| 孙思杰,邓罗义,王先斌,吴 霜.优势半球卒中患者脑功能与步态特点及相关性分析[J].中国康复医学杂志,2026,(8):1251~1260 |
| 优势半球卒中患者脑功能与步态特点及相关性分析 点此下载全文 |
| 孙思杰 邓罗义 王先斌 吴 霜 |
| 贵州医科大学附属医院，贵州省贵阳市，550004 |
| 基金项目：国家自然科学基金地区科学基金项目（82260452，82060419）；贵州省科学技术基金项目(黔科合基础-ZK[2022]重点045） |
| DOI：10.3969/j.issn.1001-1242.2026.08.009 |
| 摘要点击次数: 83 |
| 全文下载次数: 16 |
| 摘要： |
| 摘要
目的：比较单侧大脑半球卒中偏瘫患者的步态特征以及初级运动区（M1）和前额叶皮质（PFC）区域在功能性近红外光谱（fNIRS）下的脑功能差异，并分析二者之间的相关性，进一步为单侧脑卒中偏瘫患者制定精准的个体化康复策略提供理论依据。
方法：选择发病2周以上的均为右利手的单侧半球卒中偏瘫患者及健康人，分为优势半球组、非优势半球组和健康人组。评估步行状态、步行时脑网络功能连接及脑皮质激活程度。
结果：与健康人相比，优势半球卒中患者步态参数均差（P＜0.05），胫前肌、腓肠肌RMS均降低（P＜0.05），静息态健侧ROI连接增高（P＜0.05），任务态双侧M1区、PFC区激活增高（P＜0.05）；与非优势半球组相比，优势半球卒中患者时空参数均较差（P＜0.05），运动学参数中膝、踝关节最大屈曲角度均较差（P＜0.05），健侧ROI区连通性显著增高且步行中双侧M1区及双侧PFC均激活（P＜0.05）；非优势半球卒中患者单支撑相与双侧M1区HBO均值呈负相关，步频与双侧前额叶HBO均值呈负相关（P＜0.05）。
结论：优势半球卒中患者下肢运动功能相较于非优势半球卒中患者更差，主要体现在患侧膝关节、踝关节运动控制能力不足，其原因可能与优势半球卒中患者与认知和运动相关的主要ROI区过度激活，及脑网络功能连接异常增高有关。此外，非优势半球卒中患者行走时双侧M1区及双侧PFC区的氧合血红蛋白均值，可能作为预测非优势半球卒中患者下肢运动功能的生物学标志物。 |
| 关键词：脑卒中 偏瘫 单侧脑半球 功能性近红外光谱 三维步态分析 |
| Brain functional characteristics and gait features in patients with dominant hemisphere stroke: a correlation analysis Download Fulltext |
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| Affiliated Hospital of Guizhou Medical University， Guiyang， Guizhou， 550004 |
| Fund Project: |
| Abstract: |
| Abstract
Objective： To compare the gait characteristics and brain functional differences in the primary motor cortex (M1) and prefrontal cortex (PFC), as measured by functional near-infrared spectroscopy (fNIRS), between hemiplegic patients with unilateral hemispheric stroke， and to further provide a theoretical basis for the development of precise and individualized rehabilitation strategies for hemiplegic patients with unilateral stroke.
Method： Patients with unilateral hemispheric stroke hemiplegia who were all right-handed at least 2 weeks after onset and healthy individuals were recruited and divided into the dominant hemisphere group， nondominant hemisphere group， and healthy individual group. Gait performance， brain network functional connectivity during walking and the degree of cortical activation were assessed.
Result： Compared with healthy subjects， patients with stroke in the dominant hemisphere had poorer gait parameters （P<0.05）， lower root mean square (RMS) of the tibialis anterior and gastrocnemius muscles （P<0.05）， increased resting-state connectivity in contralesional regions of interest (ROI) （P<0.05）， and increased bilateral activation of the M1 and PFC area during walking tasks （P<0.05）. Compared with nondominant hemisphere group， the dominant hemisphere stroke patients had worse spatiotemporal parameters （P<0.05）， and reduced maximum flexion angles of the knee and ankle joints （P<0.05）， and higher contralesional ROI connectivity, and increased bilateral activation of M1 and PFC during walking （P<0.05）. In patients with non-dominant hemisphere stroke， the single-support phase was negatively correlated with the mean oxygenated hemoglobin (HbO) values in bilateral M1， and step frequency was negatively correlated with the mean HbO values in bilateral PFC（P<0.05）.
Conclusion： Lower limb motor function was worse in patients with dominant hemisphere stroke compared with those with nondominant hemisphere stroke， mainly reflected in knee and ankle motor control on the affected side， which may be related to the overactivation of the main cognitive- and motor-related ROI areas and the abnormal increased brain network functional connectivity in patients with dominant hemisphere stroke. In addition， mean HbO values in bilateral M1 and PFC during walking may serve as potential neurobiological markers for predicting lower limb motor function in non-dominant hemisphere stroke patients. |
| Keywords:stroke hemiparesis unilateral hemisphere functional near-infrared spectroscopy three-dimensional gait analysis |
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