核心稳定性训练对腰椎间盘突出症患者的康复效果
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摘要
目的分析核心稳定性训练对腰椎间盘突出症患者的康复效果。方法选取2016年3月至2017年3月于安徽医科大学第一附属医院康复医学科住院治疗的有单侧下肢放射痛的腰椎间盘突出症患者91例,按随机数字表法将其分为观察组(46例)和对照组(45例)。对照组患者给予常规康复治疗和非手术脊柱减压治疗2周。观察组患者在对照组的基础上给予核心稳定性训练,持续2周。于治疗前、治疗后、随访6个月后分别采用功能障碍指数(ODI)、单桥耐力试验(UHBE)评估两组患者日常生活活动和核心稳定性的情况。结果两组患者治疗前ODI评分、UHBE时间差异无统计学意义(P> 0. 05)。治疗后、随访6个月后,两组患者的ODI评分、UHBE时间均较治疗前改善,差异有统计学意义(P <0. 05)。治疗后及随访6个月后,观察组患者ODI评分低于对照组,而UHBE时间多于对照组患者,差异均有统计学意义(P <0. 05)。与治疗后相比,随访6个月后的观察组患者的ODI评分较治疗后增高,UHBE时间较治疗后减少,差异均无统计学意义(P> 0. 05);而对照患者的ODI评分较治疗后增高,UHBE时间较治疗后减少,差异均有统计学意义(P <0. 05)。结论核心稳定性训练有助于腰椎间盘突出症患者临床康复,坚持训练可巩固疗效。
Objective To observe the clinical effect of core stability training combined with non-operativespinal decompression treatment for patients with lumbar disc herniation. Methods Ninety-one patients with lumbar disc herniation admitted to the hospital from March 2016 to March 2017 were divided into treatment group of forty-six cases and control group of forty-five cases according to a random number table. All patients received non-operative spinal decompression treatment and other baseline rehabilitation including medication,physical therapy and manual therapy for two weeks,while patients in treatment group were given core stability training additionally. For the assessment,Oswestrydisability index(ODI) and unilateral hip bridge endurance test(UHBE) were used to evaluate patients' activities of daily living and core stability before and after 2 weeks,6 months of treatment. Results The baseline data and the data of ODI and UHBE before treatment had no significant difference between the two groups(P > 0. 05),while they were improved greatly in both groups after 2 weeks' rehabilitation and 6 months after treatment(P < 0. 05). Compared to control group,the data of ODI and UHBE improved significantly(P < 0. 05). The ODI scores increased and UHBE time decreased in two groups 6 months after treatment. There was no significant difference in ODI score and UHBE time in treatment group(P < 0. 05),while the control group had statistical differences(P < 0. 05). Conclusion The core stability training can significantly improve the activities of daily living and core stability in patients with lumbar disc herniation,and should be maintained.
Objective To observe the clinical effect of core stability training combined with non-operativespinal decompression treatment for patients with lumbar disc herniation. Methods Ninety-one patients with lumbar disc herniation admitted to the hospital from March 2016 to March 2017 were divided into treatment group of forty-six cases and control group of forty-five cases according to a random number table. All patients received non-operative spinal decompression treatment and other baseline rehabilitation including medication,physical therapy and manual therapy for two weeks,while patients in treatment group were given core stability training additionally. For the assessment,Oswestrydisability index(ODI) and unilateral hip bridge endurance test(UHBE) were used to evaluate patients' activities of daily living and core stability before and after 2 weeks,6 months of treatment. Results The baseline data and the data of ODI and UHBE before treatment had no significant difference between the two groups(P > 0. 05),while they were improved greatly in both groups after 2 weeks' rehabilitation and 6 months after treatment(P < 0. 05). Compared to control group,the data of ODI and UHBE improved significantly(P < 0. 05). The ODI scores increased and UHBE time decreased in two groups 6 months after treatment. There was no significant difference in ODI score and UHBE time in treatment group(P < 0. 05),while the control group had statistical differences(P < 0. 05). Conclusion The core stability training can significantly improve the activities of daily living and core stability in patients with lumbar disc herniation,and should be maintained.
引文
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[2]周谋望,岳寿伟,何成奇,等.“腰椎间盘突出症的康复治疗”中国专家共识[J].中国康复医学杂志,2017,32(2):129-135.
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[5]饶美林,肖洪波.常见病康复诊疗规范——腰椎间盘突出症康复规范管理与分级诊疗[J].安徽医学,2017,38(9):1230-1231.
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[10] ARAUJO S,COHEN D,HAYES L. Six weeks of core stability training improves landing kinetics among female capoeira athletes:a pilot study[J]. J Hum Kinet,2015,45:27-37.
[11]李威,曾祥斌,章荣,等.核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响[J].中国康复医学杂志,2014,29(9):816-822.
[12] MEHRA A,BAKER D,DISNEY S,etal. Oswestry disability index scoring made easy[J]. Ann R Coll Surg Engl,2008,90(6):497-499.
[13] BUTOWICZ C M,EBAUGH D,NOEHREN B,etal. Validation of two clinical measures of core stability[J]. Int J Sports Phys Ther,2016,11(1):15-23.
[14]彭静,王小伟,孙冬梅,等.核心稳定性训练的研究进展[J].中国康复理论与实践,2014,20(7):629-633.
[15]钱月芳,金敏娟,方昊.腰部核心肌力训练联合悬吊训练治疗腰椎间盘突出症的疗效观察[J].中华物理医学与康复杂志,2016,38(9):704-706.
