膝关节稳定性评价及膝关节置换后康复的中枢神经重塑研究

The stability of the knee joint after Total Knee Replacement Arthroplasty (TKRA) is closely related to motor function recovery of the patients. The factors affecting the knee stability include not only the biomechanical functions of the related muscles and ligaments, but also the sensing of the joint proprioception and the controlling of the central nervous system. The coupling system restrained by those factors is difficultly analyzed by any reduction analysis or qualitative evaluations. This research project utilizes the analysis techniques of complexity theory to explore the quantitative evaluation methods of the knee stability by considering the controlling system as a nonlinear dynamic process with complex properties. By experimental measurement of knee trembling sequences in dynamic movement, the complex indices are explored to characterize the knee stability with the help of complex analysis of kinetic data. By gait analysis with displacement and acceleration measurement, the characteristic quantity involved in the posture and gait are correlated with the complexity of the knee joint stability. Moreover, in the rehabilitation process of motor function of the knee system, the reconstruction of proprioception has strong correlation with the central nervous system remodeling. We will use the functional magnetic resonance imaging analysis to explore the relationship between the adaption of the central nervous network system and the reconstruction of keen joint proprioception, to find the correlation between the topological attributes in brain function network and the characters from knee stability evaluations. Based on the understanding of the relation between the central nervous regulation and the function recovery of the knee, some intervention techniques such as foot sole mechanical stimulating and transcranial direct current stimulation, will be applied to promote proprioceptive reconstruction and stability rehabilitation of the knee joint.

膝关节置换后关节的稳定性与其运动功能康复密切相关。影响膝关节稳定性的因素既包括肌肉韧带等组织的生物力学功能，也包括本体感觉传感和中枢神经控制，它们的耦合作用所形成的复杂约束系统，很难通过传统的单因素研究或定性方法进行有效的功能分析和评价。本研究项目将基于复杂性理论及其分析方法，探索从复杂系统的角度分析膝关节的功能稳定性，通过运动学实验测量和数据分析找出描述动态稳定过程的复杂性特征量，用以综合定量地评价膝关节的稳定性。另外，在置换术后膝关节运动功能康复过程中，本体感觉的重建与中枢神经的重塑密切相关。我们将利用脑功能磁共振成像分析，探究中枢神经网络系统随膝关节本体感觉重建的变化规律，找到康复过程中脑功能网络拓扑属性与膝关节稳定性评价指标的关联度；在深入理解膝关节动态稳定与中枢调控之间的关系的基础上，寻求通过足底力学刺激和经颅电学刺激干预相关的脑神经网络从而促进膝关节本体感觉的重建和稳定性康复。

本课题的研究发展了一系列非线性动力学分析方法应用于人体平衡能力评价和控制，尤其是创新性地提出了在相空间中挖掘与平衡功能降低密切相关的协调性特征。同时，基于行为学实验验证了经颅电刺激（tDCS)这种全新的平衡干预方法的可行性和有效性，并进一步利用功能核磁共振成像技术和复杂网络分析方法，揭示了利用tDCS方法改善和提高平衡能力的中枢网络机制，具有重要的学术意义和明确的潜在临床应用价值。研究成果为个性化膝关节术后平衡康复及神经康复提供了有价值的分析评价工具，也为深入理解平衡功能的中枢调节机制奠定了坚实的实验基础。