| BackgroundScapulohumeral periarthritis is a common clinical disease characterized by shoulder joint pain and movement disorder,which seriously affects the quality of life of patients and belongs to the category of "Bi symptoms" in traditional Chinese medicine.Juci is a kind of acupuncture method of taking right points from left disease,and left points from right disease.Clinical studies have shown that acupuncture at the contralateral Tiaokou point can effectively improve shoulder pain and shoulder joint activity in patients with scapulohumeral periarthritis,but the difference between the therapeutic effect of acupuncture at the contralateral Tiaokou point and acupuncture at the ipsilateral Tiaokou point and the underlying mechanism are not clear.Functional magnetic resonance imaging(fMRI)is characterized by high spatial-temporal resolution,nonintervention and repeatability,which has been widely used in the study of acupuncture mechanismPurpose1.Using small sample randomized controlled trial,patients with unilateral scapulohumeral periarthritis were randomly divided into acupuncture at the ipsilateral Tiaokou point group and acupuncture at the contralateral Tiaokou point group,using the Visual analog Scale(VAS)and Constant shoulder joint function assessment Scale(CMS)respectively to evaluate the immediate analgesia effect of acupuncture and the effect on shoulder joint function,to analyze the difference of therapeutic effect of acupuncture at ipsilateral or contralateral Tiaokou point2.The brain mechanism of unilateral scapulohumeral periarthritis was studied by resting fMRI.Taking the patients with unilateral scapulohumeral periarthritis as the research object,using the analysis method of degree centrality(DC)based on voxel,to compare the different brain areas between the patients with unilateral scapulohumeral periarthritis and the healthy people,to observe the correlation between the DC value of the different brain areas of the patients with unilateral scapulohumeral periarthritis and the clinical efficacy index,and to analyze the brain function characteristics of the patients with unilateral scapulohumeral periarthritis3.The brain mechanism of acupuncture at the contralateral Tiaokou point in the treatment of scapulohumeral periarthritis was studied by resting fMRI.Taking the patients with left periarthritis of shoulder as the research object,using the method of voxel based degree centrality(DC)analysis,we compared the diferent brain areas of acupuncture at the contralateral Tiaokou point and the ipsilateral Tiaokou point,analyzed the correlation between the DC value of the different brain areas and the clinical effect,and analyzed the brain function characteristics of acupuncture at the contralateral Tiaokou point in the treatment of periarthritis of shoulder.Method1.Using randomized controlled trials,40 patients with unilateral periarthritis of shoulder were randomly divided into acupuncture at the ipsilateral Tiaokou point group and acupuncture at the contralateral Tiaokou point group,according to the position of the disease,acupuncture at the ipsilateral Tiaokou point or acupuncture at the contralateral Tiaokou point group.Before and immediately after acupuncture,the pain of shoulder joint was evaluated by VAS and CMS The difference of pain and function of shoulder joint between contralateral acupuncture group and ipsilateral acupuncture group was compared.2.Using 3.0 mri scanner in 38 patients with unilateral periarthritis of shoulder and 24 cases of healthy subjects to head scanning,based on voxel degrees center(DC)analysis method of unilateral periarthritis of shoulder were compared with healthy subjects characteristics and differences of brain connections,the Pearson correlation analysis two groups of different brain regions DC value and the correlation of VAS/CMS score.3.From 40 cases of acupuncture treatment in patients with unilateral periarthritis of shoulder selection of 24 patients with only the left side of the sick,immediately after the acupuncture on fMRI scanning skull,based on voxel degrees center(DC)analysis method,comparing the contralateral acupuncture group and ipsilateral acupuncture group characteristics and differences of brain function in patients with connections,using Pearson correlation analysis two groups of different brain regions DC value and the correlation of VAS/CMS score.Results1.VAS scores in both groups were significantly lower immediately after acupuncture than before acupuncture(p<0.001,p=0.001).The difference of VAS score decline after acupuncture in the contralateral acupuncture group was significantly higher than that in the ipsilateral acupuncture group(p=0.009).CMS scores of patients in both groups immediately after acupuncture treatment were significantly higher than