表面肌电在腰椎间盘突出症患者功能评定中的应用研究
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摘要
目的
通过表面肌电探讨腰椎间盘突出症腰部肌肉和下肢肌肉失衡的可能依据,并试图建立一种检测下肢腓肠肌表面肌电信号的实验方法。
方法
将符合入选标准的腰5/骶1(L5/S1)椎间盘突出的腰椎间盘突出症患者44例,按照受试者腰痛程度(VAS评分)的不同分为轻度疼痛组(A组)和中、重度疼痛组(B组),采用芬兰产ME6000-T8型表面肌电图机分别采集两组受试者在完成自身重量的腰部竖脊肌等长负荷测试和自行设计的踝跖屈最大角度自身重量的腓肠肌等长负荷测试时健、患侧L5/S1水平竖脊肌和腓肠肌内侧头的表面肌电信号,分析出平均肌电值(AEMG)和中位频率的斜率(MFs)两个指标,并计算健、患侧AEMG比值和MFs比值。
结果
两组受试者在性别、年龄、患病侧、身高、体重和病程方面均无显著地统计学差异(P>0.05);两组受试者患侧腰部竖脊肌和腓肠肌内侧头AEMG较健侧均有显著地降低(P<0.05),患侧MFs绝对值较健侧显著地升高(P<0.05); A组与B组比较,受试者健、患侧两组肌肉AEMG和健侧两组肌肉的MFs绝对值未见显著性差异(P>0.05),B组受试者患侧两组肌肉MFs绝对值均较A组同侧MFs绝对值显著增大(P<0.05);B组受试者两组肌肉AEMG比值均大于A组(P<0.05);A组与B组比较,受试者竖脊肌和腓肠肌内侧头MFs比值均未见显著性差异(P>0.05)。
结论
表面肌电图可以作为一种无创检测腰椎间盘突出症腰部和下肢神经肌肉功能状态的工具;踝跖屈最大角度自身重量的腓肠肌等长负荷测试可以作为评价腰椎间盘突出症患者下肢神经肌肉功能状态的方法之一;腰椎间盘突出症患者存在双侧腰部竖脊肌和下肢腓肠肌sEMG信号的失衡;疼痛是腰椎间盘突出症患者双侧腰部竖脊肌和下肢腓肠肌失衡的一个重要因素;腰椎间盘突出症患者腰部主观疼痛感程度不同时,双侧腰部竖脊肌和腓肠肌平均肌电值的失衡程度也不同。
Objective
To explore the reason of imbalance for the lumbar and lower limb muscles by observing sEMG;Trying to establish a method of detecting sEMG for gastrocnemius.
Methods
44 patients with chronic Lumbar Disc Herniation were classified into mild pain group (A group) and moderate to severe pain group (B group), ME6000-T8-type sEMG machine were used to collecte sEMG of two groups of patients, and calculate ratios of AEMG and MFs.
Results
Two groups of subjects had no statistically significant difference in gender, age, illness side, height, weight, and course of the disease(P>0.05);AEMG of ipsilateral erector spinae and gastrocnemius with two groups than the healthy side were significantly reduced (P <0.05);absolute value of MFs in the affected side were significantly elevated (P <0.05);Both sides of AEMG in lumbar paraspinal muscles and gastrocnemius ,MFs of health side in gastrocnemius was no significant difference between A group and B group(P>0.05); absolute value of MFs in affected lumbar paraspinal muscles and gastrocnemius with B group were significantly boosted in comparison with A group (P <0.05);ratio of AEMG with B group subjects was observably increased(P<0.05);MFs of lumbar paraspinal muscles and gastrocnemius were no significantly difference between A group and B group(P>0.05).
Conclusion
sEMG could be used as a non-invasive tool in detecting neuromuscular functional status of lumbar and lower limb in patients with Lumbar Disc Herniation;isometric loading tests of gastrocnemius on maximal inflective ankle could be used as evaluation of neuromuscular functional status of crura in patients with lumbar disc herniation;sEMG of lumbar spinal muscular and gastrocnemius existed imbalance in LDH;pain was an important factor of imbalance for lumbar paraspinal and gastrocnemius in patients with lumbar disc herniation;there was dissimilar sEMG imbalance in lumbar paraspinal muscle and gastrocnemius while subjective pain levels of patients were different.
