针灸治疗脑出血患者手运动功能障碍相关疗效的可视化预测研究

Visual prediction about therapeutic effect of acupuncture on hand motor dysfunction in patients with intracranial hemorrhage

目的 利用纤维束成像技术预测针灸治疗高血压脑出血患者手运动功能障碍的临床疗效.方法 三维重建21例高血压脑出血患者中央前回手结区域的皮质脊髓束（CST）纤维,分析在不同CST受损情况下,针灸康复治疗前后患者NHISS评分以及Brunnstrom手分级评分的变化差异.结果 CST未受损患者康复治疗后NHISS评分显著低于治疗前（P〈0.05）,但Brunnstrom手分级评分差异无统计学意义;CST部分断裂患者康复治疗后两项评分均较治疗前明显改善（P〈0.05）;而CST完全断裂患者康复治疗前后两项评分差异均无统计学意义.结论 纤维束成像技术能直观显示中央前回手结相关CST纤维受损情况,对于CST部分断裂的患者来讲,针灸能明显改善手的运动功能.

Objective To investigate the therapeutic effect of acupuncture on hand motor dysfunc-tion in patients with hypertensive intracranial hemorrhage using tractography.Methods Corticospinal tract （CST） fibers from precentral knobs of 21 hypertensive intracranial hemorrhage patients were three-dimentionally recontructed. Furthermore, the different changes of NHISS scores and Brunnstrom hand stage scores were an-alyzed in accordance with different damage extent of CTS.Results In patients with undamaged CTS, NHISS scores, not Brunnstrom hand stage scores, were improved significantly after acupuncture treatment （P〈0.05）. In patients with partially damaged CTS, both NHISS scores and Brunnstrom hand stage scores were improved significantly after acupuncture treatment （P〈0.05）. However, in patients with fully damaged CTS, neither NHISS scores nor Brunnstrom hand stage scores were changed significantly.Conclusions Tractography can clearly demonstrate the damage extent of CTS fibers from hand knobs, which proves that acupuncture may obvi-ously improve hand motor dysfunction in patients with partially damaged CTS.