慢性腰痛患者在站立平衡任务期间感觉运动相关皮层的激活特征

关键词：慢性腰痛  平衡  辅助运动区  功能性近红外脑功能成像

Keywords:chronic low back pain  balance  supplementary motor area  functional near-infrared spectroscopy

摘要：

      摘要 目的：利用功能性近红外脑功能成像技术（fNIRS）对比健康志愿者与慢性腰痛（CLBP）患者在站立平衡任务期间感觉运动相关皮质的激活水平，并探究CLBP患者的姿势控制表现与感觉运动相关皮质激活水平之间的关系。 方法：纳入20例符合要求的CLBP患者（CLBP组）和20例健康志愿者（健康对照组）进行双脚站立和单脚站立平衡任务。使用便携式fNIRS设备记录站立平衡任务期间的感觉运动相关皮质的活动，选择双侧辅助运动区（SMA）和感觉运动皮层（SMC）作为感兴趣区域。使用压力平台记录平衡参数，包括压力中心（COP）的前后摇摆速度、左右摇摆速度、摇摆面积和摇摆轨迹。 结果：站立平衡表现：重复测量方差分析结果表明，前后摇摆速度和摇摆轨迹显示出显著的交互效应（P<0.05），左右摇摆速度显示出显著的组间主效应（P=0.014）。事后检验的结果显示，在左单脚站立任务期间CLBP组具有更高的前后摇摆速度（P=0.006）和摇摆轨迹（P=0.014）。皮层激活水平：双侧SMA总激活水平显示出显著的组间主效应（P=0.048），站立任务期间CLBP组的双侧SMA总激活水平显著高于健康对照组，而SMC的激活水平并未显示出显著的交互效应或组间主效应（P>0.05）。站立平衡表现和皮层激活水平之间的关系：在单脚站立期间，CLBP组的COP参数与SMC和SMA的激活水平之间存在显著的相关性。 结论：在站立平衡任务期间，CLBP患者显示出更高的感觉运动相关皮层的激活，CLBP患者的姿势控制障碍可能与SMA较低的神经效率有关。

Abstract:

      Abstract Objective： To compare sensorimotor-related cortical activation during upright stance tasks between patients with chronic low back pain （CLBP） and healthy volunteers using functional near-infrared spectroscopy （fNIRS） and to explore the relationship between postural control performance and sensorimotor-related cortical activation in CLBP patients. Method： Twenty eligible CLBP patients （CLBP group） and 20 healthy volunteers （healthy control group） were required to perform upright stance tasks： ①Standing still on a stable plane with eyes open； ②One-leg standing on a stable plane with eyes open. A wireless fNIRS system measured cortical activity during upright stance tasks， selecting bilateral supplementary motor area （SMA） and sensorimotor cortex （SMC） as regions of interest. A force platform measured balance parameters， including anteroposterior sway velocity， mediolateral sway velocity， sway area， and sway length of the center of pressure （COP）. Result： Standing balance performance： The results of repeated-measure ANOVA showed the significant interaction in anteroposterior sway velocity and sway length （P<0.05）, and a significant main effect between groups was found in mediolateral sway velocity （P=0.014）. The post-hoc tests showed that the CLBP group had higher anteroposterior sway velocity （P=0.006） and sway length （P=0.014） during the left one-leg standing task. Cortical activation： The bilateral SMA activation showed a significant main effect between groups（P=0.048）. During the upright stance tasks， the bilateral SMA activation in the CLBP group was significantly higher than that in the healthy control group， and the SMC activation did not show significant interaction effects or between-group effects （P>0.05）. Relationship between standing balance performance and cortical activation： The correlation analysis results showed significant correlations between the COP parameters and the SMC and SMA activation in the CLBP group during one-leg standing. Conclusion： During upright stance，CLBP patients exhibited higher brain activation in sensorimotor-related areas. The postural control disorder in patients with CLBP may be related to the low neural efficiency in the SMA.