脊髓型颈椎病术前及术后脑皮质重构的功能磁共振研究

发布时间：2018-04-14 20:11

本文选题：脊髓型颈椎病 + 功能磁共振　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:应用血氧水平依赖功能磁共振成像技术(BOLD-f MRI)研究脊髓型颈椎病患者行颈椎管减压手术前和手术后进行右手敲指运动时脑皮质功能性激活的情况,进而探讨颈椎管减压手术后脑皮质重构的变化对神经功能恢复的影响。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(Pr CG)可探及激活信号,术后组在左侧中央后回(Po CG)、前运动(PMA)和辅助运动区(SMA)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的降低程度具有显著的相关性(P0.05)。结论:脊髓型颈椎病患者脑皮质区可发生代偿重构,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 activation of cortical function in patients with cervical Spondylotic myelopathy (CSM) before and after decompression of cervical spinal canal before and after right hand knockout exercise using the blood oxygen level dependent functional magnetic resonance imaging technique.The effect of cortical remodeling on the recovery of neural function after cervical decompression was investigated.Methods: 19 patients in the experimental group were treated with cervical canal decompression according to the routine diagnosis and treatment.The modified Japanese Orthopedic Association (JOAA) score was evaluated before and 12 months after operation in the trial group. Brain function and conventional magnetic resonance imaging (MRI) were also performed in 19 cases of the control group.All subjects had functional magnetic resonance imaging (fMRI) action tasks for right-hand finger tapping.The data and images of the experimental group were divided into preoperative group and postoperative group according to collecting time, and brain function data were analyzed.Results: the m JOA score of postoperative group increased significantly (P 0. 001).The activation volume of VOAin the preoperative group was significantly higher than that of the control group (P 0.05).The VOA of the postoperative group was lower than that of the control group (P 0.05).In the precentral gyrus, the activated signal could be detected only in the left precentral gyrus. In the postoperation group, the signal could be detected and activated only in the left posterior central gyrus (PMA) and the auxiliary motor area (SMAs), and 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 after operation (P 0.05).Conclusion: compensatory remodeling may occur in the cortical area of cervical Spondylotic myelopathy patients, resulting in the expansion and displacement of sensory and motor activation areas.The changes of cortical remodeling after cervical decompression are related to the recovery of neural function.Surgical treatment may promote compensatory cortical remodeling.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R687.3

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