目的:分析轻中度青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)患者Cobb角与X线片直线棘突角(spinous process angle,SPA)、体表直线SPA相关性,探讨直线SPA评估脊柱侧弯的可能性。方法:Cobb角与X线片直线棘突角相关性研...目的:分析轻中度青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)患者Cobb角与X线片直线棘突角(spinous process angle,SPA)、体表直线SPA相关性,探讨直线SPA评估脊柱侧弯的可能性。方法:Cobb角与X线片直线棘突角相关性研究为单中心回顾性研究,纳入自2019年1月至2021年12月脊柱全长正位X线片的AIS患者,测量患者直线SPA与Cobb角,并对两者进行相关性分析。Cobb角与体表直线SPA相关性研究为前瞻性研究,纳入自2022年12月1日至2022年12月9日就诊的AIS患者,测量Cobb角与站立位下体表直线SPA,并对两者进行相关性分析。结果:回顾性研究中共纳入113例AIS患者,男26例,女87例,年龄10~18(14.02±2.16)岁;轻度AIS患者71例,中度AIS患者42例。AIS患者Cobb角与直线SPA存在明显负相关(r=-0.564,P<0.001),两者线性回归方程为:Cobb角=169.444-0.878×SPA;轻度侧弯患者Cobb角与直线SPA存在明显负相关(r=-0.269,P=0.012),其线性回归方程为:Cobb角=46.832-0.185×SPA;中度侧弯患者Cobb角与直线SPA也具有明显相关性(r=-0.417,P=0.003),其线性回归方程为:Cobb角=113.889-0.516×SPA。前瞻性研究纳入38例患者,Cobb角11.3°~36.0°(18.70±6.98)°;体表直线SPA 162.1°~177.7°(170.34±4.57)°;两者存在明显负相关(r=-0.651,P<0.001),其线性回归方程为:Cobb角=187.91-0.99×SPA。结论:X线片直线SPA、体表直线SPA与Cobb角均呈明显负相关,其相关程度略低于曲线SPA,为中等强度相关;两者回归方程拟合性欠佳,不适合用于脊柱侧弯的诊断;但是直线SPA可能适合用于评估自身对照的治疗效果以及脊柱柔韧性。展开更多
Objective:To elucidate how spinal manipulative therapy(SMT)exerts its analgesic effects through regulating brain function in lumbar disc herniation(LDH)patients by utilizing resting-state functional magnetic resonance...Objective:To elucidate how spinal manipulative therapy(SMT)exerts its analgesic effects through regulating brain function in lumbar disc herniation(LDH)patients by utilizing resting-state functional magnetic resonance imaging(rs-f MRI).Methods:From September 2021 to September 2023,we enrolled LDH patients(LDH group,n=31)and age-and sex-matched healthy controls(HCs,n=28).LDH group underwent rs-f MRI at 2 distinct time points(TPs):prior to the initiation of SMT(TP1)and subsequent to the completion of the SMT sessions(TP2).SMT was administered once every other day for 30 min per session,totally 14 treatment sessions over a span of 4 weeks.HCs did not receive SMT treatment and underwent only one f MRI scan.Additionally,participants in LDH group completed clinical questionnaires on pain using the Visual Analog Scale(VAS)and the Japanese Orthopedic Association(JOA)score,whereas HCs did not undergo clinical scale assessments.The effects on the brain were jointly characterized using the amplitude of low-frequency fluctuations(ALFF)and regional homogeneity(Re Ho).Correlation analyses were conducted between specific brain regions and clinical scales.Results:Following SMT treatment,pain symptoms in LDH patients were notably alleviated and accompanied by evident activation of effects in the brain.In comparison to TP1,TP2 exhibited the most significant increase in ALFF values for Temporal_Sup_R and the most notable decrease in ALFF values for Paracentral_Lobule_L(voxelwise P<0.005;clusters>30;FDR correction).Additionally,the most substantial enhancement in Re Ho values was observed for the Cuneus_R,while the most prominent reduction was noted for the Olfactory_R(voxelwise P<0.005;clusters>30;FDR correction).Moreover,a comparative analysis revealed that,in contrast to HCs,LDH patients at TP1 exhibited the most significant increase in ALFF values for Temporal_Pole_Sup_L and the most notable decrease in ALFF values for Frontal_Mid_L(voxelwise P<0.005;clusters>30;FDR correction).Furthermore,the most significant enhancement in Re Ho values was observed for Postcentral_L,while the most prominent reduction was identified for Para Hippocampal_L(voxelwise P<0.005;clusters>30;FDR correction).Notably,correlation analysis with clinical scales revealed a robust positive correlation between the Cuneus_R score and the rate of change in the VAS score(r=0.9333,P<0.0001).Conclusions:Long-term chronic lower back pain in patients with LDH manifests significant activation of the"AUN-DMN-S1-SAN"neural circuitry.The visual network,represented by the Cuneus_R,is highly likely to be a key brain network in which the analgesic efficacy of SMT becomes effective in treating LDH patients.(Trial registration No.NCT 06277739)展开更多
