慢性踝关节不稳定中平衡缺陷的中枢性调节机制研究

Balance deficiency is thought to be important in the pathological mechanism of chronic ankle instability, while the exactly regulatory mechanism of balance deficiency is not clear until now. Our preliminary research showed the injury of lateral ankle ligaments would aggravate the balance deficiency, which would be improved after the ligaments were repaired. Moreover, the balance deficiency could be improved when the patients with chronic ankle instability were stimulated by special noise. In addition, the balance deficiency in chronic ankle instability might be related to the activation of pre supplementary motor area. These findings indicate that the balance deficiency in chronic ankle instability might have regional regulatory mechanism (ankle) and central regulatory mechanism (brain). In this study, we would identify the key points of central regulatory for the balance deficiency in chronic ankle instability by several techniques, including balance testing, functional magnetic resonance imaging, electroencephalograph, and functional near-infrared imaging, et al. Furthermore, after the intervention with special factors, including operation, rehabilitation, and special noise, we would evaluate the effect of these interventions on the brain function, then investigate the specific details of the central regulatory mechanism. This study would contribute to the establishment and confirmation of the hypothesis of the central regulatory mechanism of balance deficiency in chronic ankle instability, to complement the mechanism of injury, treatment and prevention of chronic ankle instability, and to provide the theoretical and experimental basis for developing more effective treatment of chronic ankle instability.

平衡缺陷在慢性踝关节不稳定病理机制中起重要作用，但其具体调节机制尚未明确。我们的前期工作显示：踝外侧副韧带损伤加重平衡缺陷，手术修补外侧副韧带可以改善平衡缺陷；在进行特定噪声直接刺激后，平衡缺陷也可以得以改善。此外，慢性踝关节不稳定的平衡缺陷还可能和大脑前运动辅助区的激活相关。这些结果提示我们慢性踝关节不稳定的平衡缺陷可能同时存在局部（踝关节）和中枢性（大脑）调节机制。本研究拟进一步采用平衡测试、功能核磁共振、脑电图及近红外光谱脑功能成像等技术，辨别平衡缺陷中枢性调节机制的关键环节，并在利用手术、康复训练、特定噪声刺激等不同方法进行特定干预后，在体评价这些措施对大脑功能的影响，探讨该中枢性调节机制的具体作用机理。本研究有助于建立并证实慢性踝关节不稳定中平衡缺陷的中枢性调节机制假说，完善慢性踝关节不稳定的损伤、治疗及预防机制，并为发展更有效的踝关节不稳定治疗方法提供理论依据和实验基础。

慢性踝关节不稳定（chronic ankle instability, CAI）是临床最常见的运动相关性损伤之一。尽管现有保守和手术治疗方法获得了良好的疗效，但仍有部分CAI患者由于残留不稳感而不能重返运动。平衡缺陷是导致这种功能缺陷最重要的原因之一，我们首先采用体检辅助诊断CAI，然后采用核磁共振（Magnetic Resonance Imaging，MRI）和超声对踝关节外侧副韧带损伤进行精确诊断及分型，并采用平衡测试系统对CAI患者进行平衡功能检测，并在噪声刺激和康复训练后进行平衡功能检测，对康复训练后的脑功能进行脑电和近红外光谱脑功能检测。同时我们采用脑功能MRI等方法进行中枢脑功能评估，然后进行手术治疗，并随访评价临床疗效，将其与术前指标进行相关性分析，从而探讨中枢神经系统对CAI可能的作用和机制。.我们的研究发现：1）和常规的体检相比，反前外侧抽屉试验（reverse anterolateral drawer test, RALDT）能更精确及更敏感的诊断CAI；2)踝关节前距腓韧带（anterior talofibular ligament, ATFL）损伤可以基于超声表现分为6种亚型；3）基于MRI图像可以发现在CAI患者中，距骨存在内旋，ATFL与后距腓韧带（posterior talofibular ligament, PTFL)的夹角可以作为诊断CAI的辅助指标；4）CAI存在前庭功能传入能力下降，并可能与平衡缺陷相关，但短时的噪声刺激并不能改善CAI受试者的平衡功能；5）背侧前扣带回（dorsal anterior cingulum, dACC）可能是CAI中关键中枢性调控区域；6）12周的康复训练可以改善CAI平衡功能，但基于脑电或近红外光谱结果的脑功能未见明显变化；7）关节镜手术方式、合并跗骨窦综合症或小直径软骨损伤等因素不影响CAI患者接受检测的同质性。.我们的研究为CAI研究的同质性筛选提供了详细的界定，对CAI中平衡缺陷的脑功能改变及与治疗后相关性进行了深入探讨，为进一步明确CAI病理机制，开发新的治疗方式提供了良好的理论支持和实验基础，也为研究运动损伤的中枢调节提供了可靠的方法和途径。