急性脑梗死康复治疗对手运动中枢激活区BOLD—fMRI偏侧化的影响  

Lateralization in the hand motor cortex during rehabilitation after acute cerebral infarction

作　　者：周福玲[1] 元小冬[1] 王守红[2] 

机构地区：[1]河北联合大学附属开滦总医院神经内科,唐山063000 [2]河北联合大学附属开滦总医院磁共振室,唐山063000

出　　处：《中华物理医学与康复杂志》2013年第6期460-463,共4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）技术观察脑梗死急性期患者短期康复治疗前、后的手运动中枢激活区偏侧化指数（LI）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。方法选取脑梗死急性期患者16例（病例组），依据每例患者的具体情况制订个体化的康复训练计划，在患肢功能恢复的不同阶段进行患肢运动功能的康复治疗。分别于入院当日（治疗前）及康复治疗后第14天（治疗后）进行BOLD-fMRI检查，并采用Fugl—Meyer运动功能评分（FMA）评定其手运动功能，记录和比较康复治疗前和治疗后手运动中枢激活区大脑半球感觉运动皮质（SMC）体积和LI值；另选10例健康志愿者（健康对照组）进行单次fMRI检查，记录中枢激活区SMC体积及LI值。结果16例脑梗死患者，治疗前患手运动激活对侧SMC的LI值（0．010±0．808）小于健手运动的LI值（0．789±0．157），且差异有统计学意义（P〈0．05）；治疗后患手的运动激活SMC的LI值（0．701±0．480）与健手运动激活SMC的LI值（0．859±0．163）比较，差异无统计学意义（P〉0．05）；治疗后，患手被动运动激活SMC的LI值大于治疗前（P〈0．05），健手被动运动激活SMC的LI值与治疗前的差异无统计学意义（P〉0．05）。12例右侧手功能障碍患者，治疗前右手运动LI值（0．0714±0．749）小于左手运动LI值（0．779±0．168），且小于健康对照组（0．896±0．198），且差异有统计学意义（P〈0．05）。结论脑梗死急性期患者短期康复治疗可以促进患肢手运动功能的恢复，患手运动的LI值可反映两侧大脑半球在缺血性脑卒中早期康复过程中各自功能重组情况。Objective To observe any change in the laterality index （LI） in the active volume of the hand motor cortex during rehabilitation after acute cerebral infarction and to analyze the mechanisms involved in the rehabilitation of motor function. Methods Sixteen patients with acute cerebral infarcts were administered standard but individualized rehabilitation training. Blood oxygenation-dependent functional magnetic resonance imaging （BOLD-fMRI） was used to evaluate the active volume of their hand sensorimotor cortex （SMC） and the LI, at admission and after 14 days of rehabilitation. The Fugl-Meyer motor assessment for the hand （FMA） was used to evaluate hand function. Ten healthy volunteers were recruited as a control group and subjected to a single BOLD- fMRI examination to confirm the location and the volume of the active area when performing the same rehabilitation exercises. Results The baseline LI of affected hand SMC activation was significantly smaller than that of the unaffected hand [ （0.010 ±0. 808） versus （0. 789 ±0. 157） ] , but no significant difference was observed between the affected and the unaffected hands after treatment. Rehabilitation therapy significantly increased the SMC LI of affected hand activation when compared with the baseline, but no such effect was observed with the unaffected hand. In 12 patients with dysfunction of the right hand as evaluated by the FMA, the baseline LI of the affected hand was smaller than that of the unaffected hand and that of the healthy volunteers. Conclusion Rehabilitation after acute infarction can promote functional recovery. The LI of the affected hand reflects cerebral plasticity during rehabilitation after acute cerebral infarction.

关 键 词：磁共振成像 偏侧化指数 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]