慢性下腰痛患者腰椎曲度与躯干肌等长收缩肌力的关系

目的：观察慢性下腰痛患者腰椎曲度与躯干肌肌力的变化,为慢性下腰痛的康复和预防提供依据.方法：选择2004-08/12第二军医大学长海医院康复医学科门诊接诊慢性下腰痛患者36例,均为女性;平均（44.2&;#177;3.9）岁;平均体质量（61.9&;#177;7.7）kg;平均身高（160.3&;#177;5.6）cm.对36例患者分别进行躯干肌屈伸等长收缩肌力测试和腰椎曲度测量,并根据腰椎曲度测量结果分为曲度正常组19例和曲度异常组16例,评价两组间等长收缩肌力测试的屈伸峰力矩及屈、伸峰力矩之比.结果：两组屈、伸峰力矩和屈、伸峰力矩之比值的比较：两组躯干肌等长收缩肌力测试中前屈峰力矩无显著差别（t=0.525,P=0.603＞0.05）,曲度异常组后伸峰力矩值显著小于曲度正常组[（86.50&;#177;10.30）,（117.21&;#177;23.32）N&;#183;m,t=4.875,P=0.000＜0.05],曲度异常组前屈和后伸峰力矩之比值显著大于曲度正常组（0.359&;#177;0.050,0.286&;#177;0.009,t=2.699,P=0.011＜0.05）.结论：慢性下腰痛患者躯干肌后伸肌力的显著降低和腰椎曲度的降低可能存在着互为因果的密切关系,加强躯干肌后伸肌力训练和调整腰椎曲度的训练可能会促进慢性下腰痛的康复和预防慢性下腰痛的发生和发展.     

躯干肌屈曲、伸展等长收缩肌力测试的信度研究

目的:探讨躯干肌屈曲、伸展等长收缩肌力测试的信度,为临床应用提供可靠依据。方法:20例健康受试者,在1周内采用BiodexⅡAP型多关节等速测试系统对每位受试者进行了2次躯干肌屈曲、伸展等长收缩肌力测试,获得躯干肌屈曲、伸展最大平均力矩、最大重复做功、总做功和平均功率等结果,并采用组内相关系数进行信度分析。结果:躯干肌屈曲、伸展2次等长收缩肌力测试的各指标高度相关(ICC>0.90),呈现良好的稳定性。结论:躯干肌屈曲、伸展等长收缩肌力测试在反映躯干肌肌力的变化方面具有较高的信度,测试指标稳定可靠。     

躯干屈伸肌等长与等速向心收缩肌力测试的相关研究

目的探讨躯干屈伸肌等长与等速向心收缩肌力测试结果的相关性。方法对50例健康受试者分别进行躯干肌屈曲、伸展等长收缩与等速向心收缩肌力测试,将二种方法测试的屈曲、伸展峰力矩(peak torque,PT)和屈曲、伸展峰力矩之比(F/E)进行相关与回归分析。结果躯干屈伸肌等长收缩、等速向心收缩肌力测试中PT值呈显著正相关(r伸=0.827,P=0.000<0.05,r屈=0.873,P=0.000<0.05);等长收缩和等速向心收缩肌力测试获得的屈曲、伸展PT值建立的回归方程式分别为y^=8.158+1.097x和y^=-12.375+0.781x,经检验成立并有统计学意义(P<0.05);而屈曲、伸展峰力矩之比(F/E)无相关性(r=0.18,P=0.208>0.05),二者差异有统计学意义(t=-7.588,P=0.000<0.05)。结论躯干屈伸肌等长收缩肌力测试能准确地反映躯干肌肌力的变化,并且用中立位等长收缩肌力测试的F/E比值反映躯干的稳定性更合理。     

