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目的应用弥散张量成像技术(DTI)对急性脑梗死患者的皮质脊髓束(CST)进行三维重建,评估CST的形态改变,同时结合日常生活活动能力评定量表(ADL)判断患者肢体功能及评估预后。方法收集2012年6月—2013年6月在神经内科住院的39例急性脑梗死患者,初次发病,病程在3 d内,均为颈内动脉系统梗死患者,有不同程度的一侧肢体瘫痪,梗死灶仅累及白质而无皮质灰质受侵,符合中国缺血性卒中诊治指南诊断标准。其中男性患者27例,女性患者12例,年龄49~75岁,平均年龄(62.03±5.57)岁,所有病例均行MRI、DWI及DTI检查,39例患者通过DTI检查后按锥体束受累情况不同分为3组。各组按神经内科常规治疗,并在治疗2周和治疗4周后分别进行ADL评定,依据ADL分值判定患者肢体功能损伤程度。所得数据运用SPSS 13.0进行统计分析。结果 CST受累程度低的患者经过治疗后其肢体功能恢复比CST受累程度高的患者好(F=26.76,F=30.22,P<0.05)。并且CST受累程度较轻(CST受累为1级和2级)的患者随着治疗时间的推移,其肢体功能在逐渐恢复(t=5.38和t=3.21,P<0.05);CST受累较重(CST受累为3级)的患者虽然经较长时间的积极治疗,但其肢体功能恢复不明显(t=0.62,P>0.05)。结论弥散张量成像技术可以无创、直观显现梗死病灶对皮质脊髓束的损害,可对神经纤维损伤情况进行判定,对预测急性脑梗死患者肢体功能的恢复有一定价值。
Objective To evaluate the morphological changes of CST by using diffusion tensor imaging (DTI) in three-dimensional reconstruction of corticospinal tract (CST) in patients with acute cerebral infarction, and to assess the function of limbs in patients with ADL combined with daily life activity assessment (ADL) Prognosis. Methods Thirty-nine patients with acute cerebral infarction who were hospitalized in neurology from June 2012 to June 2013 were enrolled in the study. Their initial onset and course of disease were within 3 days. All of them were patients with internal carotid artery infarction with paralysis on one side of limbs, Infarct involvement only white matter without cortical gray matter invasion, in line with the guidelines for diagnosis and treatment of ischemic stroke in China diagnostic criteria. Among them, there were 27 males and 12 females, aged from 49 to 75 years, with an average age of (62.03 ± 5.57) years. All cases underwent MRI, DWI and DTI examinations. 39 patients underwent pyramidal tract involvement after DTI examination Divided into three different groups. Each group was routinely treated by neurology, and ADL assessment was performed after two weeks of treatment and four weeks of treatment, respectively. The degree of functional impairment was evaluated according to ADL score. The data obtained using SPSS 13.0 for statistical analysis. Results In patients with low CST, the functional recovery of their limbs was better than those with high CST (F = 26.76, F = 30.22, P <0.05). (C = t = 3.21, t = 3.21, P <0.05). Patients with severe CST involvement (CST involvement of grade 1 and grade 2) recovered gradually with treatment time (t = 5.38 and t = 3.21, Although the patients with CST involvement were grade 3, their functional recovery was insignificant (t = 0.62, P> 0.05) after a long period of active treatment. Conclusions Diffusion tensor imaging can determine the damage to the corticospinal tract by noninvasive visualization of the infarct lesion, and determine the damage of nerve fibers. It is of value in predicting the recovery of limb function in patients with acute cerebral infarction.