CAJ | 학술논문

目的探讨脊髓损伤后脑部萎缩情况以及脑萎缩对患者运动功能恢复的影响.方法回顾性分析2012年10月至2014年3月,25例接受脊柱内固定治疗的脊髓损伤患者完整随访资料,根据随访6个月后的运动功能恢复情况分为恢复较好组和恢复一般组,同时另选取25例年龄、性别相匹配的健康人作为对照组.恢复较好组10例,男6例,女4例;年龄24～ 55岁,平均(37.9±13.9)岁;入院时ASIA评级A级1例,B级4例,C级3例,D级2例;6个月后ASIA评级均有一个以上好转,其中A级0例,B级1例,C级3例,D级3例,E级3例;入院时ASIA运动评分为(71.9±16.3)分,6个月后为(85.5±1.5)分.恢复一般组15例,男8例,女7例;年龄24～ 55岁,平均(35.8±11.5)岁;入院时ASIA评级A级7例,B级3例,C级3例,D级2例);6个月时ASIA评级未见明显改善;入院时ASIA运动评分为(71.9±16.3)分,6个月后为(85.5±1.5)分.对照组25名,男15名,女10名,年龄(36.5±9.3)岁.采用MRI扫描三组受试者脑部结构信息,运用CIVET软件及DtiStudio软件对比三组大脑灰质和白质萎缩的区域.运用Pearson相关性分析探讨脑皮层萎缩与患者运动功能恢复率之间的相关性.结果与健康对照组相比,脊髓损伤恢复较好组和恢复一般组均存在双侧初级运动皮层的灰质萎缩,但恢复一般组的萎缩程度更广泛和严重,同时还出现右侧辅助运动区和运动前区的灰质萎缩.恢复较好组未见明显的脑内皮质脊髓束萎缩,而恢复一般组脑内皮质脊髓束初级运动皮层区域及内囊区域均出现白质萎缩.此外,脊髓损伤患者辅助运动区的灰质体积(r=0.75,P＜ 0.001)及初级运动皮层的白质体积(r=0.76,P＜ 0.001)与患者6个月后的运动恢复率存在正相关关系.结论在脊髓损伤早期,运动感觉中枢即可出现明显的萎缩现象,同时这种萎缩对患者的运动功能恢复存在不利影响.
목적 탐토척수손상후뇌부위축정황이급뇌위축대환자운동공능회복적영향.방법 회고성분석2012년10월지2014년3월,25례접수척주내고정치료적척수손상환자완정수방자료,근거수방6개월후적운동공능회복정황분위회복교호조화회복일반조,동시령선취25례년령、성별상필배적건강인작위대조조.회복교호조10례,남6례,녀4례;년령24～ 55세,평균(37.9±13.9)세;입원시ASIA평급A급1례,B급4례,C급3례,D급2례;6개월후ASIA평급균유일개이상호전,기중A급0례,B급1례,C급3례,D급3례,E급3례;입원시ASIA운동평분위(71.9±16.3)분,6개월후위(85.5±1.5)분.회복일반조15례,남8례,녀7례;년령24～ 55세,평균(35.8±11.5)세;입원시ASIA평급A급7례,B급3례,C급3례,D급2례);6개월시ASIA평급미견명현개선;입원시ASIA운동평분위(71.9±16.3)분,6개월후위(85.5±1.5)분.대조조25명,남15명,녀10명,년령(36.5±9.3)세.채용MRI소묘삼조수시자뇌부결구신식,운용CIVET연건급DtiStudio연건대비삼조대뇌회질화백질위축적구역.운용Pearson상관성분석탐토뇌피층위축여환자운동공능회복솔지간적상관성.결과 여건강대조조상비,척수손상회복교호조화회복일반조균존재쌍측초급운동피층적회질위축,단회복일반조적위축정도경엄범화엄중,동시환출현우측보조운동구화운동전구적회질위축.회복교호조미견명현적뇌내피질척수속위축,이회복일반조뇌내피질척수속초급운동피층구역급내낭구역균출현백질위축.차외,척수손상환자보조운동구적회질체적(r=0.75,P＜ 0.001)급초급운동피층적백질체적(r=0.76,P＜ 0.001)여환자6개월후적운동회복솔존재정상관관계.결론 재척수손상조기,운동감각중추즉가출현명현적위축현상,동시저충위축대환자적운동공능회복존재불리영향.
Objective To investigate the structural changes during the early stage of spinal cord injury,and the relationships between these structural changes and patients' motor recovery.Methods The clinical data of 25 patients with spinal cord injury collected from 2012 October to 2014 March were analyzed retrospectively.The spinal cord injury patients were split into two groups (Good recoverers group and Poor recoverers group) according to the clinical outcome of motor recovery at 6 months follow-up,and there were 10 Good recoverers (ASIA grade:1 A,4 B,3 C,and 2 D) and 15 Poor recoverers (ASIA grade:7 A,3 B,3 C,and 2 D).The study also recruited 25 matched healthy controls.The mean age of Good recoverers,Poor recoverers and healthy controls were 37.9± 13.9,35.8± 11.5 and 36.5±9.3,respectively.Structural MRI was used to investigate the regions with brain structural changes among the three groups.Pearson correlation analysis was used to explore the relationships between these structural changes and patients' motor recovery.Results Compared to healthy controls group,both poor recoverers and good recoverers had significantly decreased cortical thickness in the bilateral primary motor cortex.Poor recoverers exhibited more serious and widespread structural damages,in addition to reduced cortical thickness in the primary motor cortex,poor recoverers also showed decreased cortical thickness in the right SMA and premotor cortex when compared to healthy controls.Compared to the healthy controls group,poor recoverers showed reduced white matter volume in the right primary motor cortex and posterior limb of the internal capsule;good recoverers showed no significant difference in white matter microstructure.Furthermore,these structural changes at the internal capsule and primary motor cortex were associated with the motor recovery rate at 6 months follow-up (r=0.75,P＜ 0.001;r=0.76,P＜ 0.001,respectively).Conclusion These findings suggest that spinal cord injury causes significant anatomical changes in the human sensorimotor system in the early phase,and these structural changes directly affect the motor recovery of spinal cord injury.Future treatment aimed at promoting neural function recovery of spinal cord injury patients should pay close attention to the injured brain.