基于平均频率变化的腰椎间盘突出症患者核心稳定性训练的康复价值探讨
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摘要
目的通过观察腰椎间盘突出症患者两种体位下核心肌表面肌电图的平均功率值变化探讨核心稳定性训练疗法在临床腰痛康复中的价值。方法选取2016年1月—2017年6月绍兴市人民医院符合入选标准的腰椎间盘突出症患者57例,采用随机数字表法分为训练组(29例)和对照组(28例),训练组给予核心稳定性训练疗法联合常规理疗(中频脉冲和超短波治疗);对照组仅接受常规理疗,总疗程8周。在治疗前、治疗后4周和8周时分别进行JOA下背痛评定量表、ODI评估和平均频率(mean frequency,MNF)值提取,选取腹直肌、竖脊肌和多裂肌为MNF提取肌肉,进行数据分析。结果提取肌肉接受核心肌治疗后在最大前屈位、后伸位上,上述值均较治疗前改善,组内比较:相比治疗前差异均有统计学意义(均P<0.05);其中训练组内治疗后4周和8周时比较,差异有统计学意义(均P<0.05),而对照组差异无统计学意义(均P>0.05)。组间比较:治疗后8周时,ODI百分比、JOA评分及MNF值差异均有统计学意义(均P<0.05),4周时差异无统计学意义(均P>0.05)。结论核心稳定性训练在短期内与常规理疗效果相近,但延长疗程后在减轻腰痛、改善功能障碍及增加核心肌效能方面较一般理疗更为有效,且简便易行,值得临床推广。
Objective To explore the effects of core stability training in lumbar disc herniation with the change of mean frequency(MNF) signals under different position on core muscles. Methods From January 2016 to June 2017, fifty-seven patients with lumbar disc herniation were randomly divided into the experimental group(core stability training plus regular physical therapy, n=29) and the control group(regular physical therapy only, n=28). The total course of treatment was 8 weeks. All patients were assessed three times(before, after 4 and 8 weeks) using Japanese orthopaedic association(JOA), oswestry disability index(ODI) and MNF of rectus abdominis, erector spinae and lumbar multifidus. Results Two therapies were both effective. The improvements on all above indexes at 4 weeks and 8 weeks after treatment were both statistically significant(all P<0.05) under different position in two groups. There was statistically significant(all P<0.05) in experimental group, but no statistically significant(all P>0.05) in control group between 4 weeks and 8 weeks. Between two groups, no significant difference(all P>0.05) was found at 4 weeks and significant difference(all P<0.05) was found at 8 weeks. Conclusion There are similar effects on patients with lumbar disc herniation between core stability training and regular physical therapy during a short time. While continuing core stability training can further improve the ability of core muscles and relieve pain and dysfunction. It should be better than the regular physical therapy and be worthy of clinical promotion.
Objective To explore the effects of core stability training in lumbar disc herniation with the change of mean frequency(MNF) signals under different position on core muscles. Methods From January 2016 to June 2017, fifty-seven patients with lumbar disc herniation were randomly divided into the experimental group(core stability training plus regular physical therapy, n=29) and the control group(regular physical therapy only, n=28). The total course of treatment was 8 weeks. All patients were assessed three times(before, after 4 and 8 weeks) using Japanese orthopaedic association(JOA), oswestry disability index(ODI) and MNF of rectus abdominis, erector spinae and lumbar multifidus. Results Two therapies were both effective. The improvements on all above indexes at 4 weeks and 8 weeks after treatment were both statistically significant(all P<0.05) under different position in two groups. There was statistically significant(all P<0.05) in experimental group, but no statistically significant(all P>0.05) in control group between 4 weeks and 8 weeks. Between two groups, no significant difference(all P>0.05) was found at 4 weeks and significant difference(all P<0.05) was found at 8 weeks. Conclusion There are similar effects on patients with lumbar disc herniation between core stability training and regular physical therapy during a short time. While continuing core stability training can further improve the ability of core muscles and relieve pain and dysfunction. It should be better than the regular physical therapy and be worthy of clinical promotion.
