镜像疗法促进脑卒中上肢功能恢复和皮质脊髓束重塑的弥散张量成像研究

doi:10.3969/j.issn.1006-9771.2021.01.004

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (1): 31-36.doi: 10.3969/j.issn.1006-9771.2021.01.004

镜像疗法促进脑卒中上肢功能恢复和皮质脊髓束重塑的弥散张量成像研究

凌晴¹, 胡世红¹, 王田尧², 周亚飞¹, 林丽萍²

1.复旦大学附属上海市第五人民医院，康复医学科，上海市 200240
2.复旦大学附属上海市第五人民医院，放射科，上海市 200240

收稿日期:2020-02-22 修回日期:2020-04-01 出版日期:2021-01-25 发布日期:2021-01-27
通讯作者: 林丽萍，E-mail： linlplucky@163.com
作者简介:凌晴(1981-)，女，汉族，安徽萧县人，副主任医师，主要研究方向：神经康复和神经影像。
基金资助:
上海市闵行区自然科学基金项目(No. 2016MHZ12)

Effects of Mirror Therapy on Upper Limb Motor Function and Corticospinal Tract Remodeling after Stroke: A Diffusion Tensor Imaging Study

LING Qing¹, HU Shi-hong¹, WANG Tian-yao², ZHOU Ya-fei¹, LIN Li-ping²

1. Department of Rehabilitation Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China
2. Department of Radiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China

Received:2020-02-22 Revised:2020-04-01 Published:2021-01-25 Online:2021-01-27
Contact: LIN Li-ping, E-mail: linlplucky@163.com
Supported by:
Natural Science Fundation of Minhang District, Shanghai (No. 2016MHZ12)

摘要/Abstract

摘要： 目的探讨镜像治疗对脑卒中偏瘫患者上肢功能恢复和皮质脊髓束重塑的影响。方法 2017年3月至2019年3月，皮质下脑卒中伴上肢功能障碍患者42例随机分为对照组(n = 21)和观察组(n = 21)。两组均行常规康复，观察组增加镜像疗法。治疗前和治疗12周后，采用Fugl-Meyer评定量表上肢部分(FMA-UE)进行评定；磁共振弥散张量成像(DTI)获取内囊后肢各向异性分数(FA)。结果治疗后，两组FMA-UE评分均显著提高(t > 9.560, P < 0.001)，观察组评分增加值高于对照组(t > 2.634, P < 0.05)。治疗前，两组病灶侧内囊后肢FA均较对侧显著减小(t > 11.368, P < 0.001)；治疗后，观察组病灶侧内囊后肢FA高于治疗前(t = 2.385, P < 0.05)，对照组无显著性差异(t = -0.596, P > 0.05)，观察组评分增加值高于对照组(t = 2.306, P < 0.05)。结论镜像疗法可促进脑卒中患者的上肢运功功能改善和皮质脊髓束重塑。

关键词: 脑卒中, 偏瘫, 上肢, 镜像疗法, 弥散张量成像, 皮质脊髓束

Abstract: Objective To explore the effects of mirror therapy on upper limb motor function recovery and corticospinal tract remodeling after stroke. Methods From March, 2017 to March, 2019, 42 subcortical stroke patients with upper limb dysfunction from Shanghai Fifth People's Hospital were randomly divided into control group (n = 21) and observation group (n = 21). Both groups received routine rehabiliation, while the observation group received mirror therapy additionally, for twelve weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), and scanned with diffusion tensor imaging (DTI) before and after treatment. The fractional anisotropy (FA) in posterior limb of internal capsule (PLIC) was obtained. Results The scores of FMA-UE improved in both groups after treatment (t > 9.560, P < 0.001), and improved more in the observation group than in the control group (t > 2.634, P < 0.05). FA decreased significantly in the affected-lateral PLIC compared with that in the unaffected-lateral PLIC in both groups (t > 11.368, P < 0.001). FA in the affected side increased significantly after treatment in the observation group (t = 2.385, P < 0.05), while there was no significant difference in the control group (t = -0.596, P > 0.05). FA increased more significantly in the observation group than in the control group (t = 2.306, P < 0.05). Conclusion Mirror therapy can promote the recovery of motor function of upper limb and the corticospinal tract remodeling in stroke patients.

Key words: stroke, hemiplegia, upper limb, mirror therapy, diffusion tensor imaging, corticospinal tract

中图分类号:

R743.3

凌晴, 胡世红, 王田尧, 周亚飞, 林丽萍. 镜像疗法促进脑卒中上肢功能恢复和皮质脊髓束重塑的弥散张量成像研究[J]. 《中国康复理论与实践》, 2021, 27(1): 31-36.

LING Qing, HU Shi-hong, WANG Tian-yao, ZHOU Ya-fei, LIN Li-ping. Effects of Mirror Therapy on Upper Limb Motor Function and Corticospinal Tract Remodeling after Stroke: A Diffusion Tensor Imaging Study[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(1): 31-36.

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镜像疗法促进脑卒中上肢功能恢复和皮质脊髓束重塑的弥散张量成像研究

Effects of Mirror Therapy on Upper Limb Motor Function and Corticospinal Tract Remodeling after Stroke: A Diffusion Tensor Imaging Study

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