慢性下腰痛患者腰屈伸肌的等速肌力评价

目的：通过对慢性下腰痛患者腰屈伸肌进行等速向心、离心肌力测试,定量评价患者腰屈伸肌肌力的变化,为慢性下腰痛患者腰屈伸肌肌肉功能的康复训练提供依据。方法：运用Ｃｙｂｅｘ － ６０００ 型等速测力系统分别对３０ 例慢性下腰痛患者及３０ 例正常人在慢速（３０°／ｓ） 和中速（９０°／ｓ） 条件下进行腰屈伸肌的等速向心和离心肌力测试,评价屈肌与伸肌的峰力矩／ 体重比值,以及腰屈伸肌向心与离心的峰力矩／ 体重比值。结果：两种测试速度下,患者组与正常组相比,腰屈肌向心测试和屈、伸肌离心测试的峰力矩／ 体重值降低,伸肌向心测试的峰力矩／ 体重值较正常组显著下降（ Ｐ＜ ０ ．００１） ;向心测试屈、伸肌峰力矩与体重比值显著增大（ Ｐ＜ ０ ．０１） ,离心测试屈、伸肌峰力矩与体重比值增大;屈肌向心、离心测试的峰力矩与体重的比值降低,伸肌向心、离心测试的峰力矩与体重的比值显著降低（ Ｐ＜ ０ ．０１） 。结论：慢性下腰痛患者腰屈伸肌存在屈伸肌力的下降及失衡,需针对性地进行屈伸肌肌力训练,以恢复屈伸肌对腰椎主动稳定和功能性活动的作用,避免肌源性下腰痛的反复发作和牵延难愈     

躯干肌等长收缩角度对测试结果的影响

目的:研究不同角度对躯干肌等长收缩测试的影响,探讨躯干肌等长收缩测试的合理角度参数。方法:32例健康在校男性军人作为受试者,使用美国产BiodexⅡAP型等速测试系统进行躯干肌等长收缩测试,测定其最大平均力矩(MAT)、相对最大平均力矩(MAT/BW)、最大重复做功(MRW)、相对最大重复做功(MRW/BW)、总做功(TW)、平均功率(AP)和最大平均力矩屈伸比值(F/E)等指标,测试角度分别选用后伸15°位、中立0°位和前屈15°位,利用方差分析对结果进行统计学分析。结果:伸展测试时三组间上述所有指标的差异有显著性意义(P<0.05),屈曲测试时上述指标的差异无显著性意义(P>0.05);三组间F/E差异亦有显著性意义(P<0.05)。结论:在躯干肌等长收缩测试中,角度的选择对于伸展测试的结果影响是明显的,而对屈曲测试的结果影响并不明显;中立0°位可作为躯干肌等长收缩测试的推荐角度。     

冠心病患者等长收缩运动与心肌缺血的关系

目的　探讨冠心病患者等长收缩运动与心肌缺血的关系。方法　采用超声多普勒技术 ,比较 2 0例冠心病患者和 10例正常人极量短暂等长收缩运动 (briefisometricexercise ,BIE)、极量持续等长收缩运动(sustainedisometricexercise ,SIE)与动力性运动 (dynamicexercise ,DE)时的血流动力学反应和心功能表现。 结果　有心肌缺血的冠心病患者在DE运动终点时有心肌缺血表现 ,但BIE和SIE时无相应表现。心血管反应总体趋势为 :DE时心率和两项乘积运动增量均明显高于BIE和SIE ,各组间差异不显著。正常组DE时血流动力学多数指标的运动增量均高于BIE和SIE ,但有无心肌缺血的冠心病患者之间无明显差异。结论　在同等主观用力的前提下 ,冠心病患者等长收缩运动时心肌缺血发生率低于动力性运动。等长收缩运动时较高的舒张压和较长的灌注时间对心肌缺血有一定的保护作用。等长收缩运动在冠心病康复中的应用有合理的生理学基础。     

慢性腰痛患者的躯干肌力研究进展

慢性腰痛是一种严重影响患者生活质量和劳动能力的疾患。从慢性腰痛患者的躯干肌力(TMS)在慢性腰痛发生、发展及治疗中的作用等几个方面,对TMS评定在慢性腰痛康复中的重要意义进行了阐述。     

慢性腰痛患者躯干旋转肌群肌力与腰部稳定性的关系

目的探讨慢性非特异性腰痛患者躯干旋转力量与腰部稳定性的关系。方法对22例慢性非特异性腰痛患者,在进行悬吊运动训练前,应用Proxomed Tergumed脊柱功能评估训练系统检查患者躯干旋转时核心肌群的力量,应用悬吊运动仪器来评定腰部核心稳定性,并对两组数据进行相关性分析。结果躯干旋转时核心肌群的肌力与局部的稳定性呈正相关（r=0.876, P<0.001）。结论躯干旋转时核心肌群肌力的增强,对于改善慢性非特异性腰痛患者的局部稳定性有重要意义。     

慢性非特异性腰痛患者躯干肌的等速力学特征和肌电信号研究

目的:探讨慢性非特异性腰痛的潜在致病原因,为日后治疗慢性腰痛提供临床支持.方法:招募31例慢性非特异性腰痛患者,了解其疼痛程度(NRS)和Oswestry腰背功能障碍指数(ODI),同时收集在30°/s、60°/s和90°/s角速度下躯干屈伸肌群的峰力矩值(PT),并实时记录运动过程中双侧腹直肌和竖直肌的均方根值(RM...     

