Gao Ge-jun, Feng Xiao-yuan, Xu Wen-dong, Gu Yu-dong, Tang Wei-jun, Li Ke, Li Yuan, Geng Dao-ying
Department of Radiology, Huashan Hospital, Shanghai 200040, China.
Zhonghua Yi Xue Za Zhi. 2005 Jul 6;85(25):1752-6.
To map dynamic changes of primary motor cortex after total brachial plexus traction injury by using functional magnetic resonance imaging, and to explore underlying probable mechanisms.
Five patients with total traumatic root avulsions of the brachial plexus underwent varied kinds of nerve transfer to restore partially shoulder or elbow function. Four of them (cases 1, 3, 4, 5) accepted the first fMRI examination prior to surgery treatment, and four of them (cases 2, 3, 4, 5) accepted second or third or fourth fMRI follow-up re-examinations after surgery treatment. Maps of neuronal activation within the motor cortex were generated for both hands in each patient by using BOLD-fMRI and the cluster size and position were recorded. The motor tasks consisted of simple hand grasping of both hands respectively. Patients with paralytic hand were asked to complete task under "virtual" condition. The cluster size and intensity as well as location of motor activation within the primary motor cortex of the affected hand generated were compared with those of unaffected hand generated as reference in single subject, and the resultant maps of follow-up re-examinations were also compared with those of the prior examinations.
All patients' unaffected hand movement generated strong signal change within the contralateral primary motor cortex. In contrast, the clusters generated by affected hand showed very small and lower intensity than usual (2 cases) or could not be induced (2 case) in the first examination that prior to surgery treatment and seemed larger gradually in the following re-examination with time increasing.
Peripheral nerve injury can produced significant changes in the motor cortex of human brain. fMRI is a valuable tool to evaluate neural plasticity in motor cortex after peripheral nerve injury.
运用功能磁共振成像技术描绘全臂丛神经牵拉伤后初级运动皮层的动态变化，并探究其潜在的可能机制。
5例全臂丛神经创伤性神经根撕脱伤患者接受了各种神经移位术以部分恢复肩部或肘部功能。其中4例（病例1、3、4、5）在手术治疗前接受了首次功能磁共振成像检查，4例（病例2、3、4、5）在手术治疗后接受了第二次、第三次或第四次功能磁共振成像随访复查。通过血氧水平依赖性功能磁共振成像技术为每位患者的双手生成运动皮层内神经元激活图，并记录簇大小和位置。运动任务包括分别简单地双手抓握。瘫痪手的患者被要求在“虚拟”条件下完成任务。将患侧手在初级运动皮层内产生的运动激活的簇大小、强度以及位置与作为对照的健侧手所产生的进行单受试者内比较，并且随访复查的结果图也与先前检查的结果图进行比较。
所有患者健侧手的运动在对侧初级运动皮层内产生强烈的信号变化。相比之下，患侧手在手术治疗前的首次检查中所产生的簇非常小且强度低于正常（2例）或无法诱发（2例），并且在随后的复查中随着时间推移似乎逐渐变大。
周围神经损伤可导致人脑运动皮层发生显著变化。功能磁共振成像是评估周围神经损伤后运动皮层神经可塑性的一种有价值的工具。
