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针刺诱导的皮层可塑性的无创评估在面瘫的高级康复中的应用。

Noninvasive Evaluation of Acupuncture-Induced Cortical Plasticity in Advanced Rehabilitation of Facial Paralysis.

机构信息

Department of Acupuncture, Shanghai Changning Tianshan Traditional Chinese Medicine Hospital.

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

J Craniofac Surg. 2024 Oct 1;35(7):2015-2020. doi: 10.1097/SCS.0000000000010544. Epub 2024 Aug 26.

Abstract

OBJECTIVE

Facial paralysis (FP), which resulted from head and neck cancer resection, significantly impacts patients' quality of life. Traditional assessments rely on subjective evaluations and electromyography, whereas functional magnetic resonance imaging offers a noninvasive alternative for enhanced rehabilitation. Acupuncture has shown promise in promoting cerebral cortex reorganization, yet the precise relationship between acupuncture-induced structural and functional changes remains unclear, necessitating further investigation into therapeutic mechanisms.

METHODS

Fifty-five patients afflicted with FP underwent evaluations using voxel-mirrored homotopic connectivity (VMHC) and tract-based spatial statistics and were divided into the acupuncture intervention group (n = 35) and pseudo intervention group (n = 20). Comparative analyses of metrics pre and postintervention were conducted to delineate therapy-induced modifications in acupuncture intervention. The postacupuncture effect between groups to verify the necessity of accurate positioning for the rehabilitation of FP.

RESULTS

Patients with FP showed deficits in VMHC in regions of the postcentral, precentral, and parietal areas. Corpus callosum and internal capsule showed significantly increased fractional anisotropy of the white matter skeleton in tract-based spatial statistics after treatment. Comparison postintervention results between groups exhibited deficits in VMHC and increased fractional anisotropy in regions of the corpus callosum in the acupuncture intervention group.

CONCLUSIONS

Early acupuncture intervention may suppress cortical hyperactivation and restore interhemispheric inhibition across the corpus callosum to inhibit maladaptive structural plasticity. Precise acupoint localization is crucial for effective therapy, highlighting the potential of postacupuncture cortical space data for refining therapeutic strategies.

摘要

目的

头颈部癌症切除术后导致的面瘫(FP)显著影响患者的生活质量。传统评估依赖于主观评估和肌电图,而功能磁共振成像提供了一种增强康复的非侵入性替代方法。针灸在促进大脑皮层重组方面显示出前景,但针灸引起的结构和功能变化之间的确切关系尚不清楚,需要进一步研究治疗机制。

方法

55 例 FP 患者接受了体素镜像同伦连接(VMHC)和基于束的空间统计学评估,并分为针刺干预组(n=35)和伪干预组(n=20)。比较了干预前后的指标,以描绘针刺干预引起的治疗性改变。组间的针刺后效果验证了准确定位对 FP 康复的必要性。

结果

FP 患者在后中央、前中央和顶叶区域的 VMHC 中存在缺陷。治疗后,基于束的空间统计学显示胼胝体和内囊的白质骨架分数各向异性明显增加。组间干预后比较结果显示,针刺干预组在 VMHC 中存在缺陷,胼胝体区域的分数各向异性增加。

结论

早期针刺干预可能抑制皮质过度激活,并通过胼胝体恢复半球间抑制,以抑制适应不良的结构可塑性。精确的穴位定位对于有效的治疗至关重要,这突出了针刺后皮质空间数据在完善治疗策略方面的潜力。

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