基于脑功能运动控制网络探讨通督强脊手法治疗颈椎病的作用机制

Cervical spondylosis is a common clinical disease, "Tongdu Qiangji" is the innovation research group put forward prevention and treatment of cervical vertebra disease theory, has won the Fujian Province scientific progress award 2, early 11th Five-Year 12th Five-Year, the national science and technology support program research confirmed tongduqiangji technique for the treatment of cervical disease curative effect significantly, preliminary study of National Natural Science Project confirm the stability of cervical spondylosis and cervical vertebra is closely related to the recent domestic and foreign research shows that the brain can accurately reflect the state of pain, muscle coordination and motor control level, but tongduqiangji technique is through the brain function of motion control mechanism to treat cervical vertebra disease is not clear. This study compared with the group of cervical patients through the normal population, the application of surface EMG detection to observe tongduqiangji technique of cervical muscle around the anti fatigue ability, efficiency, synergistic effect; application of nuclear magnetic resonance detection of multifidus net cross-sectional area ratio changes; application of functional magnetic resonance imaging of brain function from the functional link the network in regional brain activity and the effect of integration of the resting and task state functional motion control level. From the perspective of cervical stability and motor function control, we explored the mechanism of Tong Du chiropractic manipulation in the treatment of cervical spondylosis, and further improved the scientific connotation of "Tong Du Qiang Qiang" theory.

颈椎病是临床常见病与多发病，“通督强脊”是课题组创新提出颈椎病防治理论，已获得福建省科学进步奖2项，前期十一五、十二五国家科技支撑计划项目研究证实通督强脊手法治疗颈椎病疗效显著，前期国家自然科学基金项目研究证实颈椎病与颈椎的稳定性密切相关，近期国内外研究表明，脑功能可以准确反映疼痛状态、肌肉运动协调与运动神经控制的水平，但通督强脊手法是否通过脑功能运动控制来治疗颈椎病机制尚未清楚。本研究通过正常人群与颈椎病人群比较，应用表面肌电检测观察通督强脊手法对颈椎周围肌肉抗疲劳能力、活动效率、协同性的影响；应用核磁共振检测多裂肌净横截面面积比的改变情况；应用脑功能核磁成像技术从脑功能网络中内脑区的活动和网络间的功能链接整合效应方面分析静息态与作业任务态脑功能运动控制水平。本研究从颈椎稳定性与脑功能运动控制水平等角度探讨通督强脊手法治疗颈椎病的作用机制，进一步完善“通督强脊”理论的科学内涵。

前期研究证实颈椎病与颈椎的稳定性密切相关，近期国内外研究表明，脑功能可以准确反映疼痛状态、肌肉运动协调与运动神经控制的水平。研究结果表明：1.通督强脊手法能改善颈型颈椎病患者疼痛及其颈椎功能，改善活动度及肌力（P＜0.05）；增加后伸肌群中斜方肌、头夹肌募集及肌肉参与度（P＜0.05）；增加侧屈肌群上斜方肌募集及肌肉参与度（P＜0.05）；增加前屈肌群胸锁乳突肌募集及肌肉参与度（P＜0.05）。相对于常规推拿手法，通督强脊手法通过远端肝脾肾三经穴位按揉配合颈部运动能更明显增加患者脑部中央前回，小脑等运动控制相关网络ReHo值和影响后扣带回和额下回三角部的功能连接疼痛认知相关网络（P＜0.05），能在一定程度上对患者的颈部功能和疼痛产生更好调节作用。相对于通督强脊手法，常规推拿在颈项部的重点按揉能更好的激活右枕叶楔叶部、右内侧额上回（P＜0.05），对患者视觉中枢皮质眼球运动区产生了更大的作用。2.通督强脊颈椎导引术结合手法治疗能够降低颈椎病慢性疼痛患者的颈椎功能障碍程度及患者因颈痛所带来的自身焦虑情况（P＜0.05），同时在手法治疗的基础上进行通督强脊颈椎导引术训练更有利于患者颈椎左、右侧屈关节活动度以及患者左、右侧枕下疼痛情况的改善（P＜0.05）。颈椎导引术训练能通过改变大脑中央后回、中央前回、颞上回、颞中回、楔前叶等与疼痛、情绪处理有关的脑区的活动情况（P＜0.05），来影响患者对颈椎病慢性疼痛的感知反应，从进一步增强手法治疗对疼痛的改善效果。

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