基于fMRI对视觉反馈平衡仪联合腕踝针治疗脑卒中后平衡障碍的机制

Study on the mechanism of visual feedback balance instrument combined with wrist ankle acupuncture in the treatment of balance disorder after stroke and its effects on fMRI

目的观察视觉反馈平衡仪联合腕踝针治疗脑卒中后平衡障碍的临床疗效及功能磁共振成像(fMRI)变化。方法采用随机数字表法将康复科住院的90例脑卒中后平衡障碍患者分为对照组、平衡组和联合组,各30例。所有患者均接受常规脑卒中康复训练,平衡组在此基础上增加视觉反馈平衡训练仪,联合组在平衡组的基础上增加踝关节的围刺法治疗。分别在治疗前、治疗后2周和4周时测定3组患者平衡指标并进行静息态血氧水平依赖性功能磁共振成像(BOLD-fMRI)和弥散张量成像(DTI)的检查,比较3组患者平衡参数、各脑区[感觉运动区(SMC区)、辅助运动区(SMA区)、主运动区(M1区)、小脑]的比率低频振幅(fALFF)和皮质脊髓束的各向异性分数(FA)值。结果治疗后2周和4周时,3组患者轨迹长、左右偏离、外周面积和矩形面积等重心转移轨迹参数,X轴重心转移距离均值(Mean-X)、Y轴重心转移距离均值(Mean-Y)、X轴重心转移距离最大值(Max-X)、Y轴重心转移距离最大值(Max-Y)、重心转移距离(LSKG)、重心转移面积(SSKG)、重心转移面积比(LFS)等重心转移距离参数以及体质量分布系数(WDI)和稳定性系数(SI)均显著降低,单位面积轨迹长均显著增加(P<0.05)。联合组患者治疗后2周和4周时的轨迹长、左右偏离、外周面积和矩形面积等重心轨迹参数,Mean-X、Mean-Y、Max-X、Max-Y、LSKG、SSKG、LFS等重心转移距离参数以及WDI和SI均显著小于对照组和平衡组,单位面积轨迹长显著大于对照组和平衡组(P<0.05)。经过治疗,3组患者SMC区、M1区、SMA区和小脑等fALFF以及患侧皮质脊髓束FA均呈显著增加趋势(P<0.05)。联合组患者治疗后2周和4周时SMC区、M1区、SMA区和小脑等fALFF以及患侧皮质脊髓束FA均显著大于对照组和平衡组,平衡组显著大于对照组,差异有统计学意义(P<0.05)。结论视觉反馈平衡仪联合腕踝针能够有效改善脑卒中后平衡障碍患者平衡功能,这与脑卒中后神经可塑和运动功能重组有关,可将fALFF和FA作为平衡障碍康复指标使用。

Objective To observe the clinical effect ofvisual feedback balance instrument combined with wrist ankle acupuncture on balance disorder after stroke and the changes of functional magnetic resonance image(fMRI).Methods Ninety patients with poststroke balance disorder were randomly divided into control group,balance group and combination group(n=30).All patients received routine stroke rehabilitation training.The balance group added visual feedback balance training instrument on this basis,and the combined group added ankle joint peripheral acupuncture treatment on the basis of the balance group.The balance indexes of the three groups of patients were measured before treatment,and 2 weeks and 4 weeks after treatment;and BOLD-fMRI and DTI were performed at rest.The balance parameters,ratio low frequency amplitude(fALFF)of each brain regions(sensorimotor region,auxiliary motor region,main motor region,cerebellum)and anisotropy fraction(FA)of corticospinal tract were compared among the three groups.Results Two and four weeks after treatment,the parameters of barycenter transfer trajectory,such as track length,left and right deviation,peripheral area and rectangular area,the parameters of barycenter transfer distance,such as Mean-X,Mean-Y,Max-X,Max-Y,LSKG,SSKG,LFS,WDI and SI,of the three groups were significantly reduced,and the track lengths per unit area were significantly increased(P<0.05).Two and four weeks after treatment,the center of gravity trajectory parameters,such as track length,left and right deviation,peripheral area and rectangular area,the center of gravity transfer distance parameters,such as Mean-X,Mean-Y,Max-X,Max-Y,LSKG,SSKG,LFS,and WDI and SI,of patients in the combined group were significantly smaller than those in the control group and the balance group;and the track length of monophasic area was significantly larger than those in the control group and the balance group(P<0.05).After treatment,fALFF in SMC,M1,SMA and cerebellum of the three groups and FA in the affected corticospinal tract showed significant increase trend(P<0.05).Two and four weeks after treatment,fALFF in SMC,M1,SMA and cerebellum,and FA in the affected corticospinal tract in the combined group were significantly greater than those in the control group and the balance group,and those in the balance group were significantly greater than the control group(P<0.05).Conclusion Visual feedback balance instrument combined with wrist ankle acupuncture can effectively improve the balance function of patients with balance disorder after stroke,which is correlated to neural plasticity and motor function reorganization after stroke.fALFF and FA can be used as rehabilitation indicators of balance disorder.