Chemnitz Anette, Weibull Andreas, Rosén Birgitta, Andersson Gert, Dahlin Lars B, Björkman Anders
Department of Clinical Sciences Malmö - Hand Surgery, Lund University, Skåne University Hospital, SE - 20502, Malmö, Sweden.
Department of Medical Radiation Physics, Lund University, Skåne University Hospital, Malmö, Sweden.
Eur J Neurosci. 2015 Aug;42(4):2022-7. doi: 10.1111/ejn.12917. Epub 2015 May 9.
The clinical outcome following a peripheral nerve injury in the upper extremity is generally better in young children than in teenagers and in adults, but the mechanism behind this difference is unknown. In 28 patients with a complete median nerve injury sustained at the ages of 1-13 years (n = 13) and 14-20 years (n = 15), the cortical activation during tactile finger stimulation of the injured and healthy hands was monitored at a median time since injury of 28 years using functional magnetic resonance imaging (fMRI) at 3 Tesla. The results from the fMRI were compared with the clinical outcome and electroneurography. The cortical activation pattern following sensory stimulation of the median nerve-innervated fingers was dependent on the patient's age at injury. Those injured at a young age (1-13 years) had an activation pattern similar to that of healthy controls. Furthermore, they showed a clinical outcome significantly superior (P = 0.001) to the outcome in subjects injured at a later age; however, electroneurographical parameters did not differ between the groups. In subjects injured at age 14-20 years, a more extended activation of the contralateral hemisphere was seen in general. Interestingly, these patients also displayed changes in the ipsilateral hemisphere where a reduced inhibition of somatosensory areas was seen. This loss of ipsilateral inhibition correlated to increasing age at injury as well as to poor recovery of sensory functions in the hand. In conclusion, cerebral changes in both brain hemispheres may explain differences in clinical outcome following a median nerve injury in childhood or adolescence.
上肢周围神经损伤后，幼儿的临床预后通常比青少年和成年人更好，但这种差异背后的机制尚不清楚。在28例年龄在1至13岁（n = 13）和14至20岁（n = 15）时遭受正中神经完全损伤的患者中，使用3特斯拉的功能磁共振成像（fMRI），在受伤后中位时间28年时监测受伤手和健康手在手指触觉刺激期间的皮质激活情况。将fMRI的结果与临床预后和神经电生理检查结果进行比较。正中神经支配手指感觉刺激后的皮质激活模式取决于患者受伤时的年龄。那些在幼年（1至13岁）受伤的患者具有与健康对照相似的激活模式。此外，他们的临床预后明显优于（P = 0.001）较晚受伤的受试者；然而，两组之间的神经电生理参数没有差异。在14至20岁受伤的受试者中，一般可见对侧半球更广泛的激活。有趣的是，这些患者同侧半球也出现了变化，即体感区域的抑制作用减弱。同侧抑制的丧失与受伤时年龄的增加以及手部感觉功能恢复不良相关。总之，两个脑半球的大脑变化可能解释儿童或青少年正中神经损伤后临床预后的差异。
