核心稳定训练联合手法治疗腰椎间盘突出症30例
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摘要
目的观察核心稳定训练联合手法治疗腰椎间盘突出症的临床疗效。方法将60例腰椎间盘突出症患者随机分为治疗组和对照组,每组30例。对照组予推拿手法治疗,治疗组在对照组治疗措施的基础上加用核心稳定训练。两组疗程均为20天,比较疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及腹部屈肌群、腰背部伸肌群峰力矩(PT)值的变化情况。结果①治疗前后组内比较,两组VAS评分、ODI值均较治疗前减少(P<0.05);组间治疗后比较,治疗组VAS评分、ODI值少于对照组(P<0.05)。②治疗前后组内比较,两组腹部屈肌群、腰背部伸肌群的PT值均升高(P<0.05);组间治疗后比较,腹部屈肌群、腰背部伸肌群的PT值差异无统计学意义(P>0.05)。结论核心稳定训练联合手法对腰椎间盘突出症疗效满意,较单纯手法能更好地缓解疼痛,提高患者的日常生活能力。
Objective To observe the clinical efficacy of core stability exercises combined with manipulation therapy in the treatment of lumbar disc herniation(LDH). Methods 60 patients with LDH were randomly assigned into treatment group and control group, 30 patients in each group. Both groups received manipulation therapy, and the treatment group was treated with core stability exercises additionally. The treatment course was 20 days. The changes in the visual analogue score(VAS) of pain, Oswestry disability index(ODI), and values of peak torque(PT) of the abdominal flexors and the extensors of lumbar and dorsal region were compared. Results ①After treatment, the VAS score and ODI decreased in both groups compared to those before treatment(P<0.05); and they were lower in the treatment group than in the control group(P<0.05). ②After treatment, the PT values of the abdominal flexors and the extensors of lumbar and dorsal region increased in both groups compared to those before treatment(P<0.05), with no statistically significant differences between the groups(P<0.05). Conclusion Core stability exercises combined with manipulation therapy shows satisfactory effects in treating LDH, is more effective in relieving pain, and improves activities of daily living of patients compared to manipulation therapy alone.
Objective To observe the clinical efficacy of core stability exercises combined with manipulation therapy in the treatment of lumbar disc herniation(LDH). Methods 60 patients with LDH were randomly assigned into treatment group and control group, 30 patients in each group. Both groups received manipulation therapy, and the treatment group was treated with core stability exercises additionally. The treatment course was 20 days. The changes in the visual analogue score(VAS) of pain, Oswestry disability index(ODI), and values of peak torque(PT) of the abdominal flexors and the extensors of lumbar and dorsal region were compared. Results ①After treatment, the VAS score and ODI decreased in both groups compared to those before treatment(P<0.05); and they were lower in the treatment group than in the control group(P<0.05). ②After treatment, the PT values of the abdominal flexors and the extensors of lumbar and dorsal region increased in both groups compared to those before treatment(P<0.05), with no statistically significant differences between the groups(P<0.05). Conclusion Core stability exercises combined with manipulation therapy shows satisfactory effects in treating LDH, is more effective in relieving pain, and improves activities of daily living of patients compared to manipulation therapy alone.
引文
[1] 张瑞春,王洪霞.推拿联合中药外敷治疗腰椎间盘突出症效果观察[J].陕西中医,2018,39(7):956- 958.
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[7] MONFORT- PAňEGO M,VERA- GARCíA F J,SáNCHEZ- ZURIAGA D,et al.Electromyographic studies in abdominal exercises:a literature synthesis[J].J Manipulative Physiol Ther,2009,32(3):232- 244.
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[9] 胡有谷.腰椎间盘突出症[M].北京:人民卫生出版社,2004:221.
[10] 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:201.
[11] ROLAND M,MORRIS R.A study of the natural history of back pain.Part I:development of a reliable and sensitive measure of disability in low- back pain[J].Spine,1983,8(2):141- 144.
[12] ZHANG B,XU H,WANG J,et al.A narrative review of non- operative treatment,especially traditional Chinese medicine therapy,for lumbar intervertebral disc herniation[J].Biosci Trends,2017,11(4):406- 417.
[13] 罗春,王宁华,谢斌.脊柱核心稳定控制系统的研究进展[J].中国康复医学杂志,2016,31(9):1022- 1027.
