CHANGES IN SENSATION AFTER NERVE INJURY OR AMPUTATION - THE ROLE OF CENTRAL FACTORS
CHANGES IN SENSATION AFTER NERVE INJURY OR AMPUTATION - THE ROLE OF CENTRAL FACTORS
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DOI：
10.1136/jnnp.56.4.393
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发表时间：
1993-04-01
影响因子：
11
通讯作者：
SCHADY, W
中科院分区：
文献类型：
--
作者：
BRAUNE, S;SCHADY, W
在周围神经切断或切断的实验动物中，体感皮层地图的动态变化是已知的。为了研究中枢神经系统适应暂时或永久性的输入从手的一部分，多模态定量感觉测试进行了11例完全创伤性分裂和修复的正中或尺神经和6例患者谁经历了截肢的一个或多个数字。正如预期的那样，振动，两点歧视，触觉阈值在受伤的神经的领土在一个分级的方式，敏感性最差的患者最近的伤害。令人惊讶的是，定位是更好的提示比在基地的hypoaesthetic手指，这表明中央注意力梯度。刺激-反应曲线符合幂函数，其指数在失神经支配的皮肤高于正常皮肤。心理生理功能的变化在完整的手也是明显的。在邻近受伤神经的区域或截肢者的残肢中没有感觉过敏。中枢因素有助于神经损伤后出现的感觉变化，但部分传入神经阻滞后皮质重组的功能效应比周围皮肤敏感性的简单提高更为微妙。
Dynamic changes in somatosensory cortical maps are known to occur in experimental animals subjected to peripheral nerve transection or amputation. To study the sensory effects of central nervous system adaptation to temporary or permanent loss of input from a part of the hand, multimodality quantitative sensory tests were carried out in 11 patients with complete traumatic division and repair of the median or ulnar nerves and in six patients who had undergone amputation of one or more digits. As expected, vibration, two point discrimination, and tactile thresholds were raised in the territory of the injured nerve in a graded fashion, sensitivity being poorest in the patients with the most recent injuries. Surprisingly, localisation was better in the tips than at the base of the hypoaesthetic fingers, suggesting a central attentional gradient. Stimulus-response curves conformed to a power function whose exponent was higher in denervated than in normal skin. Changes in psychophysical functions were also discernible in the intact hand. There was no hyperaesthesia in the territory of the nerve adjacent to the injured one or in the stump in the case of amputees. Central factors contribute to the sensory changes seen after nerve injury, but the functional effects of the cortical reorganisation that follows partial deafferentation are more subtle than a simple heightening of sensitivity in the surrounding skin.