基于在体运动评价的"肌/骨"动态平衡对青少年特发性脊柱侧凸的机理研究

Bilateral structures imbalance and dysfunction of spine play an important role in adolescent idiopathic scoliosis (AIS) development. Motion treatments have been found to be effective on AIS, whereas their mechanisms were still unknown. The prosthesis of mechanism, which enhancement of weak muscles and improvement of muscle coordination would improve the dynamic balance of spine, is put forward. Since there were no accurate and safe musculoskeletal dynamic kinematic analysis, it is hard to reveal the kinematic relationship between the external movements of human body and internal movements of musculoskeletal system, which make the mechanism unclear. Therefore in this study, we plan to carry out the mechanism research of musculoskeletal dynamic balance on AIS based on kinematic evaluation in vivo. Firstly, a safe and accurate in vivo kinematic analysis system of spine will be established by ultrasound-model registration. An in vivo musculoskeletal kinematic analysis with multi-parameters will be performed which combined with the synchronously information of coordination of ultrasound detector, thickness/elasticity, and surface myoelectricity of muscles. Secondly, the physiological and weak-chain exercises of spine of healthy volunteers and patients with different degrees of AIS will be evaluated in vivo. Weak muscles and poor motor coordination were found. Their impacts on the spinal balance were further evaluated. After that, the relationship between musculoskeletal dynamic mechanics function with AIS progress were analyzed. Finally, the effects of weak muscle enhancement and motor coordination improvements were evaluated also based on kinematic analysis in vivo. The mechanism of dynamic balance training was further investigated. The result of this study will provide us with the scientific basis of exercise therapy of AIS.

脊柱两侧结构不平衡和功能异常对青少年特发性脊柱侧凸（AIS）的发病及进展有重要作用。运动治疗对AIS有一定疗效，但作用机制尚不明确。我们提出“增强薄弱肌力、改善运动协调性，可改善脊柱动态平衡”的机理假说，但由于无准确安全的“肌/骨”动态力学检测，无法解析人体外在运动与“肌/骨”内部运动的关系，很难揭示其机理。因此，本研究将基于在体运动评价开展“肌/骨”动态平衡对AIS的机理研究，包括①基于超声-模型配准技术，并同步整合运动时序、厚度/弹性、肌电等信息，构建多参数肌骨系统在体运动评价系统；②通过脊柱生理及弱链运动的在体运动检测，发现薄弱肌力和运动协调不佳等异常，评价其对脊柱平衡的影响，分析“肌/骨”动态力学作用与AIS进展的关系；③基于在体运动检测，评价增强薄弱肌力及改善运动协调性对AIS的影响，探索AIS动态平衡训练的机理。本研究将为AIS规范化运动治疗提供科学依据。

脊柱两侧结构不平衡和功能异常对青少年特发性脊柱侧凸（AIS）的发病及进展有重要作用。运动治疗对AIS有一定疗效，但作用机制尚不明确。我们提出“增强薄弱肌力、改善运动协调性，可改善脊柱动态平衡”的机理假说。. 本研究基于在体运动评价开展了“肌/骨”动态平衡对AIS的机理研究，包括①基于超声-模型配准技术设计了一种智能化、无辐射、实时的基于机械臂的脊柱自动三维超声成像系统，并测试了其准确度；②采用超声检测手段，测量核心肌肉厚度及肌肉收缩厚度变化率等作为评价参数，以研究不同运动条件下不同程度AIS患者椎旁肌的运动规律，分析肌骨系统动态力学作用与 AIS 进展的关系；同时，构建轻度青少年特发性脊柱侧凸患者的有限元模型，从有限元分析角度探索AIS的肌 骨动态力学表现；③开展前瞻性对照队列研究，验证采用新苗治疗系统（XTS）进行的物理治疗性脊柱侧弯的运动疗效，比较不同年龄组之间的矫正效果，探索 AIS“肌/骨”动态平衡训练机理。. 本项目已基本达到了研究目标：①通过超声-模型配准（UMR）等技术开展 AIS 肌骨系统多参数在体运动评价，测试精度可达到了0.8mm和0.83°；②通过超声影像测量与分析发现不同体位下AIS患者主弯曲线多个椎体节段椎旁肌对称性不良，建立了AIS有限元仿真模型并开展了初步分析；③前瞻性队列研究显示运动治疗可有效控制或改善Cobb角在10°至25°之间的AIS患者的曲线进展。本项目共发表论文5篇，其中SCI论文4篇（中科院二区论文2篇，三区论文2篇），中文核心期刊论文1篇；发表EI会议论文1篇；申请发明专利1项，实用新型专利1项；获得内蒙古科学技术进步奖一等奖1项；参加《儿童青少年脊柱弯曲异常防控技术指南》的编写，并已在国家卫健委官网发布。