引文
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[17] HOPPES C W,SPERIER A D,HOPKINS C F,et al.The efficacy of an eight-week core stabilization program on core stabilization program on core muscle function and endurance:a randomized trial[J].Int J Sports Phys Ther,2016,11(4):507-519.
[2] ABOAGYE E,KARLSSON M L,HAGBERG J,et al.Cost-effectiveness of earlyinterventions for non-specific low back pain:A randomized controlled study investigating medical yoga,exercise therapy and self-care advice[J].J Rehabil Med,2015,47(2):167-173.
[3] BAGHERI R,TAKAMJANI I E,DADGOO M,et al.A protocol for clinical trial study of the effect of core stabilization exercises on spine kinematics during gait with and without load in patients with non-specific chronic low back pain[J].Chiropr Man Therap,2017,25:31.
[4] 胥少汀,葛宝丰,徐印坎.实用骨科学[M].3版.北京:人民卫生出版社,2007:1693-1697.
[5] 李建华,王健.表面肌电图诊断技术临床应用[M].杭州:浙江大学出版社,2015:308-309.
[6] KRAMER M,EBERT V,KINZL L,et al.Surface electromyography of the paravertebral muscles in patients with chronic low back pain[J].Arch Phys Med Rehabil,2005,86(1):31-36.
[7] 丁惠民,韦继南,吴小涛,等.三维可调微创拉钩手术系统与显微内镜椎间盘切除术治疗腰椎间盘突出症效果对比分析[J].中国医药,2015,10(11):1644-1648.
[8] 李春镇,舒国建,陈颖,等.Thera-Band渐进抗阻系统结合针刺、推拿治疗慢性非特异性腰痛的疗效观察[J].中国康复医学杂志,2013,28(1):51-53.
[9] BARBOSA A C,CARVALHO R A,BONIFáCIO D N,et al.Increased activation amplitude levels of gluteusMedius in women during isometric and dynamic conditions following a 4-week protocol of low-load eccentric exercises[J].Physiother Res Int,2016,21(4):257-263.
[10] STREISFELD G M,BARTOSZEK C,CRERAN E,et al.Relationship between body positioning,muscle activity,and spinal kinematics in cyclists with and without low back pain:A systematic review[J].Sports Health,2017,9(1):75-79.
[11] RUTKOWSKA-KUCHARSKA A,SZPALA A.The use of electromyography and magnetic resonance imaging to evaluate a core strengthening exercise programme[J].J Back Musculoskelet Rehabil,2018,31(2):355-362.
[12] 龚剑秋,范顺武.单侧症状腰椎间盘突出患者双侧多裂肌的病理生理改变[J].中华物理医学与康复杂志,2014,36(1):31-35.
[13] PEREIRA I L R,QUEIROZ B,LOSS J,et al.Trunk muscle EMG during intermediate pilates mat exercises in beginner healthy and chronic low back pain individuals[J].J Manipulative Physiol Ther,2017,40(5):350-357.
[14] KOVáCSNé BOBáLY V,SZILáGYI B,MAKAI A,et al.Improvement of lumbal motor control and trunk muscle conditions with a novel low back pain prevention exercise program[J].Orv Hetil,2017,158(2):58-66.
[15] XIAO J,SUN J,GAO J,et al.The activity of surface electromyographic signal of selected muscles during classic rehabilitation exercise[J].Rehabil Res Pract,2016,2016:4796875.doi:10.1155/2016/4796875.
[16] CHANG W D,LIN H Y,LAI P T.Core strength training for patients with chronic low back pain[J].J Phys Ther Sci,2015,27(3):619-622.
[17] HOPPES C W,SPERIER A D,HOPKINS C F,et al.The efficacy of an eight-week core stabilization program on core stabilization program on core muscle function and endurance:a randomized trial[J].Int J Sports Phys Ther,2016,11(4):507-519.
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