躯干肌肌力训练与牵伸对慢性腰痛的康复作用观察

目的探讨躯干肌肌力训练与牵伸对慢性腰痛患者的疗效和预防其复发的效果。方法46例慢性腰痛患者随机分为观察组和对照组,观察组采用超短波、躯干肌肌力训练与牵伸;对照组采用超短波、腰背部和下肢传统中医按摩。结果两组经过5个疗程治疗后,观察组总有效率为86.96％,对照组总有效率为65.21％,两组有显著性差异（P<0.05）。结论躯干肌肌力训练与牵伸对慢性腰痛患者的疗效明显并肥有效的防治其复发。     

青年下背痛患者躯干肌力及腰椎曲度的临床研究

目的 研究青年下背痛患者躯干肌力和腰椎曲度的变化以及二者之间的关系。方法 应用CYBEX-6000型等速测试训练系统测试下背痛组和正常组的躯干肌力指标,并在立位腰椎侧位X光片上测量腰椎曲度,两组间进行比较。结果 躯干屈肌:下背痛组PT/BW与正常组无差异(P>0.05),TAE低于正常组(P<0.05),ER大于正常组(P<0.05)。躯干伸肌:下背痛组PT/BW和TAE均低于正常组(P<0.05),ER与正常组无差异(P>0.05)。下背痛组的F/E大于正常组(P<0.05)。下背痛组腰椎曲度小于正常组(P<0.05)。结论 青年下背痛患者存在着明显的腰背肌肌力下降和腰椎生理曲度变直,以及由腰背肌肌力下降所致的躯干肌肌力失衡。     

Relationships between strength of low back muscle contraction and reported intensity of chronic low back pain

The electromyographic patterns produced by recording the left and right paraspinal muscles of subjects while in motion (bending and rising) and still (standing upright, sitting supported and unsupported, and prone) were contrasted for people with: 1) no history of back pain; 2) past episodes of low back pain but currently pain free; and 3) chronic low back pain with various diagnosed etiologies. Each of the 83 individuals recorded during episodes of low back pain produced a unique pattern of muscle contraction which was relatively stable between weekly recording sessions. In every case, at least one of the six positions showed elevated contraction levels significantly above that of the 15 subjects with no history of back pain and the 28 with no current back pain. For nine of the eleven subjects who reported changes in pain intensity between recording sessions, a clearly positive correlation occurred between the reported intensity of pain and the level of contraction in the one position most different from the reference group. No diagnostic subgroup of low back pain subjects produced a single unique pattern. Furthermore, no single aspect of the EMG signal, such as bilateral asymmetry, had predictive value for any individual subject. Our recordings did not differ with respect to diagnostic category so further research will have to be done to determine whether the diagnostic categories currently in use do not fit the physiological bases for the problems and/or whether prolonged abnormal levels of muscle contraction eventually produce problems such as disc displacement.     

Reliability of lumbar isometric torque in patients with chronic low back pain.

In this study, the test-retest reliability of lumbar isometric strength testing in patients with chronic low back pain (CLBP) was assessed. Isometric torque measurements were obtained from 89 patients with CLBP at seven different angles of lumbar flexion. Because previous studies have demonstrated significant strength differences between male and female subjects, separate data analyses were performed for each gender. Results indicated moderate to high reliability for patients with CLBP when tested at individually determined angles of flexion within their idiosyncratic range of motion (ROM) (female subjects: r = .59-.96, P less than .05, SEE = 12.0-24.2 N.m; male subjects: r = .71-.93, P less than .05, SEE = 25.1-62.1 N.m). For comparison with previously published data on asymptomatic controls, an additional set of analyses was conducted for subjects with full lumbar ROM. Similar reliability was demonstrated for this subsample (female subjects: r = .57-.93, P less than .05, SEE = 12.4-27.9 N.m; male subjects: r = .63-.93, P less than .05, SEE = 34.2-44.2 N.m). The authors concluded that isometric lumbar extension torque could be reliably measured in patients with CLBP at multiple positions within the full ROM, although reliability decreased at the most extended positions. The demonstrated reliability will allow researchers to assess treatment effects and group differences without undue concern for artifact attributable to measurement error.     