[16] KONG J Y,JANG G U,PARK S. The effects of prone bridge exercise on the oswestry disability index and proprioception of patients with chronic low back pain[J]. J Phys Ther Sci,2015,27(9):2749-2752.
[17] LEE A S,CHOLEWICKI J,REEVES N P,et al. Comparison of trunk proprioception between patients with low back pain and healthy controls[J]. Arch Phys Med Rehabil,2010,91(9):1327-1331.
[18]张聘,张雷.髋-腰综合征的诊疗进展[J].安徽医学,2017,38(4):520-523.
[19]李宏彦,宋俊.核心稳定性训练治疗椎间盘源性下背痛的疗效观察[J].中华物理医学与康复杂志,2018,40(7):535-537.
[20] CHEN CH X,LIN Z CH,ZHANG Y J,et al. Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?[J]. Pak J Med Sci,2017,33(3):631-634.
[21] VAN DEN BERG L E M,FAVEJEE M M,WENS S C A,et al. Safety and efficacy of exercise training in adults with Pompe disease:evalution of endurance,muscle strength and core stability before and after a 12 week training program[J]. Orphanet J Rare Dis,2015,10:87.
[22] STILWELL P,HARMAN K. Contemporary biopsychosocial exercise prescription for chronic low back pain:questioning core stability programs and considering context[J]. J Can Chiropr Assoc,2017,61(1):6-17.
[23] AHMED R,SHAKIL-UR-REHMAN S,SIBTAIN F. Comparison between specific lumber mobilization and core-stability exercises with core-stability exercises alone in mechanical low back pain[J]. Pak J Med Sci,2014,30(1):157-160.
[2]周谋望,岳寿伟,何成奇,等.“腰椎间盘突出症的康复治疗”中国专家共识[J].中国康复医学杂志,2017,32(2):129-135.
[3] WANG X Q,ZHENG J J,YU Z W,et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain[J]. PLo S One,2012,7(12):e52082.
[4]吴方超,李建华.核心稳定性训练治疗腰椎间盘突出症的疗效及表面肌电指标分析[J].中华物理医学与康复杂志,2014,36(11):859-863.
[5]饶美林,肖洪波.常见病康复诊疗规范——腰椎间盘突出症康复规范管理与分级诊疗[J].安徽医学,2017,38(9):1230-1231.
[6]于长隆.骨科康复学[M].北京:人民卫生出版社,2010:467-470.
[7]张绍岚,何小花.疾病康复[M]. 2版.北京:人民卫生出版社,2016:133-141.
[8] KELLIE C,BLIVEN H,ANDERSON B E. Core stability training for injury prevention[J]. Sports Health,2013,5(6):514-522.
[9] PARK J M,HYUN G S,JEE Y S. Effects of pilates core stability exercises on the balance abilities of archers[J]. J Exerc Rehabil,2016,12(6):553-558.
[10] ARAUJO S,COHEN D,HAYES L. Six weeks of core stability training improves landing kinetics among female capoeira athletes:a pilot study[J]. J Hum Kinet,2015,45:27-37.
[11]李威,曾祥斌,章荣,等.核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响[J].中国康复医学杂志,2014,29(9):816-822.
[12] MEHRA A,BAKER D,DISNEY S,etal. Oswestry disability index scoring made easy[J]. Ann R Coll Surg Engl,2008,90(6):497-499.
[13] BUTOWICZ C M,EBAUGH D,NOEHREN B,etal. Validation of two clinical measures of core stability[J]. Int J Sports Phys Ther,2016,11(1):15-23.
[14]彭静,王小伟,孙冬梅,等.核心稳定性训练的研究进展[J].中国康复理论与实践,2014,20(7):629-633.
[15]钱月芳,金敏娟,方昊.腰部核心肌力训练联合悬吊训练治疗腰椎间盘突出症的疗效观察[J].中华物理医学与康复杂志,2016,38(9):704-706.
[16] KONG J Y,JANG G U,PARK S. The effects of prone bridge exercise on the oswestry disability index and proprioception of patients with chronic low back pain[J]. J Phys Ther Sci,2015,27(9):2749-2752.
[17] LEE A S,CHOLEWICKI J,REEVES N P,et al. Comparison of trunk proprioception between patients with low back pain and healthy controls[J]. Arch Phys Med Rehabil,2010,91(9):1327-1331.
[18]张聘,张雷.髋-腰综合征的诊疗进展[J].安徽医学,2017,38(4):520-523.
[19]李宏彦,宋俊.核心稳定性训练治疗椎间盘源性下背痛的疗效观察[J].中华物理医学与康复杂志,2018,40(7):535-537.
[20] CHEN CH X,LIN Z CH,ZHANG Y J,et al. Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?[J]. Pak J Med Sci,2017,33(3):631-634.
[21] VAN DEN BERG L E M,FAVEJEE M M,WENS S C A,et al. Safety and efficacy of exercise training in adults with Pompe disease:evalution of endurance,muscle strength and core stability before and after a 12 week training program[J]. Orphanet J Rare Dis,2015,10:87.
[22] STILWELL P,HARMAN K. Contemporary biopsychosocial exercise prescription for chronic low back pain:questioning core stability programs and considering context[J]. J Can Chiropr Assoc,2017,61(1):6-17.
[23] AHMED R,SHAKIL-UR-REHMAN S,SIBTAIN F. Comparison between specific lumber mobilization and core-stability exercises with core-stability exercises alone in mechanical low back pain[J]. Pak J Med Sci,2014,30(1):157-160.