| 张晓钰,桑德春,王丽华.弥散张量纤维束成像分析脑卒中偏瘫患者镜像治疗康复后大脑再塑变化的临床研究[J].中国康复医学杂志,2013,28(8):727~730 |
| 弥散张量纤维束成像分析脑卒中偏瘫患者镜像治疗康复后大脑再塑变化的临床研究 点此下载全文 |
| 张晓钰 桑德春 王丽华 |
| 首都医科大学康复医学院，中国康复研究中心北京博爱医院综合康复科，北京丰台区角门，100068 |
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| 摘要
目的：应用弥散张量纤维束成像（DTT）分析脑卒中偏瘫患者镜像治疗康复后大脑再塑变化。
方法：收集2011年2月—2012年1月我院收治的临床资料完整且脑梗死发生于3天内的中老年脑卒中偏瘫患者60例；按年龄分为三组，第Ⅰ组20例，年龄45—54岁，第Ⅱ组20例，年龄55—64岁，第Ⅲ组20例，年龄65—75岁；均采用镜像治疗，连续治疗6周；NIHSS对治疗前后神经功能评分；FMA对上肢运动功能评分。
结果：第Ⅰ、Ⅱ、Ⅲ组治疗前梗死灶部分各向异性（FA）值分别为（0.43±0.09）、（0.40±0.05）、（0.33±0.07），明显低于对应侧正常脑组织FA值（P＜0.05），经过6周镜像治疗后第Ⅰ、Ⅱ、Ⅲ组梗死灶FA值分别为（0.48±0.04）、（0.44±0.02）、（0.40±0.05），均较治疗前显著升高（P＜0.05）；随着年龄的增长，FA值降低；各组治疗后FMA评分明显高于治疗前（P＜0.01）；DTT中CST分为1级（完整）和2级（受压或移位）两级，同组同CST分级的患者，治疗6周后其NIHSS评分明显低于治疗前（P＜0.05）；各组CST 2级的NISHH评分明显高于CST 1级（P＜0.05）。
结论：DTT可直观地显现梗死病灶与纤维束走行之间的关系，可对神经损伤情况进行判定，结合镜像治疗利于患者康复。 |
| 关键词：弥散张量纤维束成像 镜像治疗 脑卒中 偏瘫 大脑再塑变化 |
| Clinical study of diffusion tensor tractography on brain plasticity changes after mirror therapy rehabilitation in stroke patients with hemiplegia Download Fulltext |
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| China Rehabilitation Research Center, Beijing, 100068 |
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| Abstract: |
| Abstract
Objective: To study diffusion tensor tractography(DTT) on brain plasticity changes affer mirror therapy rehabilitation in stroke patients with hemiplegia.
Method: Sixty elderly stroke patients with hemiplegia were collected from February 2011 to January 2012 and divided into three groups: Group Ⅰ 20 patients aged 45—54 years old. group Ⅱ 20 patients aged 55—64 years old. group Ⅲ 20 patients aged 65 to 75 years old. All patients were treated with mirror therapy for 6 weeks continuously. National institutes health staoke scale(NIHSS) was used to evaluate neurological function before and after treatment; FMA was used to evaluate upper limb motor function.
Result: Fractional anisotropy(FA) values were (0.43±0.09),(0.40±0.05),(0.33±0.07) in group Ⅰ,Ⅱ,Ⅲ, respectively, and were significantly lower than those in the corresponding side of normal brain tissue (P＜0.05). After 6 weeks mirror therapy, FA value was (0.48±0.04), (0.44±0.02), (0.40±0.05) in the group of Ⅰ,Ⅱ,Ⅲ respectively, and were significantly higher than those before treatment (P＜0.05). FA values decreased with age increasing, after treatment FMA score in each group was significantly higher than that before treatment (P＜0.01). In DTT, there were two grades of corticospinal tracts(CST): grade 1(intact) and grade 2(compressed or displace). Patients' NIHSS score in the same group and the same CST grade after 6 weeks treatment was significantly lower than before treatment (P＜0.05). In each group NIHSS score of grade 2 CST was significantly higher than that of grade 1 CST.
Conclusion: DTT can visually display the relation of the location of infarction lesion and the track of fiber bundle,to determine the nerve damage, and combining with mirror therapy to promote the rehabilitation of patients. |
| Keywords:diffusion tensor tractography mirror therapy stroke hemiplegia brain plasticity change |
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