刘凯,徐志鹏,王强.前交叉韧带断裂患者本体感觉和脑灰质体积变化的研究[J].中华物理医学与康复杂志,2020,42(4):339-343
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| 前交叉韧带断裂患者本体感觉和脑灰质体积变化的研究 |
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| DOI：10.3760/cma.j.issn.0254-1424.2020.04.012 |
| 中文关键词: 断裂,前交叉韧带 本体感觉 标准灰质体积 磁共振成像 |
| 英文关键词: Anterior cruciate ligament Proprioception Grey matter volume MRI Star excursion balance test |
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| 中文摘要: |
| 目的 探索前交叉韧带断裂患者本体感觉的改变和脑结构重塑的特征，以及两者的关系。 方法 纳入经临床资料和影像学诊断证实的单纯右侧前交叉韧带完全断裂且右利手男性患者18例设为病例组，另选取活动水平相匹配的右利手健康男性18例作为对照组。分别使用膝关节稳定度测试仪（Kneelax3，荷兰）、等速肌力测试系统（ISOmed2000，美国）、改良的星偏移平衡测试（mSEBT）、单腿跳距离（SHD）测试等设备和方法对受试的胫骨前移程度（APST）、主动关节位置觉（AART）、平衡功能等方面进行评估；脑结构图像使用磁共振成像设备（3.0T）采集并使用SPM 8软件进行分析，并分析脑标准灰质体积变化与患者功能的相关性。 结果 病例组的APST、AART、mSEBT、SHD等各项指标与对照组比较，差异均有统计学意义（P＜0.01）。与对照组相比，病例组的左侧小脑脚1区部位标准灰质体积显著增大，右侧大脑的辅助运动区、顶上回、顶下缘角回、尾状核和海马旁回部位显著减小。经Pearson相关分析发现，右侧辅助运动区、顶上回、顶下缘角回、尾状核的标准灰质体积变化与mSEBT得分显著负相关（P＜0.05）。 结论 前交叉韧带断裂患者的神经肌肉控制能力下降且脑结构发生了可塑性改变；前交叉韧带断裂患者的运动控制策略由皮质向皮质下运动控制策略转移；mSEBT可间接反映前交叉韧带断裂患者脑结构的变化。 |
| 英文摘要: |
| Objective To investigate any changes in proprioception or grey matter volume (GMV) after anterior cruciate ligament (ACL) rupture. Methods Eighteen male patients with right-side ACL rupture (diagnosed through clinical examination and MRI) and healthy right hand function constituted the case group, while another 18 right-handed healthy counterparts were enrolled as the control group. Proprioception, balance and functional performance were assessed for both groups using the anteroposterior shift of the tibia (APST), an active angle reproduction test (AART), a modified star excursion balance test (mSEBT) and single-leg hop distance (SHD). MRI (at 3.0T) was used to collect the brain structure images and SPM8 software was used to perform voxel-based morphometry. Any correlation between changes in function and GMV were analyzed. Results Significant differences were observed between the two groups in their average APST, AART, SEBT and SHD scores. Compared with the healthy controls, the average volume of grey matter in the cerebelum-crus1-L was significantly larger in the case group, while their Supp_Motor_Area_R, Parietal_Sup_R, Parietal_Inf_R, Caudate_R and ParaHippocampal_R grey matter volumes were significantly smaller. Among the case group, the average volumes of their Supp_Motor_Area_Rs, Parietal_Sup_Rs, Parietal_Inf_Rs, and Caudate_Rs were negatively correlated with their mSEBT scores. Conclusions The brain′s structure changes after ACL rupture and neuromuscular control becomes impaired. The cortical motor control strategy shifts to subcortical motor control after ACL rupture. The mSEBT can reflect indirectly the changes in brain structure plasticity after ACL rupture. |
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