通过表面肌电探讨腰椎间盘突出症腰部肌肉和下肢肌肉失衡的可能依据,并试图建立一种检测下肢腓肠肌表面肌电信号的实验方法。
方法
将符合入选标准的腰5/骶1(L5/S1)椎间盘突出的腰椎间盘突出症患者44例,按照受试者腰痛程度(VAS评分)的不同分为轻度疼痛组(A组)和中、重度疼痛组(B组),采用芬兰产ME6000-T8型表面肌电图机分别采集两组受试者在完成自身重量的腰部竖脊肌等长负荷测试和自行设计的踝跖屈最大角度自身重量的腓肠肌等长负荷测试时健、患侧L5/S1水平竖脊肌和腓肠肌内侧头的表面肌电信号,分析出平均肌电值(AEMG)和中位频率的斜率(MFs)两个指标,并计算健、患侧AEMG比值和MFs比值。
结果
两组受试者在性别、年龄、患病侧、身高、体重和病程方面均无显著地统计学差异(P>0.05);两组受试者患侧腰部竖脊肌和腓肠肌内侧头AEMG较健侧均有显著地降低(P<0.05),患侧MFs绝对值较健侧显著地升高(P<0.05); A组与B组比较,受试者健、患侧两组肌肉AEMG和健侧两组肌肉的MFs绝对值未见显著性差异(P>0.05),B组受试者患侧两组肌肉MFs绝对值均较A组同侧MFs绝对值显著增大(P<0.05);B组受试者两组肌肉AEMG比值均大于A组(P<0.05);A组与B组比较,受试者竖脊肌和腓肠肌内侧头MFs比值均未见显著性差异(P>0.05)。
结论
表面肌电图可以作为一种无创检测腰椎间盘突出症腰部和下肢神经肌肉功能状态的工具;踝跖屈最大角度自身重量的腓肠肌等长负荷测试可以作为评价腰椎间盘突出症患者下肢神经肌肉功能状态的方法之一;腰椎间盘突出症患者存在双侧腰部竖脊肌和下肢腓肠肌sEMG信号的失衡;疼痛是腰椎间盘突出症患者双侧腰部竖脊肌和下肢腓肠肌失衡的一个重要因素;腰椎间盘突出症患者腰部主观疼痛感程度不同时,双侧腰部竖脊肌和腓肠肌平均肌电值的失衡程度也不同。
Objective
To explore the reason of imbalance for the lumbar and lower limb muscles by observing sEMG;Trying to establish a method of detecting sEMG for gastrocnemius.
Methods
44 patients with chronic Lumbar Disc Herniation were classified into mild pain group (A group) and moderate to severe pain group (B group), ME6000-T8-type sEMG machine were used to collecte sEMG of two groups of patients, and calculate ratios of AEMG and MFs.
Results
Two groups of subjects had no statistically significant difference in gender, age, illness side, height, weight, and course of the disease(P>0.05);AEMG of ipsilateral erector spinae and gastrocnemius with two groups than the healthy side were significantly reduced (P <0.05);absolute value of MFs in the affected side were significantly elevated (P <0.05);Both sides of AEMG in lumbar paraspinal muscles and gastrocnemius ,MFs of health side in gastrocnemius was no significant difference between A group and B group(P>0.05); absolute value of MFs in affected lumbar paraspinal muscles and gastrocnemius with B group were significantly boosted in comparison with A group (P <0.05);ratio of AEMG with B group subjects was observably increased(P<0.05);MFs of lumbar paraspinal muscles and gastrocnemius were no significantly difference between A group and B group(P>0.05).
Conclusion
sEMG could be used as a non-invasive tool in detecting neuromuscular functional status of lumbar and lower limb in patients with Lumbar Disc Herniation;isometric loading tests of gastrocnemius on maximal inflective ankle could be used as evaluation of neuromuscular functional status of crura in patients with lumbar disc herniation;sEMG of lumbar spinal muscular and gastrocnemius existed imbalance in LDH;pain was an important factor of imbalance for lumbar paraspinal and gastrocnemius in patients with lumbar disc herniation;there was dissimilar sEMG imbalance in lumbar paraspinal muscle and gastrocnemius while subjective pain levels of patients were different.
引文
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[22] He LH, Wang S, Shen P,etal.Effect of lumbar protective belt on prevention of low back fatigue in personnel during simulated driving.Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi,2004,22(4):254-256.
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