中风偏瘫肢体运动功能恢复和头针疗效水平的fMRI与DTI研究

Rehabilitation of motor function and curative effect of scalp acupuncture in patients with hemiplegia after stroke: studies on fMRI and DTI

目的探讨偏瘫肢体活动以及针刺头皮针的即刻脑功能成像(fMRI)反应,结合弥散张量成像(DTI),探讨偏瘫肢体功能恢复的机制。方法对偏瘫患者进行头针治疗和临床观察,发现有针刺有效和针刺无效的现象,对针刺有效和针刺无效各1例患者进行偏瘫肢体被动运动和头针任务的fMRI扫描和DTI扫描。结果 2例受试者的肢体运动脑激活部位较一致,而针刺的脑激活效应差异较大,激活范围与针刺有效性相关,DTI结果显示运动传导束纤维受损程度有差异。结论中风后运动功能恢复与小脑的作用关系密切;头针针刺对运动调节功能有部分影响作用,针刺的临床疗效水平与脑激活反应有相关性;病损具体部位、大小和临床症状与神经功能的恢复程度和恢复机制密切相关。

Objective To study the mechanism of limb function recovery through investigating the reactions of immediate cerebral functional magnetic resonance imaging （fMRI） and diffusion tensor imaging （DTI） in the patients with hemiplegia after stroke and treated with scalp acupuncture. Methods The patients were treated with scalp acupuncture for clinical observation and finding out effective and ineffective phenomenons, and two patients （one had curative effect and one had not） were given scanning of fMRI and DTI on the passive movement of hemiplegia limb and scalp acupuncture actions. Results The cerebral activating areas of limb movement were similar in the two patients, while the cerebral activating effectiveness of scalp acupuncture had significant difference. The activating range was correlated to the effectiveness of scalp acupuncture. The results of DTI showed that there was difference in the injury degrees of pyramidal tract fibers. Conclusion The recovery of movement function is closely related to cerebellar function after stroke, and scalp acupuncture has some effects on movement regulation. The curative effect of scalp acupuncture is correlated to cerebral activating reaction. The position, size and symptoms of hemiplegia injury are closely related to the recovery degree and mechanism of neural function.