脊髓型颈椎病术前及术后脑皮质重构的功能磁共振成像研究

Study of brain cortical reorganization changes preoperatively and postoperatively in cervical spondylotic myelopathy by f MRI

目的研究脊髓型颈椎病(CSM)患者术前和术后脑皮质功能性激活的情况,探讨手术对功能恢复中脑皮质重构的影响。方法依据诊疗常规对试验组19例患者行颈椎管减压手术。于术前和术后12个月对试验组进行改良日本骨科协会(m JOA)评分评估,并同时行脑功能和常规磁共振扫描。19例对照组也进行相同范式的脑功能和常规磁共振。所有对象的脑功能磁共振动作任务为右手敲指运动。试验组的数据和图像按照采集时间分为术前组和术后组,并进行脑功能数据分析。结果术后组m JOA评分均显著提高(P<0.001)。术前组激活体积(VOA)显著高于对照组(P<0.05)。术后组VOA降低,但仍显著高于对照组(P<0.05)。术前组仅在左侧中央前回可探及激活信号,术后组在左侧中央后回、前运动和辅助运动区可探及激活信号,右侧部分皮质也可探及少量激活信号。术后组m JOA上肢运动和感觉评分的提高程度与左侧运动和感觉皮质VOA的降低程度呈显著的相关性(P<0.05)。结论 CSM患者发生脑皮质重构,引起感觉和运动功能激活区域的扩大和移位。颈椎管减压术后的脑皮质重构变化与神经功能的恢复有关。手术治疗可能促进了产生代偿性作用的皮质重构。

Objective To study cerebral cortical activation preoperatively and postoperatively in patients with cervical spondylotic myelopathy( CSM),and discuss effect of the surgery on cortical reorganization in functional recovery. Methods 19 cases with CSM intrial group underwent cervical vertebra canal decompression surgery according to clinical routine. Cases in trial group completed clinical assessment using the modified Japanese Orthopaedic Association Scores( m JOA) prior to decompression and 12 months following surgery,and underwent cerebral functional MRI and conventional MRI in the same time. 19 controls also carried out cerebral functional MRI and conventional MRI. All subjects performed a finger-tapping paradigm with right hand during processing functional MRI.The imagings and data of trial group were divided into preoperative group and postoperative group in accordance with the time of completed and than analysed. Results The m JOA score of postoperative group was increased significantly( P < 0. 001). Cortical volume of activation( VOA) of preoperative group was significantly higher than the control group( P < 0. 05). VOA was lower in the postoperative group,but still significantly higher than the control group( P < 0. 05). The preoperative group was able to detect and activate the signal only in the left precentral gyrus. The postoperative group was able to detect and activate the signal in the l left postcentral gyrus,the premotor area and the supplementary motor area,and the right cerebral cortex could also detect a small amount of activation signal. Conclusion CSM patients undergo cerebral cortical remodeling,causing sensory and motor function activation areas to expand and shift. The changes of cortical reorganization after cervical vertebra canal decompression surgery are associated with functional recovery. The surgical treatment may promote the compensating cortical reorganization.