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

发布时间：2018-02-28 08:11

本文关键词： 脊髓型颈椎病功能磁共振椎管减压术皮质重构　出处：《安徽医科大学学报》2017年08期 　论文类型：期刊论文

【摘要】：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(P0.001)。术前组激活体积(VOA)显著高于对照组(P0.05)。术后组VOA降低,但仍显著高于对照组(P0.05)。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(P0.05)。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。
[Abstract]:Objective to study the functional activation of cerebral cortex in patients with cervical Spondylotic myelopathy (CSM) before and after operation. Methods 19 patients in the experimental group were treated with cervical spinal canal decompression according to the routine diagnosis and treatment. The modified Japanese Orthopedic Association (JOAA) score was evaluated before and 12 months after operation. Brain function and conventional MRI were performed simultaneously. 19 cases of control group were also performed with the same paradigm of brain function and conventional MRI. All subjects' brain functional magnetic resonance action task was right finger tapping movement. Data and images of the experimental group. According to the time of collection, they were divided into preoperative group and postoperative group. Results the m JOA scores in the postoperative group were significantly higher than those in the control group (P 0.001). The activation volume was significantly higher in the preoperative group than that in the control group (P 0.05). The VOA in the postoperative group was lower than that in the control group. But it was still significantly higher than that in the control group (P 0.05). The signal could be detected and activated only in the left precentral gyrus in the preoperative group, and in the left posterior central gyrus, the premotor and auxiliary motor regions in the postoperative group. A small amount of activation signals could also be detected in the right cortex. There was a significant correlation between the improvement of m JOA upper limb motor and sensory score and the decrease of VOA in the left motor and sensory cortex in the postoperative group (P 0.05). Conclusion the cerebral cortex remodeling occurs in the patients with CSM. The changes of cortical remodeling after cervical decompression are related to the recovery of neural function. Surgical treatment may promote the compensatory effect of cortical remodeling.
【作者单位】：安徽医科大学第一附属医院骨科;
【基金】：安徽省自然科学基金(编号:1508085MH151)
【分类号】：R445.2;R687.3

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