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目的应用功能磁共振成像(fMRI)技术探索脑卒中后运动功能恢复的脑代偿形式和机制。方法选择25例脑卒中患者作为患者组,其中男16例,女9例;年龄28～75岁,平均54.1岁;进行fMRI检查时间最短为发病2周,最长为60个月。同时选择15例正常人作为对照组进行fMRI检查,其中男11例,女4例,年龄35～69岁,平均48.6岁。结果对照组双侧手分别运动时,均在对侧SM1区产生激活,12例右手运动时激活同侧SMl区(12/15),6例左手运动时激活同侧SMI区(6/7)。SMl激活区呈斑片状或不规则状高信号。各非主要运动区亦有一定比例的激活。患者组均在对侧SM1区产生激活,同侧SM1区则有22例产生激活,激活体积多数以对侧较大,LI值为正值。右侧患手对侧SM1激活平均体积及LI值与正常组相近,同侧SM1平均激活体积大于正常组,LI值小于正常组,差异有统计学意义(P<0.05)。左侧患手的双侧SM1平均激活体积及LI值与正常组比较,差异均无统计学意义。PM、SMA、CMA激活的出现率有不同程度增高,以对侧明显。结论脑卒中后处于康复进程中者,患手对侧SM1体积已恢复到正常水平,同侧SM1仍有代偿现象。双侧的PM、SMA和CMA也有代偿表现。
Objective To explore the form and mechanism of brain compensatory motor function recovery after stroke by using functional magnetic resonance imaging (fMRI) technique. Methods Twenty-five stroke patients were selected as the patient group, including 16 males and 9 females, aged 28-75 years (average 54.1 years). The shortest time for fMRI examination was 2 weeks and the longest was 60 months. At the same time, 15 normal subjects were selected as the control group for fMRI examination, including 11 males and 4 females, aged from 35 to 69 years with an average of 48.6 years. Results In the control group, the contralateral SM1 area was activated when both hands were in motion, the ipsilateral SM1 area was activated in 12 cases (12/15), and the ipsilateral SMI area was activated in 6 cases (6/7) . SMl activation area was patchy or irregular high signal. Each non-major sports area also has a certain percentage of activation. In the patient group, activation occurred in the contralateral SM1 region, while in the ipsilateral SM1 region, 22 patients developed activation. The majority of the activation volume was larger in the contralateral side and the LI value was positive. The average volume of activated SM1 and the LI value of the right side of the affected hand were similar to those of the normal group. The mean activation volume of the SM1 on the ipsilateral side was larger than that of the normal group, and the LI value was smaller than that of the normal group (P <0.05). The average volume of bilateral SM1 activation volume and LI value of the affected left hand were not significantly different from those of the normal group. The incidences of PM, SMA and CMA activation increased to different extents. Conclusions In the course of rehabilitation after stroke, the volume of contralateral SM1 in the affected hand has returned to the normal level, and the ipsilateral SM1 still has compensatory phenomena. Bilateral PM, SMA and CMA also have compensatory performance.