| 周星辰;吕智桢;黄玉波;吴双;洪泽;吕立江.基于静息态功能磁共振探讨杠杆定位手法治疗腰椎间盘突出症的即刻脑网络效应[J].,2024,44(1):49-55 |
| 基于静息态功能磁共振探讨杠杆定位手法治疗腰椎间盘突出症的即刻脑网络效应 |
| Study on the Immediate Brain Network Effect of Lever Positioning Manipulation in the Treatment of Lumbar Disc Herniation Based on Resting State Functional Magnetic Resonance Imaging |
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| DOI：10.7661/j.cjim.20230731.285 |
| 中文关键词: 推拿 杠杆定位手法 腰椎间盘突出症 功能磁共振 即刻脑效应 |
| 英文关键词:massage （Tuina） lever positioning manipulation lumbar disc herniation magnetic resonance imaging Real-time brain activity |
| 基金项目:浙江省“尖兵”“领雁”重大研发攻关项目（No.2022C03123）;国家自然科学基金资助项目（No.82274672，No.81774442） |
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| 中文摘要: |
| 目的 运用静息态功能磁共振成像技术（rs-fMRI），观察杠杆定位手法（LPM）干预腰椎间盘突出症（LDH）的即刻脑网络效应。方法 纳入19例LDH患者（简称LDH组）及20名健康者（对照组），LDH组采用LPM治疗30 min，并于治疗前后行rs-fMRI扫描，健康组仅纳入时行rs-fMRI扫描。分析入组时LDH组与健康组在除均值标准化低频振幅（mALFF）有统计学意义的脑区，并以差异有统计学意义的脑区为感兴趣区（ROI）分析LDH组治疗前治疗后即刻的功能连接（FC）变化。结果 与健康组比较，治疗前LDH组在左侧顶上回、双侧楔前叶、右侧背外侧额上回的mALFF显著增强；在左侧中央后回的mALFF值显著降低（P＜0.05）。不同脑区，mALFF值最大的是右侧楔前叶。以右侧楔前叶所在团块峰值坐标划定10 mm半径作为ROI进行FC分析，与健康组比较，LDH组治疗前在右侧背外侧额上回、左侧中央前回及左侧背外侧额上回的FC值显著增强，在左侧内侧和旁扣带脑回的FC值显著降低（P＜0.05）。以右侧楔前叶划定10 mm半径作为ROI进行FC分析，与治疗前比较，治疗后LDH组在左侧内侧和旁扣带脑回、左侧楔前叶、右侧后扣带回、右侧中央旁小叶及左侧背外侧额上回的FC增强（P＜0.05）。结论 LDH患者的长期慢性疼痛存在“默认网络—背外侧前额叶—第一感觉皮层”（DMN-dlPFC-S1）神经环路的显著激活。执行控制网络—默认网络—背外侧前额叶（ECN-DMN-dlPFC）可能是LPM干预LDH患者发挥即刻镇痛起效的关键神经环路。 |
| 英文摘要: |
| Objective To observe the effect of lever positioning manipulation （LPM） on the immediate brain network in patients with lumbar disc herniation （LDH） using resting state functional magnetic resonance imaging （rs-fMRI）. Methods Totally 19 patients with LDH （the LDH group）and 20 healthy people （the healthy control group） in line with inclusion criteria were enrolled. Those in LDH group were treated with LPM for 30 min， and rs-fMRI was performed before and after treatment. Those in healthy control group were only scanned with rs-fMRI when included. Brain regions with statistical significance in the mean normalized low-frequency amplitude （mALFF） were analyzed between the LDH group and the healthy control group at enrollment. Functional connectivity （FC） changes in the LDH group before and immediately after treatment using statistically significant brain regions as regions of interest （ROI） were analyzed. Results Compared with the healthy control group， mALFF of left superior parietal gyrus， bilateral anterior cuneiform lobe， and right dorsolateral superior frontal gyrus were significantly enhanced in the LDH group before treatment. mALFF value in the left posterior central gyrus decreased significantly （P＜0.005）. In different brain regions， the maximum mALFF value was in the right anterior cuneiform lobe. The right anterior cuneiform lobe mass peak coordinate was demarcated with a radius of 10 mm as the ROI for FC analysis. Compared with the healthy control group， the FC values in the right dorsolateral superior frontal gyrus， the left anterior central gyrus， and the left dorsolateral superior frontal gyrus were significantly enhanced in LDH group before treatment， and the FC values in the left medial and paracingulate gyrus were significantly lowered （P＜0.05）. The right anterior cuneiform lobe was demarcated with a radius of 10 mm as ROI for FC analysis. Compared with before treatment， FC in left medial and paracingulate gyrus， left anterior cuneiform lobe， right posterior cingulate gyrus， right paracentral lobule， and left dorsolateral superior frontal gyrus were enhanced in LDH group after treatment （P＜0.05）. Conclusions There existed significant activation of "default mode network-dorsolateral prefrontal cortex-S1" （"DMN-dlPFC-S1"） neural circuit in chronic pain of LDH patients. Executive control network-default mode network-dorsolateral prefrontal cortex （ECN-DMN-dlPFC） might be the key neural circuit for LPM to intervene LDH patients to exert immediate analgesia. |
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