完全性脊髓损伤亚急性期脑运动控制功能变化的功能磁共振研究

目的 探讨完全性脊髓损伤患者脑运动控制功能的变化情况。方法 2017年1月至2019年1月,病程3~6个月完全性脊髓损伤患者11例与健康人12例,在试图/实际运动、意象运动(MI)任务下行功能磁共振成像(fMRI)扫描,观察不同运动任务引发激活效应的空间分布和信号强度。结果 患者试图运动时的脑激活区域显著多于健康人实际运动时的激活区域,包括双侧初级感觉/运动皮质(S1/M1)、辅助运动区(SMA)、外侧苍白球(PA)、小脑、左侧丘脑和壳核等。健康人意象运动的比较,患者激活簇主要存在于右M1、SMA、背侧运动前区(PMd)、左SMA、岛叶和基底核。患者试图运动比意象运动在左M1、双SMA、扣带回运动区和右小脑诱发更多的兴奋。结论 亚急性期完全性脊髓损伤患者执行运动任务时,M1、SMA的兴奋模式基本正常,顶叶和小脑等感觉运动整合区域激活增加,提示发生适应性重组。

Motor Control Function of Brain in Subacute Complete Spinal Cord Injured Patients: A Functional Magnetic Resonance Imaging Study

Objective To study the changes of brain motor control function in patients with complete spinal cord injury within three to six months. Methods From January, 2017 to January, 2019, eleven inpatients with complete spinal cord injury and twelve healthy controls were screened with functional magnetic resonance imaging during attempted/executive movement (MA/ME) and motor imagery (MI). The involved area and activation were compared between the groups under tasks. Results More areas were activated in the patients than in the controls as MA/ME, such as bilateral primary sensorimotor cortex, supplementary motor area, lateral globus pallidus, cerebellum, contralateral thalamus and putamen. During MI, the activation was more in the patients in ipsilateral primary motor cortex, supplementary motor area, dorsal premotor area, contralateral supplementary motor area, insular and basal ganglia. The patients induced more activation as MA than as MI in ipsilateral primary motor cortex, bilateral supplementary motor area and cingulate motor area, and contralateral cerebellum.Conclusion The activation remains normal in primary motor cortex and supplementary motor area for subacute complete spinal cord injury patients when undergoing motor tasks, but some reorganization may occur in parietal lobe and cerebellum that involve in sensorimotor integration.