脑损伤范围和部位与运动功能恢复的关系

目的：根据ＣＴ扫描确定脑损伤的部位及大小，探讨康复后患者运动功能的恢复情况。方法：根据病例选择标准，从７８例中选出３５例，男２４例，女１１例；年龄１６～７０岁；左侧病变１８例，右侧１６例，双侧１例（特殊病例）；脑血肿１９例，脑梗塞或脑实质软化１６例。ＣＴ检查采用横断面扫描，厚度１ｃｍ。采用康复运动及功能性电刺激治疗。结果：额顶叶受损主要表现为手的精细运动及踝背屈功能障碍；基底节部分病变累及内囊中部主要表现为手指的精细运动恢复差，Ｂａｒｔｈｅｌ指数均达１００分；内囊大部分或完全受累，病变范围４３．６±２１．３ｃｍ３，Ｂａｒｔｈｅｌ指数为６９．２±７．３分，Ｂｒｕｎｎｓｔｒｏｍ上肢Ⅱ级２例，Ⅲ级５例，Ⅳ级５例，Ⅴ级１例；手Ⅱ级６例，Ⅲ级４例，Ⅳ级３例；下肢Ⅳ级１３例。结论：ＣＴ检查确定病变部位及大小，有助于判断患者康复后日常生活活动能力及运动功能恢复的预后。

The relationship of motor recovery with cerebral damage in size and location after rehabilitation

Objective :The size and location examined by CT scanning of cerebral damage and the prognosis of motor functional recovery were explored after rehabilitation. Method: By standard criterion, 35 cases including 19 cases with cerebral haematoma and 16 cases with cerebral infarction and brain softening. There were 24 male and 11 female at age of 1670 years old, were chosen from 78 cases in our studies. The transverse sections of CT with 1cm scanning thickness were used to examine the cerebral damage of patients. Result: The poor recovery of fine motor in hand and ankle extension was found in the damage of frontoparietal lobe with Barthel index 100. In patients with damage of some basal ganglia and the genu of internal capsule, there was poor recovery of fine motor in hand with Barthel index 100. In patients with total damage of internal capsule in size of 43.621.3cm3, the motor functional recovery was 69.27.3 evaluated by Barthel index, in level 2 cases, level 5 cases, level 5 cases, level 1 case in upper limbs, level 6 cases, level 4 cases, level 3 cases in hand and level 13 cases in lower limbs by Brunnstrom. Conclusion: The size and location of damage examined by CT scanning are helpful to predict the prognosis of the recovery of ADL and motor function in the future.