慢性下腰痛患者腰部肌肉放电的均衡性

目的:观察慢性下腰痛患者腰部肌肉放电的均衡性.方法:实验于2007-05在沈5H体育学院重点实验室完成.以14名健康受试者和14名慢性下腰痛患者为观察对象,让其在静力性收缩的条件下观察腰部肌肉放电的情况.使用表面肌电技术测量受试者腰部3个节段(L1,L2,L5)两侧最长肌、铭腰肋肌、多裂肌的放电情况,令受试者躯干分别在40%最大随意收缩和80%最大随意收缩的情况做等长收缩30 s,观察受试者腰部脊柱两侧肌肉的疲劳时的失衡情况.结果:慢性下腰痛患者腰部肌肉的最大随意收缩仅仅足对照组最大随意收缩的55%,与对照组相比慢性下腰痛患者腰部肌肉疲劳程度较低,可能与他们并没有产生真正的最大随意收缩有关;慢性下腰痛患者腰部两侧肌肉失衡程度较大.结论:下腰痛患者出现疼痛时,其腰部两侧的肌肉活动重新分布;同时表血肌电可能成为一种无创伤地检测肌肉失衡的有效工具.     

Reliability of the assessment of lumbar range of motion and maximal isometric strength in patients with chronic low back pain

Roussel NA, Truijen S, De Kerf I, Lambeets D, Nijs J, Stassijns G. Reliability of the assessment of lumbar range of motion and maximal isometric strength in patients with chronic low back pain.

Objective

To examine the interobserver reliability of the assessment of lumbar range of motion (ROM) and maximal isometric strength in patients with chronic low back pain (CLBP) using commercially available equipment.

Design

A prospective repeated-measures design.

Setting

Ambulatory care in a university hospital.

Participants

Twelve patients (5 men, 7 women; age range, 20−52y) with CLBP, with a mean visual analog scale score of 31.5±25.8mm, volunteered for the study. The duration of their symptoms was 63±115 months and the mean Oswestry Disability Index score was 31%.

Interventions

Not applicable.

Main Outcome Measures

Movements of the lumbar spine were assessed with commercially available equipment. Both the range of motion (ROM) and the maximal isometric strength for flexion, extension, lateroflexion, and rotation of the lumbar spine were evaluated twice to analyze the interobserver reliability. The same test procedure was performed on 2 separate days by 2 investigators who were blinded to the outcome of the assessment of their colleague. The order of investigator was balanced, so that each investigator tested the same number of patients as first investigator.

Results

The intraclass correlation coefficient varied between .91 and .98 for the measurements of the lumbar ROM and was between .93 and .97 for all the strength measurements. Post hoc power analysis confirmed previous power analysis, that is, despite the small sample size, an excellent power was found for the observed interobserver reliability coefficients (power range, 0.93−1.00). No learning effect was found when comparing the results of the second measurement with the first measurement (P>.05).

Conclusions

The interobserver reliability is excellent for the measurement of the ROM of the lumbar spine and for the maximal isometric strength using specific devices in patients with CLBP.     

青年慢性非特异性腰痛患者腰部本体感觉及其与肌力的相关性

目的:对比青年慢性非特异性腰痛(CNLBP)患者和正常健康青年腰部本体感觉及肌力的差异,并分析腰部本体感觉与肌力的相关性。方法:选取25例青年CNLBP患者纳入腰痛组,25例正常健康青年纳入对照组。采用CON-TREX等速系统测试其腰部本体感觉及腰部屈肌、伸肌肌群在60°/s角速度下的等速向心肌力。以被动复位绝对误差角度(AE)作为个体本体感觉评价指标,以各肌群的峰值力矩(PT)、峰力矩体重比(PT/BW)及屈/伸肌峰值力矩比(F/E)作为等速向心肌力观察的主要指标。并分析CNLBP患者腰部本体感觉与腰部肌力的相关性。结果:(1)腰痛组患者腰部前屈、后伸的AE值均高于对照组,差异有显著性意义(P0.05);(2)腰痛组患者伸肌肌群的PT及PT/BW与对照组相比均有降低,差异有显著性意义(P0.05);腰痛组患者屈肌肌群的PT及PT/BW与对照组相比,差异无显著性意义(P0.05);同时腰痛组F/E与对照组相比,差异无显著性意义(P0.05);(3)腰痛组腰部AE值与PT、PT/BW及F/E之间均无相关性(P0.05)。结论:青年CNLBP患者的腰部本体感觉及腰部伸肌肌群肌力均较正常健康青年有所减弱,且青年CNLBP患者的腰部本体感觉与腰部肌力之间无相关性。     