those before acupuncture(p<0.001,p<0.001).The change value of CMS score in the contralateral acupuncture group was significantly higher than that in the ipsilateral acupuncture group(p<0.001).Compared with before treatment,the scores of each dimension in the contralateral acupuncture group were significantly increased(all p<0.05).The pain and range of active activity score were significantly increased in the ipisional acupuncture group(p=0.042,p=0.010),but the improvement in daily life activity and muscle strength score was not significant(p=0.205,p=0.331).Compared with the ipsilateral acupuncture group,the contralateral acupuncture group could significantly improve active range of motion and muscle strength score(all p<0.05),but the difference in pain score between groups was not statistically significant(p=0.057).No serious adverse reactions were reported during or after acupuncture treatment.2.Compared with healthy subjects,patients with unilateral periarthritis of shoulder bilateral anterior cingulate,temporal lobe,insula,the amygdala,parahippocampal gyrus,thalamus,brainstem and cerebellum,DC value is higher,the medial prefrontal cortex of patients with unilateral periarthritis of shoulder,orbitofrontal cortex,central back before,after the central back and precuneus DC value is low,the Gaussian random field(GRF)multiple comparison correction difference is statistically significant.However,there was no significant correlation between the mean degree center value of different brain regions and VAS and CMS scores in patients with unilateral periarthritis of shoulder(p>0.05)3.During the scan,3 patients with head movement greater than 3 mm were excluded,and 1 patient refused to accept the treatment and had a cranial scan.Finally,20 patients with periarthritis of the left shoulder were included for analysis,including 12 in the contralateral acupuncture group and 8 in the ipsilateral acupuncture group.Compared with before treatment,DC values of bilateral anterior cingulate gyrus and collateral cingulate gyrus increased and DC values of bilateral central posterior gyrus decreased after acupuncture at contralateral Tiaokou point.DC values of right thalamus and bilateral cerebellum decreased after acupuncture at the ipsilateral Tiaokou point.The DC value of bilateral anterior cingulate gyrus and collateral cingulate gyrus increased significantly after acupuncture at contralateral cingulate gyrus compared with acupuncture at ipsilateral cingulate gyrus.The differences corrected by multiple GRF comparisons were statistically significant.Pearson correlation analysis results showed that the increase of DC value of bilateral anterior cingulate gyrus and paracentric cingulate gyrus after acupuncture at contralateral Tiaokou point was positively correlated with the change of CMS score(r=0.736,p=0.006).There was no significant correlation between the decrease of DC value in bilateral cerebellar hemispheres and right thalamus after acupuncture at the ipsilateral Tiaokou point and the changes in VAS and CMS scores(r=0.307,p=0.460).Conclusions1.In this study,a randomized controlled clinical study with a small sample was conducted,and it was found that the immediate analgesic effect and the improvement effect of acupuncture on the shoulder joint function of the contralateral Tiaokou point were better than that of acupuncture on the ipsilateral Tiaokou point,providing clinical evidence for the treatment of periarthritis of shoulder by acupuncture on the contralateral Tiaokou point.2.The mechanism of brain function of unilateral periarthritis of shoulder was observed by combining degree of center of resting state functional magnetic resonance imaging(fMRI).It was found that compared with healthy people,patients with unilateral periarthritis of shoulder had abnormal functions of anterior cingulate gyrus,cerebellum and insula involved in pain processing and cognitive processing.3.By using the method of resting fMRI and centrality analysis,the different brain regulatory mechanisms of acupuncture at the contralateral Tiaokou point and the ipsilateral Tiaokou point in the treatment of scapulohumeral periarthritis were compared.It was found that acupuncture at the contralateral Tiaokou point had multiple brain functional abnormalities such as bilateral anterior cingulate gyrus,paracingulate gyrus and central posterior gyrus,which were related to the clinical functional score.It suggested that acupuncture at the contralateral Tiaokou point was effective by adjusting the anterior cingulate gyrus and paraccingulate gyrus to improve shoulder joint pain and function,the traditional acupuncture theory of "treating right with left disease and treating left with right disease" was preliminarily verified. |
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