臂丛损伤健侧C7神经移位术前后运动想象任务fMRI研究  

Motor Imagery of the Patients with Brachial Plexus Injury before and after Contralateral C7 Nerve Transfer:an f MRI Study

作　　者：王卫卫[1] 刘彬[1] 华续赟[2] 刘含秋[1,3] 汤伟军[1] 张俊海[1] 孙华平[1] 冯晓源[1] 

机构地区：[1]复旦大学附属华山医院放射科 [2]复旦大学附属华山医院手外科 [3]华山医院宝山分院放射科

出　　处：《中国医学计算机成像杂志》2015年第1期6-10,共5页Chinese Computed Medical Imaging

基　　金：国家自然科学基金(项目编号:30872408)~~

摘　　要：目的:运用功能磁共振成像(f MRI)研究臂丛神经根性撕脱伤患者健侧C7神经移位术前后执行运动想象任务时激活脑区的特点,探讨周围神经损伤影响运动想象的神经机制。方法:14例右侧全臂丛根性撕脱伤患者及7例健康对照接受磁共振检查,其中7名患者接受术前f MRI检查,另7名患者于健侧C7神经根移位于患肢正中神经术后接受f MRI检查。任务为分别想象双侧手抓握运动。结果:健康对照组想象右手抓握运动激活双侧辅助运动区(SMA)、双侧运动前区(PMA)以及左侧顶下小叶、左侧基底节区等脑区。14例臂丛损伤患者想象健侧手抓握运动时激活脑区与健康对照类似。术后组患者想象患手抓握运动时激活双侧SMA区、左侧初级运动皮质(PMC(M1))、左侧PMA区以及双侧顶上小叶。右侧臂丛损伤神经移位术后组激活图像减去术前组激活图像后保留右侧顶上小叶。结论:运动想象与真实运动有共用的脑功能区;臂丛损伤后周围神经传入、传出通道的完整性受损是引起运动想象任务脑功能网络改变的基础。Purpose： To detect the changes of neural activation patterns before and after contralateral C7 nerve transfer while performing motor imagery task by using functional MRI （fMRI）, and to investigate the neural mechanisms of motor imagery after peripheral nerve injury. Methods： Fourteen patients with right side unilateral brachial plexus avulsion injury and 7 healthy volunteers were recruited in this study. Seven patients underwent fMRI before nerve transfer operation, while another 7 patients underwent fMRI after contralateral C7 nerve transferred to the median nerve. The subjects performed imaginary unilateral hand grasping movement without overt movement of the hand during fMRI scanning. Results： Bilateral SMA and PMA, left inferior parietal lobe and basal ganglia were activated while the healthy controls performed imaginary unilateral hand grasping movement. Activated areas were similar when the pre-operation and post-operation patients performed imaginary grasping movement of the healthy hand. Bilateral SMA, left PMA and superior parietal lobe were activated when post-operation patients performed imaginary grasping movement of the affected hand. Right superior parietal lobe was obtained after subtracted pre-operation group from post-operation group. Conclusion： Motor imagery and motor execution share the same brain functional areas. Brachial plexus injury disrupts the afferent and efferent pathway, which is the basis of reorganization of brain areas represented for motor imagery.

关 键 词：运动想象 臂丛损伤 神经移位术 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]