[14] HODGES P W,ERIKSSON A E,SHIRLEY D,et al.Intra- abdominal pressure increases stiffness of the lumbar spine[J].J Biomech,2005,38(9):1873- 1880.
[15] HIDES J A,JULL G A,RICHARDSON C A.Long term effects of specific stabilizing exercises for first episode low back pain[J].Spine,2001,26(11):E243- E248.
[16] HODGES P W,RICHARDSON C A.Inefficient muscular stabilization of the lumbar spine associated with low back pain.A motor control evaluation of transversus abdominis[J].Spine,1996,21(22):2640- 2650.
[17] 严隽陶.推拿学[M].北京:中国中医药出版社,2003:11- 13.
[18] 屈庆,张宏,张国辉.推拿法舒经通络效应机制浅析[J].辽宁中医杂志,2015,42(3):598- 600.
[19] 郭朝卿,程英武.推拿局部镇痛机制的概述[J].湖北中医药大学学报,2015,17(1):107- 110.
[20] 纪树荣.运动疗法技术学[M].2版.北京:华夏出版社,2015:100.
[2] 许成华,俞年塘,鲁静,等.隔姜药物铺灸配合推拿治疗腰椎间盘突出症的疗效观察[J].上海针灸杂志,2018,37(9):1059- 1062.
[3] BELLIDO- FERNáNDEZ L,JIMéNEZ- REJANO J J,CHILLóN- MARTíNEZ R,et al.Effectiveness of massage therapy and abdominal hypopressive gymnastics innonspecific chronic low back pain:A randomized controlled pilot study[J/OL].Evid Based Complement Alternat Med,2018,2:3601984[2019- 03- 01].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842706/.DOI:10.1155/2018/3684194.
[4] MACHADO G C,MAHER CG,FERREIRA P H,et al.Can recurrence after an acute episode came of low back pain be predicted[J].Phys Ther,2017,97(9):889- 895.
[5] 张国辉,张宏,高明丽,等.腰腹肌协同训练治疗腰部运动损伤的临床疗效研究[J].辽宁中医杂志,2014,41(12):2665- 2666.
[6] PANJABI M M.The stabilizing system of the spine.Part I.Function,dysfunction,adaptation,and enhancement[J].J Spinal Disord,1992,5(4):383- 389.
[7] MONFORT- PAňEGO M,VERA- GARCíA F J,SáNCHEZ- ZURIAGA D,et al.Electromyographic studies in abdominal exercises:a literature synthesis[J].J Manipulative Physiol Ther,2009,32(3):232- 244.
[8] BORGHUIS J,HOF A L,LEMMINK K A.The importance of sensory- motor control in providing core stability[J].Sports Med,2008,38(11):893- 916.
[9] 胡有谷.腰椎间盘突出症[M].北京:人民卫生出版社,2004:221.
[10] 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:201.
[11] ROLAND M,MORRIS R.A study of the natural history of back pain.Part I:development of a reliable and sensitive measure of disability in low- back pain[J].Spine,1983,8(2):141- 144.
[12] ZHANG B,XU H,WANG J,et al.A narrative review of non- operative treatment,especially traditional Chinese medicine therapy,for lumbar intervertebral disc herniation[J].Biosci Trends,2017,11(4):406- 417.
[13] 罗春,王宁华,谢斌.脊柱核心稳定控制系统的研究进展[J].中国康复医学杂志,2016,31(9):1022- 1027.
[14] HODGES P W,ERIKSSON A E,SHIRLEY D,et al.Intra- abdominal pressure increases stiffness of the lumbar spine[J].J Biomech,2005,38(9):1873- 1880.
[15] HIDES J A,JULL G A,RICHARDSON C A.Long term effects of specific stabilizing exercises for first episode low back pain[J].Spine,2001,26(11):E243- E248.
[16] HODGES P W,RICHARDSON C A.Inefficient muscular stabilization of the lumbar spine associated with low back pain.A motor control evaluation of transversus abdominis[J].Spine,1996,21(22):2640- 2650.
[17] 严隽陶.推拿学[M].北京:中国中医药出版社,2003:11- 13.
[18] 屈庆,张宏,张国辉.推拿法舒经通络效应机制浅析[J].辽宁中医杂志,2015,42(3):598- 600.
[19] 郭朝卿,程英武.推拿局部镇痛机制的概述[J].湖北中医药大学学报,2015,17(1):107- 110.
[20] 纪树荣.运动疗法技术学[M].2版.北京:华夏出版社,2015:100.