噪声前庭电刺激对青少年特发性脊柱侧凸患者椎旁肌激活与姿势控制的即时效应

doi:10.3969/j.issn.1006-9771.2026.02.012

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (2): 222-232.doi: 10.3969/j.issn.1006-9771.2026.02.012

噪声前庭电刺激对青少年特发性脊柱侧凸患者椎旁肌激活与姿势控制的即时效应

谢浩宇¹^,², 李岩¹^,³, 谢皓¹, 王楚怀¹()

1.中山大学附属第一医院康复医学科，广东广州市 510080
2.南京医科大学附属苏州医院/苏州市立医院/南京医科大学姑苏学院，江苏苏州市 215008
3.温州医科大学药学院，浙江温州市 325035

收稿日期:2025-12-09 出版日期:2026-02-25 发布日期:2026-03-02
通讯作者: 王楚怀，E-mail： wangchuh@mail.sysu.edu.cn E-mail:wangchuh@mail.sysu.edu.cn
作者简介:谢浩宇(1996-)，男，汉族，江苏苏州市人，博士，主管技师，主要研究方向：脊柱疾病的康复治疗。
基金资助:
1. 国家重点研发计划项目(2022YFC2009700);2. 粤港科技创新联合资助项目(2023A0505010014);3. 国家自然科学基金项目(82172532);4. 广东省基础与应用基础研究基金项目(2023A1515110185);5.苏州市立医院"科教兴卫"专项资金资助项目(Szslyyrc202601040)

Immediate effect of noisy galvanic vestibular stimulation on paraspinal muscle activation and postural control in adolescent idiopathic scoliosis

XIE Haoyu¹^,², LI Yan¹^,³, XIE Hao¹, WANG Chuhuai¹()

1. Department of Rehabilitation Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
2. The Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital/Gusu School of Nanjing Medical University, Suzhou, Jiangsu 215008, China
3. School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China

Received:2025-12-09 Published:2026-02-25 Online:2026-03-02
Contact: WANG Chuhuai, E-mail: wangchuh@mail.sysu.edu.cn E-mail:wangchuh@mail.sysu.edu.cn
Supported by:
National Key Research and Development Program of China(2022YFC2009700);Guangdong-Hong Kong Technology and Innovation Cooperation Funding(2023A0505010014);National Natural Science Foundation of China(82172532);Guangdong Basic and Applied Basic Research Foundation(2023A1515110185);Suzhou Municipal Hospital Ke Jiao Xing Wei Special Fund(Szslyyrc202601040)

摘要/Abstract

摘要：

目的探讨噪声前庭电刺激(nGVS)对青少年特发性脊柱侧凸(AIS)患者静止站立时姿势控制、椎旁肌激活程度和对称性，以及大脑皮质激活水平的影响。

方法 2023年12月至2025年6月，于中山大学附属第一医院招募符合要求的AIS患者30例，在稳定和不稳定平面上进行静止站立任务时分别施加nGVS、伪刺激和无刺激。同步采用三维测力台测量静止站立时压力中心(COP)的位移面积、内-外向与前-后向位移长度和速度，无线表面肌电图测量上端椎、顶椎和下端椎水平双侧椎旁肌的均方根和凸/凹侧激活比，功能性近红外光谱测量双侧背外侧前额叶(DLPFC)、辅助运动区、运动前区、初级感觉皮质和初级运动皮质的活动。

结果相较于伪刺激和无刺激条件，nGVS降低AIS患者静止站立时的COP位移面积(F = 4.645, P = 0.006, η²_p = 0.138)，内-外向位移长度(F = 7.651, P = 0.001, η²_p = 0.209)和速度(F = 5.035, P = 0.010, η²_p = 0.148)；提高顶椎凹侧椎旁肌均方根值(F = 6.486, P = 0.003, η²_p = 0.183)，降低凸/凹侧激活比(F = 4.028, P = 0.023, η²_p = 0.122)；提高双侧DLPFC激活水平(F > 6.718, P < 0.01, η²_p > 0.188)。中介效应分析存在nGVS-DLPFC-凸/凹侧激活比-COP位移面积的路径(P < 0.05)。

结论 nGVS可能通过增强双侧DLPFC激活，提高椎旁肌对称性，从而改善AIS患者的姿势控制能力。

关键词: 青少年特发性脊柱侧凸, 噪声前庭电刺激, 姿势控制, 椎旁肌, 背外侧前额叶

Abstract:

Objective To investigate the effect of noisy galvanic vestibular stimulation (nGVS) on postural control, paraspinal muscle activation and cortical activation of patients with adolescent idiopathic scoliosis (AIS) during quiet standing.