The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle

Decreases in the size of the multifidus muscle have been consistently documented in people with low back pain. Recently, ultrasound imaging techniques have been used to measure contraction size of the multifidus muscle, via comparison of the thickness of the muscle at rest and on contraction. The aim of this study was to compare both the size (cross-sectional area, CSA) and the ability to voluntarily perform an isometric contraction of the multifidus muscle at four vertebral levels in 34 subjects with and without chronic low back pain (CLBP). Ultrasound imaging was used for assessments, conducted by independent examiners. Results showed a significantly smaller CSA of the multifidus muscle for the subjects in the CLBP group compared with subjects from the healthy group at the L5 vertebral level (F = 29.1, p = 0.001) and a significantly smaller percent thickness contraction for subjects of the CLBP group at the same vertebral level (F = 6.6, p = 0.02). This result was not present at other vertebral levels (p > 0.05). The results of this study support previous findings that the pattern of multifidus muscle atrophy in CLBP patients is localized rather than generalized but also provided evidence of a corresponding reduced ability to voluntarily contract the atrophied muscle.     

Relationships between coping strategies and lumbar muscle activity in subjects with chronic low back pain

BackgroundConcerning chronic low back pain (CLBP), different cognitive–behavioral models have hypothesized that coping strategies play a role in the chronification of pain by changes in physical activity. Strategies such as avoidance – or persistent coping may be related to changes in (lumbar) muscle activity.AimInvestigate the different coping strategies present in CLBP and whether these are differentially related to lumbar muscle activity during walking.MethodsIn a cross sectional study, 63 subjects with CLBP walked on a treadmill at 3.8 km/h. Coping strategies were measured with the Dutch version of the Coping Strategies Questionnaire and three factors were identified with principal component analysis. Surface electromyography data of the erector spinae were obtained and smooth rectified electromyography (SRE) values were averaged per periods of swing and double support. The ratio of SRE values (swing/double support) was used as a measure of relaxation. The relation between SRE values and coping strategies was analyzed with random coefficient analysis.ResultsThree coping strategies (i.e. “catastrophizing”, “distraction” and “persistence and control”) could be discerned. “Catastrophizing” was positively related to (natural logarithm) SRE values (β = 0.06, 95% CI = 0.01–0.10; R² = 7.7%). “Distraction” was negatively associated with SRE ratios (β = ?0.03, 95% CI = ?0.05 to ?0.01; R² = 7.5%). No relation was found between “persistence and control” and SRE values or ratios.ConclusionsIn CLBP, a maladaptive coping strategy like “catastrophizing” is related to increased lumbar muscle activity, and an adaptive strategy like “distraction” to increased lumbar muscle relaxation during walking.     

腰椎前部结构MR退变征象与慢性下腰痛的关系

目的探讨腰椎前部结构MR退变征象与慢性下腰痛的关系。方法本研究回顾性分析2011年8月1日-2012年1月15日于我院就诊、并行腰椎MRI的患者,进行问卷调查,最终回收有效问卷386份,于其中选取慢性下腰痛者139例,其中68例为有神经根压迫组A,71例为无神经根压迫组B。选取本院无下腰痛且无神经根压迫的62名职工作为正常对照组C。观察下列MRI征象：平均间盘退变分级（ADD）、间盘后方高信号区（HIZ）、许莫氏结节、Modic I型改变。采用统计学方法分析MRI征象在不同组的分布特征。结果慢性下腰痛有神经根压迫组A、慢性下腰痛无神经根压迫组B、对照组C的MRI征象分布分别为：ADD（P50,2.20/P50,2.00/P50,1.40）、HIZ发生率（52.9%,39.4%,25.8%）、Modic I型改变发生率（22.1%,22.5%,4.8%）、许莫结节发生率（17.6%,18.3%,14.5%）。其中,ADD、Modic I型改变发生率在A、B组间无统计学差异,但较C组高,差异有统计学意义;许莫结节发生率在三组间无统计学差异。HIZ发生率在A、B组间及B、C组间无统计学差异,但在A、C组间有统计学差异。结论 ADD、Modic I型改变可能与慢性下腰痛有关。