| Objective:1.To explore the mechanism of pain in knee osteoarthritis from the perspective of cerebral cortex by analysis the difference of brain structure between knee osteoarthritis patients and healthy subjects based on VBM image analysis technique.2.To study the impact of aerobic exercise(taking the power cycling as the representative)on pain symptoms of knee osteoarthritis,and explore its possible mechanism based on VBM image analysis technology.3.To study the effect of different exercise modes(Taijiquan and Baduanjin)on the pain symptoms of knee osteoarthritis and its mechanism from the perspective of brain structure change based on VBM analysisMethods:1.According to the rate principle of 3:1,the patients with knee osteoarthritis who match the inclusion criterias were recruited.The healthy subjects who matched the age and gender with the patients were selected.The KOOS scale was used to test the pain symptoms.The T1 image was received from America GE Corporation(Signa,GE medical systems,Milwaukee,USA)3.0T scanner.The VBM image analysis technology was used to compare the brain structure of patients with knee osteoarthritis and healthy subjects.The multiple regression analysis was used to investigate the related brain regions with the symptoms of pain.2.According to the rate principle of 1:1,the subjects with knee osteoarthritis were randomly divided into cycling group and health education group.Participants in the cycling groups practiced the cycling for 12 weeks,60 minutes each session and five sessions per week and those in the health education group received basic health education for 12weeks,60minutes each session and once time per week.KOOS scale pain sub-test and MRI scans were conducted at baseline and at the end of the study to compare the pain of the patients with knee osteoarthritis.Then the MRI data was analysised based on VBM image analysis technology to study its possible mechanisms.3.The subjects with knee osteoarthritis were randomly divided into Taijiquan group,Baduanjin group,cycling group and health education group by the block design.Every subject of the Taijiquan group,Baduanjin group and cycling groups practiced the Taijiquan,Baduanjin or cycling for 12 weeks,60 minutes each session and five sessions per week and those in the health education group received basic health education for 12weeks,60minutes each session and once time per week.KOOS scale pain sub-test and MRI scans were conducted at baseline and at the end of the study to compare the pain of the patients with knee osteoarthritis.Then the MRI data was analysised based on VBM image analysis technology to study its possible mechanisms.Results:1.Compared with the health subjects,the patients with knee osteoarthritis showed higher density of the brain areas in the island cover of inferior frontal gyrus,middle frontal gyrus,precentral gyrus,triangularis of inferior frontal gyrus in the right hemisphere and globus pallidus,putamen,thalamus,and amygdala in the left hemisphere,and showed lower density of the brain areas in superior frontal gyrus,triangularis of inferior frontal gyrus,middle frontal gyrus,orbital of inferior frontal gyrus,inferior occipital gyrus,middle occipital gyrus,middle temporal gyrus,superior temporal gyrus,angular gyrus in the right hemisphere and the inner section of frontal gyrus,eshange pole,middle frontal gyrus,anterior cingulate gyrus in the left hemisphere,and bilateral auxiliary exercise areas.Moreover,we found that the brain areas in the right superior frontal gyrus,the right auxiliary exercise area,the left posterior cingulate gyrus,middle section of the right cingulate gyrus,the right praecuneus,the left lobulus parietalis superior,the left post-central gyrus were associated with the pain of knee osteoarthritis.2.Compared with health education group,cycling group could significantly reduce its pain symptoms(p<0.05).The VBM study found that compared with the health education group,cycling group showed the higher density of the brain areas mainly in the right precentral gyrus,the right post-central gyrus.The pain symptoms changed in the cycling group have the positive correlation with the bilateral auxiliary exercise areas,the bilateral precentral gyrus,the bilateral superior frontal gyrus and the right thalamus,which means the more obvious reduce of the pain,the higher gyrus density in the bilateral auxiliary exercise area,the bilateral precentral gyrus,the bilateral superior frontal gyrus,the right hippocampus,and the right parahippocampal.3.Compared with the health education group,The Taijiquan,Baduanjin and cycling exercise could significantly reduce their pain symptoms(P<0.05).Then Taijiquan compared with Baduanjin,Taijiquan compared with cycling,cycling compared with Baduanjin have no significantly difference in pain scores changes(P>0.05).VBM analysis found that compared with the health education group,the Taijiquan group increased the brain gray matter volume mainly including the left middle frontal gyrus,the left superior frontal gyrus,the right inferior temporal gyrus,the right lateral cerebellum and the right fusiform gyrus,and reduced the brain gray matter volume areas mainly including the right hippocampus,the right parahippocampal gyrus,the right amygdaloid nucleus and the right medial entorhinalis area.Before and after treatment,compared with the health education group,Baduanjin group increased the brain areas mainly including the bilateral thalamus and the right caudate nucleus and Baduanjin group(vs Taijiquan group)increased the brain gray matter volume mainly including the bilateral thalamus,the taijiquan group compared with cycling increased the brain gray matter volume mainly including the right inferior temporal gyrus,the right lateral cerebellum and the right fusiform gyrus.Cycling group compared with the Tai Chi Group,Baduanjin group compared with Cycling group,and the gray matter volume increased in the left thalamus.Conclusions:1.The reduction of KOOS score in KOA patients is related to changes in the volume of brain tissue regulated by pain,including precentral gyrus,postcentral gyrus,limbic system,thalamus and the frontal lobe,et....,which may be one of the central mechanisms of pain in KOA patients.2.Cycling,the Taijiquan and the Baduanjin training can improve KOOS score in patients with KOA,relieve pain in KOA patients.3.Compared with the health education group,cycling exercise increased KOA patients'brain volume of the hippocampus and hippocampus paraphernalia and other brain volume;Taijiquan training increased KOA patients' brain volume of the lateral cerebellar and the left temporal gyrus;the Baduanjin training increased KOA patients' brain volume of the bilateral thalamus and right caudate nucleus,which may be one of the central mechanisms of different exercise rehabilitation methods to reduce the pain of KOA patients. |
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