Methods A total of 30 eligible participants with AIS were recruited from the First Affiliated Hospital of Sun Yat-Sen University between December, 2023 and June, 2025, and finished upright standing tasks on both stable and unstable surfaces under nGVS, sham and no stimulation conditions. They were synchronously measured sway area (SA), medial-lateral and anterior-posterior sway length (SL_MLand SL_AP) and velocity (V_MLand V_AP) of center of pressure (COP) with three-dimensional force platform; the root mean square (RMS) of the bilateral paraspinal muscles at upper end vertebra, apical vertebra and lower end vertebra levels were measured with wireless surface electromyography, and convex/concave activation ratio was calculated; and cortical activation of bilateral dorsolateral prefrontal cortex (DLPFC), supplementary motor area, premotor cortex, primary somatosensory cortex and primary motor cortex were measured with functional near-infrared spectroscopy.

Results Compared to the sham and no stimulation conditions, nGVS significantly reduced SA (F= 4.645, P= 0.006, η²_p = 0.138), SL_ML(F = 7.651, P= 0.001, η²_p = 0.209) and V_ML(F= 5.035, P= 0.010, η²_p = 0.148); increased the RMS of paraspinal muscles on the concave side of the apical vertebra (F= 6.486, P= 0.003, η²_p = 0.183), and decreased its convex/concave activation ratio (F= 4.028, P= 0.023, η²_p = 0.122), and enhanced activation of bilateral DLPFC (F> 6.718, P <0.01, η²_p > 0.188). The mediation analysis confirmed a significant path of nGVS-DLPFC-convex/concave activation ratio-COP displacement (P< 0.05).

Conclusion nGVS may improve postural control in patients with AIS by enhancing DLPFC activation and ameliorating paraspinal muscle imbalance.

Key words: adolescent idiopathic scoliosis, noisy galvanic vestibular stimulation, postural control, paraspinal muscle, dorsolateral prefrontal cortex

中图分类号:

R681.5

谢浩宇, 李岩, 谢皓, 王楚怀. 噪声前庭电刺激对青少年特发性脊柱侧凸患者椎旁肌激活与姿势控制的即时效应[J]. 《中国康复理论与实践》, 2026, 32(2): 222-232.

XIE Haoyu, LI Yan, XIE Hao, WANG Chuhuai. Immediate effect of noisy galvanic vestibular stimulation on paraspinal muscle activation and postural control in adolescent idiopathic scoliosis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(2): 222-232.

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变量	平面	n	无刺激		伪刺激		nGVS
变量	平面	n	均值	标准差	均值	标准差	均值	标准差
SA/mm²	稳定	30	569.74	64.31	542.61	51.72	407.55	57.11
	不稳定	30	3338.59	409.16	3209.77	264.33	2565.95	180.05
SL_ML/mm	稳定	30	19.65	4.88	18.54	4.61	16.29	4.84
	不稳定	30	42.39	15.93	39.99	15.03	33.88	10.34
SL_AP(mm)	稳定	30	9.27	2.75	9.09	2.70	7.69	2.10
	不稳定	30	24.82	10.65	24.34	10.44	21.65	6.23
V_ML/(mm·s^-1)	稳定	30	11.89	4.02	11.01	3.73	11.30	3.36
	不稳定	30	30.41	7.23	28.16	6.70	24.21	5.45
V_AP/(mm·s^-1)	稳定	30	14.62	4.27	14.09	4.45	14.93	4.40
	不稳定	30	28.07	4.99	29.24	5.20	26.84	5.71

变量		平方和	自由度	均方	F值	P值	η²_p
SA	刺激	8516946.969	2	4258473.484	16.249	< 0.001	0.359
	平面	284133686.900	1	284133686.9	152.009	< 0.001	0.840
	刺激×平面	3868265.047	2	1934132.523	4.645	0.006	0.138
SL_ML	刺激	1409.972	2	704.986	19.872	< 0.001	0.407
	平面	18254.416	1	18254.146	81.778	< 0.001	0.738
	刺激×平面	357.440	2	178.720	7.651	0.001	0.209
SL_AP	刺激	195.272	2	97.63	3.077	0.054	0.096
	平面	10037.121	1	10037.121	97.158	< 0.001	0.770
	刺激×平面	20.350	2	10.175	2.339	0.105	0.075
V_ML	刺激	347.760	2	173.798	18.798	< 0.001	0.393
	平面	11795.972	1	11795.972	268.392	< 0.001	0.902
	刺激×平面	258.712	2	129.356	5.035	0.010	0.148
V_AP	刺激	27.294	2	13.647	3.059	0.055	0.095
	平面	8656.411	1	8656.411	397.598	< 0.001	0.932
	刺激×平面	88.869	2	44.435	1.895	0.160	0.061

