right shoulder adduction resulted in excitation in the fight frontal lobe and apical lobe, including SM1 and SMA, with simultaneous subcortical area activation. Conclusion Functional imaging evidences of transhemispheric plasticity in aduh brain were obtained. The cortical areas involved in functional reorganization were delineated. The hypothesis that the brain may try to restore control of an injured limb to its original cortical areas after nerve transfer was put forth.

关 键 词：神经移位 臂丛 神经元可塑性 大脑皮层 

分 类 号：R686[医药卫生—骨科学]