中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2017, Vol. 12 ›› Issue (9): 1465-1471.doi: 10.4103/1673-5374.215258

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

步态异常发育迟滞患儿皮质网状束损伤的弥散张量纤维束成像评价

  

  • 收稿日期:2017-05-11 出版日期:2017-09-15 发布日期:2017-09-15
  • 基金资助:

    韩国教育、科学技术部国家基础科学研究项目

Corticoreticular tract lesion in children with developmental delay presenting with gait dysfunction and trunk instability

Yong Min Kwon1, Jessica Rose2, Ae Ryoung Kim1, Su Min Son1   

  1. 1 Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Taegu, Republic of Korea
    2 Department of Orthopedic Surgery, College of Medicine, Stanford University, Stanford, CA, USA
  • Received:2017-05-11 Online:2017-09-15 Published:2017-09-15
  • Contact: Su Min Son, M.D., Ph.D.,sumin430@hanmail.net.
  • Supported by:

    This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012-013997).

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摘要：

 

皮质网状束功能可涉及行走和姿势控制，研究应用弥散张量纤维束成像检测了患儿步态异常和躯干不稳定患儿的皮质网状束损伤情况。纳入的受试者包括30例发育延滞的患儿和15名年龄相匹配的正常发育儿童。患儿包括15例双侧躯干不稳的步态异常者和15例单侧躯干不稳的步态异常者。应用弥散张量纤维束成像检测皮质网状束各向异性分数，表观扩散系数，纤维数量，以及皮质网状束与皮质脊髓束的神经纤维束整合性。研究显示，双侧躯干不稳的步态异常者双侧皮质网状束都被破坏，而在单侧躯干不稳的步态异常者中观察到临床表现对侧半球的皮质网状束中断。双侧躯干不稳的步态异常者双侧皮质网状束的各向异性分数和纤维数量均较正常发育儿童明显减少。单侧躯干不稳的步态异常者的病灶侧皮质网状束的各向异性分数和纤维数量下降更明显。相关分析显示，功能评估结果和临床表现均与皮质网状束状态相关，但与皮质脊髓束状态无关。由此认为，弥散张量纤维束成像有助于评估步态异常的发育迟滞患儿皮质网状束状态。

 

orcid:0000-0003-1185-1858(Su Min Son)

关键词: 神经再生, 皮质网状束, 皮质脊髓束, 步态, 躯干, 弥散张量成像, 躯干控制, 运动功能

Abstract:

The corticoreticular tract (CRT) is known to be involved in walking and postural control. Using diffusion tensor tractography (DTT), we investigated the relationship between the CRT and gait dysfunction, including trunk instability, in pediatric patients. Thirty patients with delayed development and 15 age-matched,typically-developed (TD) children were recruited. Fifteen patients with gait dysfunction (bilateral trunk instability) were included in the group A, and the other 15 patients with gait dysfunction (unilateral trunk instability) were included in the group B. The Growth Motor Function Classification System, Functional Ambulation Category scale, and Functional Ambulation Category scale were used for measurement of functional state. Fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract were measured. Diffusion parameters or integrity of corticospinal tract were not significantly different in the three study groups. However, CRT results revealed that both CRTs were disrupted in the group A, whereas CRT disruption in the hemispheres contralateral to clinical manifestations was observed in the group B. Fractional anisotropy values and fiber numbers in both CRTs were decreased in the group A than in the group TD. The extents of decreases of fractional anisotropy values and fiber numbers on the ipsilateral side relative to those on the contralateral side were greater in the group B than in the group TD. Functional evaluation data and clinical manifestations were found to show strong correlations with CRT status, rather than with corticospinal tract status. These findings suggest that CRT status appears to be clinically important for gait function and trunk stability in pediatric patients and DTT can help assess CRT status in pediatric patients with gait dysfunction.

Key words: nerve regeneration, corticoreticular tract, corticospinal tract, gait, trunk, diffusion tensor, Trunk Control Measurement Scale, Functional Ambulation Category, Growth Motor Function Classification System, cerebral palsy, motor, neural regeneration