急性脑梗死患者足踝关节功能康复的fMRI研究

Research of rehabilitation effect of ankle joint function on patients with acute cerebral infarction by fMRI

目的:运用功能性磁共振成像(functional magnetic resonance imaging,fMRI)技术,探讨足踝关节功能康复对急性脑梗死(acute cerebral infarction,ACI)患者脑功能重塑及其瘫痪肢体功能的影响。方法:利用1.5T磁共振成像系统对11例参与康复治疗、5例未参与康复治疗的ACI患者的治疗前后,以及5例正常志愿者行血氧水平依赖功能磁共振成像(BOLD-fMRI)检查。采用组块刺激功能测试,观察卒中康复前后足踝关节运动时脑激活区域和激活区体积的差异及Fugl-Meyer运动功能评分。结果:ACI患者健侧足踝关节运动时激活区与正常人群组相似;偏瘫侧足踝关节运动时除了对侧半球初级感觉运动区(SM1区)激活之外,同侧SM1区、运动前区(PMC区)也可见不同程度的激活,对侧半球的激活体积大于同侧(P<0.05)。治疗后,患者对侧半球SM1区激活体积较治疗前有明显增加(P<0.05),而参与康复治疗组激活体积的增加更为显著(P<0.05);Fugl-Meyer运动评分在治疗后亦有提高,参与康复治疗组较未伴康复治疗组提高更为显著,差异有统计学意义(P<0.01)。结论:fMRI能客观显示ACI后脑功能重塑特征,对患者进行早期的足踝运动功能康复治疗,有利于脑功能的重塑及瘫痪肢体功能的恢复。

Objective：To investigate the effect of ankle joint function rehabilitation therapy for cerebral function reconstruction and paralysis limbs function in patients with acute cerebral infarction（ACI） using functional magnetic resonance imaging（fMRI）.Methods：Before and after treatment,BOLD-fMRI examinations were performed by 1.5T MRI to 11 ACI patients with rehabilitation therapy,5 ACI patients without rehabilitation therapy respectively.Five healthy volunteers act as controls.The block stimulation function testing was introduced to observe the changes in cerebral activated areas and activated volume and Fugl-Meyer movement function scores.Results：The areas activated by healthy side ankle joint of ACI patients moving were similar to the normal group.When paralyzed side ankle joint moving,in addition to contralateral cerebral hemisphere region（SM1）,the ipsilateral SM1 and PMC areas were also activated in varying degrees.The activated volume in the contralateral hemisphere is larger than that in the ipsilateral volume（P〈0.05）.After treatment,the activated volume in the contralateral SM1 region was increased obviously（P〈0.05）.The activated volume of patients with rehabilitation therapy was more significantly increased（P〈0.05）.The Fugl-Meyer movement score was increased after treatment,and the increase of score was more significant in the patients with rehabilitation therapy,compared to the group without treatment（P〈0.01）.Conclusion：The fMRI can display objective reconstruction feature of brain after ACI.Early stage moving function rehabilitation therapy of ankle is beneficial to reconstruction of cerebral function and recovery of paralysis limbs function.