基金Supported by the General Program of the National Natural Science Foundation of China(No.82274672)the"Pioneer"and"Leading Goose"R&D Program of Zhejiang Province(No.2022C03123)the Scientific Research Project of the Zhejiang Provincial Department of Education(No.Y202351266)。
文摘Objective:To elucidate how spinal manipulative therapy(SMT)exerts its analgesic effects through regulating brain function in lumbar disc herniation(LDH)patients by utilizing resting-state functional magnetic resonance imaging(rs-f MRI).Methods:From September 2021 to September 2023,we enrolled LDH patients(LDH group,n=31)and age-and sex-matched healthy controls(HCs,n=28).LDH group underwent rs-f MRI at 2 distinct time points(TPs):prior to the initiation of SMT(TP1)and subsequent to the completion of the SMT sessions(TP2).SMT was administered once every other day for 30 min per session,totally 14 treatment sessions over a span of 4 weeks.HCs did not receive SMT treatment and underwent only one f MRI scan.Additionally,participants in LDH group completed clinical questionnaires on pain using the Visual Analog Scale(VAS)and the Japanese Orthopedic Association(JOA)score,whereas HCs did not undergo clinical scale assessments.The effects on the brain were jointly characterized using the amplitude of low-frequency fluctuations(ALFF)and regional homogeneity(Re Ho).Correlation analyses were conducted between specific brain regions and clinical scales.Results:Following SMT treatment,pain symptoms in LDH patients were notably alleviated and accompanied by evident activation of effects in the brain.In comparison to TP1,TP2 exhibited the most significant increase in ALFF values for Temporal_Sup_R and the most notable decrease in ALFF values for Paracentral_Lobule_L(voxelwise P<0.005;clusters>30;FDR correction).Additionally,the most substantial enhancement in Re Ho values was observed for the Cuneus_R,while the most prominent reduction was noted for the Olfactory_R(voxelwise P<0.005;clusters>30;FDR correction).Moreover,a comparative analysis revealed that,in contrast to HCs,LDH patients at TP1 exhibited the most significant increase in ALFF values for Temporal_Pole_Sup_L and the most notable decrease in ALFF values for Frontal_Mid_L(voxelwise P<0.005;clusters>30;FDR correction).Furthermore,the most significant enhancement in Re Ho values was observed for Postcentral_L,while the most prominent reduction was identified for Para Hippocampal_L(voxelwise P<0.005;clusters>30;FDR correction).Notably,correlation analysis with clinical scales revealed a robust positive correlation between the Cuneus_R score and the rate of change in the VAS score(r=0.9333,P<0.0001).Conclusions:Long-term chronic lower back pain in patients with LDH manifests significant activation of the"AUN-DMN-S1-SAN"neural circuitry.The visual network,represented by the Cuneus_R,is highly likely to be a key brain network in which the analgesic efficacy of SMT becomes effective in treating LDH patients.(Trial registration No.NCT 06277739)