变量	平面	刺激	刺激	平均值差	P值	95%置信区间
变量	平面	刺激	刺激	平均值差	P值	下限	上限
SA	稳定	nGVS	伪刺激	-135.060	0.032	-235.263	-35.857
		nGVS	无刺激	-162.190	0.021	-298.084	-26.296
		伪刺激	无刺激	-27.130	0.685	-162.532	108.272
	不稳定	nGVS	伪刺激	-643.820	0.025	-1200.799	-86.841
		nGVS	无刺激	-772.642	0.010	-1345.876	-199.408
		伪刺激	无刺激	-128.822	0.720	-856.623	598.979
SL_ML	稳定	nGVS	伪刺激	-2.246	0.067	-4.659	0.167
		nGVS	无刺激	-3.358	0.009	-5.811	-0.905
		伪刺激	无刺激	-1.112	0.368	-3.599	1.375
	不稳定	nGVS	伪刺激	-6.110	0.018	-11.093	-1.127
		nGVS	无刺激	-8.509	0.004	-14.074	-2.944
		伪刺激	无刺激	-2.400	0.551	-10.535	5.735
V_ML	稳定	nGVS	伪刺激	-0.295	0.750	-2.170	1.580
		nGVS	无刺激	-0.585	0.546	-2.543	1.373
		伪刺激	无刺激	-0.881	0.383	-2.915	1.153
	不稳定	nGVS	伪刺激	-3.949	0.006	-6.673	-1.225
		nGVS	无刺激	-6.201	< 0.001	-8.966	-3.436
		伪刺激	无刺激	-2.253	0.216	-5.896	1.390

变量	平面	n	无刺激		伪刺激		nGVS
变量	平面	n	均值	标准差	均值	标准差	均值	标准差
上端椎凸侧RMS/μV	稳定	30	24.20	6.57	21.60	6.12	22.31	4.37
	不稳定	30	34.14	5.72	30.48	5.10	30.69	6.21
上端椎凹侧RMS/μV	稳定	30	21.61	8.63	19.73	7.87	21.92	5.62
	不稳定	30	32.01	13.89	29.21	12.67	29.65	11.90
上端椎凸/凹侧激活比	稳定	30	1.14	0.37	1.13	0.37	1.05	0.29
	不稳定	30	1.19	0.38	1.17	0.37	1.12	0.27
顶椎凸侧RMS/μV	稳定	30	21.44	6.51	22.57	6.86	23.05	5.54
	不稳定	30	39.06	11.62	41.12	12.24	43.37	14.86
顶椎凹侧RMS/μV	稳定	30	17.00	7.33	18.83	8.19	22.99	5.43
	不稳定	30	26.35	7.95	28.64	8.47	38.40	10.52
顶椎凸/凹侧激活比	稳定	30	1.42	0.40	1.26	0.35	1.15	0.36
	不稳定	30	1.76	0.61	1.57	0.54	1.28	0.40
下端椎凸侧RMS/μV	稳定	30	25.27	6.31	23.31	8.33	23.62	7.18
	不稳定	30	37.62	9.77	38.76	8.63	37.11	10.09
下端椎凹侧RMS/μV	稳定	30	22.36	5.00	21.03	3.32	20.02	4.31
	不稳定	30	27.81	8.59	28.38	9.97	29.17	8.10
下端椎凸/凹侧激活比	稳定	30	1.24	0.42	1.16	0.33	1.20	0.27
	不稳定	30	1.33	0.68	1.36	0.56	1.29	0.44

sEMG参数		平方和	自由度	均方	F值	P值	η²_p
上端椎凸侧RMS	刺激	36.624	2	18.312	1.878	0.162	0.061
	平面	733.578	1	733.578	15.118	0.001	0.343
	刺激×平面	16.713	2	8.357	0.675	0.513	0.023
上端椎凹侧RMS	刺激	165.734	2	82.867	2.123	0.129	0.068
	平面	3694.127	1	3694.127	66.422	< 0.001	0.696
	刺激×平面	74.104	2	37.052	1.010	0.371	0.034
上端椎凸/凹侧激活比	刺激	0.134	2	0.067	2.456	0.095	0.078
	平面	0.151	1	0.151	0.540	0.468	0.018
	刺激×平面	0.024	2	0.012	0.734	0.485	0.025
顶椎凸侧RMS	刺激	253.675	2	126.837	1.610	0.209	0.053
	平面	895.677	1	895.677	118.000	< 0.001	0.803
	刺激×平面	51.705	2	25.853	2.755	0.072	0.087
顶椎凹侧RMS	刺激	2624.620	2	1312.310	54.059	< 0.001	0.675
	平面	5674.165	1	5674.165	112.779	< 0.001	0.813
	刺激×平面	355.470	2	177.735	6.486	0.003	0.183
顶椎凸/凹侧激活比	刺激	4.031	2	2.015	30.828	< 0.001	0.542
	平面	2.455	1	2.455	8.290	0.008	0.242
	刺激×平面	2.457	2	1.229	4.028	0.023	0.122
下端椎凸侧RMS	刺激	567.253	2	283.627	2.672	0.079	0.093
	平面	10415.013	1	10415.013	28.347	< 0.001	0.522
	刺激×平面	97.901	2	48.950	1.332	0.272	0.044
下端椎凹侧RMS	刺激	490.386	2	245.193	2.321	0.107	0.074
	平面	1729.458	1	1729.458	8.320	0.008	0.257
	刺激×平面	7.065	2	3.528	2.088	0.133	0.067
下端椎凸/凹侧激活比	刺激	1.952	2	0.976	1.342	0.269	0.044
	平面	1.381	1	1.381	5.519	0.027	0.187
	刺激×平面	0.137	2	0.069	2.339	0.105	0.075

噪声前庭电刺激对青少年特发性脊柱侧凸患者椎旁肌激活与姿势控制的即时效应

Immediate effect of noisy galvanic vestibular stimulation on paraspinal muscle activation and postural control in adolescent idiopathic scoliosis

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ROI		平方和	自由度	均方	F值	P值	η²_p
凸侧DLPFC	刺激	10794.371	2	5397.186	8.581	0.001	0.228
	平面	122.785	1	122.785	0.096	0.759	0.003
	刺激×平面	590.181	2	295.091	8.297	0.001	0.222
凹侧DLPFC	刺激	10655.967	2	5327.983	7.031	0.002	0.195
	平面	262.489	1	262.489	0.212	0.649	0.007
	刺激×平面	60.339	2	30.169	6.718	0.002	0.188
凸侧SMA/PMC	刺激	54.007	2	27.004	1.012	0.370	0.034
	平面	124.026	1	124.026	0.028	0.868	0.001
	刺激×平面	591.254	2	295.627	0.893	0.415	0.030
凹侧SMA/PMC	刺激	318.190	2	159.095	0.065	0.937	0.002
	平面	239.391	1	239.391	0.046	0.832	0.002
	刺激×平面	1121.571	2	560.786	1.258	0.292	0.042
凸侧M1	刺激	28.586	2	14.293	1.003	0.373	0.033
	平面	220.345	1	220.345	0.041	0.841	0.002
	刺激×平面	69.349	2	34.674	2.561	0.086	0.081
凹侧M1	刺激	1945.269	2	972.635	0.556	0.576	0.019
	平面	570.521	1	570.521	0.099	0.755	0.003
	刺激×平面	201.860	2	100.930	2.734	0.073	0.086
凸侧S1	刺激	77.106	2	38.553	2.017	0.142	0.065
	平面	2542.608	1	2542.608	0.452	0.507	0.015
	刺激×平面	91.275	2	45.637	1.898	0.159	0.061
凹侧S1	刺激	812.155	2	406.078	0.561	0.574	0.020
	平面	2362.898	1	2362.898	0.382	0.537	0.014
	刺激×平面	11.369	2	5.684	2.137	0.127	0.069

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ROI	平面	n	无刺激		伪刺激		nGVS
ROI	平面	n	均值	标准差	均值	标准差	均值	标准差
凸侧DLPFC	稳定	30	3.79	2.60	3.61	2.52	16.28	6.33
	不稳定	30	2.76	5.10	5.82	3.82	23.16	8.47
凹侧DLPFC	稳定	30	5.28	7.76	5.50	8.98	20.49	6.05
	不稳定	30	6.26	4.59	8.06	7.08	19.56	9.02
凸侧SMA/PMC	稳定	30	1.85	1.05	2.37	1.60	4.89	3.16
	不稳定	30	2.73	5.28	3.29	4.55	-2.39	2.20
凹侧SMA/PMC	稳定	30	-2.92	4.80	2.77	1.73	5.50	4.71
	不稳定	30	5.15	6.16	5.72	5.73	2.35	2.51
凸侧M1	稳定	30	12.52	9.96	16.77	11.45	12.60	8.35
	不稳定	30	12.48	8.97	11.35	6.79	13.91	7.65
凹侧M1	稳定	30	5.70	4.53	1.40	3.06	8.54	4.08
	不稳定	30	6.39	6.20	5.65	4.33	13.48	8.59
凸侧S1	稳定	30	5.90	8.05	6.56	4.50	5.58	6.30
	不稳定	30	11.79	8.32	13.87	9.20	17.41	6.56
凹侧S1	稳定	30	5.53	4.02	4.61	3.68	9.66	4.08
	不稳定	30	15.37	6.39	14.45	7.25	16.61	5.29