温泉水游泳加腰背肌功能锻炼治疗下腰痛疗效观察

目的探讨温泉水游泳加腰背肌功能锻炼对缓解下腰痛的疼痛症状及改善腰部运动功能的疗效。方法选择128例下腰痛疗养员随机分为观察组和对照组各64例。观察组患者进行温泉水游泳加腰背肌功能锻炼治疗,对照组腰背肌功能锻炼治疗,两组均治疗1个月,比较两组治疗后下腰痛的疼痛症状及腰部运动功能变化。结果两组治疗后观察组患者的下腰痛的疼痛症状明显缓解,腰部运动功能得到显著改善,总有效率达95.3%,对照组总有效率75.0%,两组比较差异有高度统计学意义,P0.01。结论温泉水游泳加腰背肌功能锻炼是有氧运动,一定疗程后能减轻下腰痛,改善腰部功能,从而提高生活质量。     

慢性腰痛患者站立位躯干屈伸运动时腰背肌的功能变化研究

目的:研究慢性腰痛(CLBP)患者在站立位矢状面屈伸运动时腰背肌功能状况的变化,揭示其改变的可能机制及临床意义。方法:慢性非特异性腰痛患者25例和健康人25例,在站立位进行躯干的屈曲伸展运动,运用表面肌电图(sEMG)仪和摄像系统同步采集记录双侧L2/3、L4/5水平最长肌、多裂肌在站立位、前屈运动、完全屈曲及回到直立位不同运动时相的sEMG值。结果:两组受试对象站立位时,最长肌及多裂肌均方根(RMS)值差异无显著性意义(P>0.05);前屈运动时,最长肌及多裂肌RMS值增大,完全屈曲时,最长肌及多裂肌RMS值减小,腰痛组在前屈运动和完全屈曲时,最长肌和多裂肌RMS值较健康对照组增大,差异具有显著性意义(P<0.05);由屈曲位回至直立位时,腰痛组最长肌和多裂肌的RMS值明显小于健康对照组,差异具有显著性意义(P<0.05);腰痛组最长肌和多裂肌的屈曲-放松比较健康对照组降低,差异具有显著性意义(P<0.05);运动时相对两组受试对象的最长肌和多裂肌RMS值影响均有显著性意义(P<0.05)。结论:在躯干屈伸运动中,健康人腰背肌存在屈曲-放松现象(FRP),腰痛患者腰背肌功能发生疼痛适应性改变,表现为屈曲-放松反应缺如和主动活动机能不足。     

下肢闭链等速测试系统在慢性下腰痛患者康复评价中的应用

目的通过对慢性下腰痛(CLBP)患者的下肢肌力的闭链等速测试,定量评价患者的下肢肌力的变化并探讨该项测试技术的意义.方法采用BIODEX-2AP闭链测试系统对36例慢性下腰痛患者的下肢进行测试.结果在60°/s、120°/s、180°/s限速条件下,患侧下肢屈伸肌的峰力矩、下肢屈伸肌峰力矩占体质量的比值和平均功率均较健侧有明显下降(P＜0.001);患侧的下肢屈伸肌肌力(峰力矩)比值与健侧比较差异无显著性意义(P＞0.05).结论CLBP患者的患侧下肢屈伸肌力有不同程度的下降,同时用闭合链测试系统对CLBP患者进行下肢肌力等速测试,不失为一种反映其运动功能较全面的客观指标.     

慢性下背痛患者腰背肌功能的评价方法

下背痛(low back pain，LBP)是指各种背部症状所导致的活动不适，其中背部症状主要包括背部及与背部有关的腿部疼痛(坐骨神经痛)，而活动不适包括酸、麻、胀、痛和活动受限，并除外其他内科急症所致的腰背部疼痛，包括肿瘤、骨折、感染等。由于很多因素(如个人、职业、心理等因素)都可以导致该病的高发，因此该疾病的发病率非常高，据估计在工业化国家中，     

腰背肌协调性测试的阻力量选择

目的探讨不同的阻力量选择对腰背肌协调性测试结果可信度的影响。方法由1 名测试者在1 周内分别对30 例青年腰痛男子进行2 次腰背肌协调性测试。在每次测试中,受试者随机完成5 kg、10 kg 和15 kg 3 种阻力量的测试,测试内容包括向心运动平均值、向心运动偏移值、离心运动平均值和离心运动偏移值4 项。应用组内相关系数(ICC)对3 个阻力量组的4 项测试结果进行重测信度评价。结果5 kg 阻力量组ICC分别为0.303、0.500、0.358 和0.360;10 kg 阻力量组ICC分别为0.449、0.382、0.365 和0.272;15 kg 阻力量组ICC分别为0.453、0.442、0.614 和0.411。结论施加15 kg 阻力,腰背肌协调性测试具有较好的重测信度。     

非特异性下腰痛患者腰肌表面肌电特征的研究

目的分析非特异性下腰痛患者与正常者腰肌表面肌电信号的差异。方法对非特异性下腰痛患者和正常对照者进行半桥动作、单侧足支撑半桥动作时腰肌的活动进行肌电信号的分析比较。结果非特异性下腰痛患者组双侧多裂肌在实施实验动作时的表面肌电时阈指标存在统计学差异,而对照组双侧多裂肌在实施实验动作时的表面肌电时阈指标不存在统计学差异。结论非特异性下腰痛患者双侧多裂肌收缩失平衡。     

小针刀综合治疗对慢性下腰痛患者腰屈曲活动度及生存质量的影响

目的:观察小针刀治疗对慢性下腰痛患者腰屈曲活动度和生存质量的影响。方法:将265例下腰痛患者随机分为两组,Ⅰ组为对照组(132例),采用超短波、调制中频电、推拿及功能训练治疗。Ⅱ组为针刀组(133例),采用小针刀,辅以封闭和功能训练,两组治疗前后均测量腰屈曲活动度,并采用改良的Oswestry腰痛问卷进行评分,以评定生存质量。结果:针刀组患者治疗后腰屈曲活动度明显改善且Oswestry腰痛问卷评分分值明显下降,与对照组比较,差异均有显著性意义(P<0.01)。两组患者随访6—48个月,平均随访10.85±5.74个月,针刀组疗效稳定,与对照组比较,差异有显著性意义(P<0.01)。结论:小针刀治疗可明显改善慢性下腰痛患者腰屈曲活动度及生存质量,且远期疗效稳定。     

运动训练性下腰痛患者肌肉及腰椎组织的生物力学变化

目的:以运动训练所致下腰痛患者为对象,观察运动疗法治疗下腰痛患者肌肉及腰椎组织的生物力学变化。方法:试验于2006-06/2007-01在广州体育学院康复中心完成。①试验对象:经运动训练引起下腰痛的患者18例,均对本试验知情同意。纳入标准:经骨科专科体检诊断为慢性下腰痛,除外骨关节性及椎管性下腰痛病变,症状持续在3个月以上,近5年内无腰部手术或心血管、神经系统方面的疾病。拍摄腰椎正侧位X光片,未见脊柱、腰椎异常,但可见腰椎前凸过度(54.89±6.12)°,超过正常。经视觉类比法确定疼痛程度在5以下。②试验方法:18例患者随机分为运动组和对照组,每组各9例,运动组按体疗方案实施运动疗法;对照组以服用止痛药为主。③试验评估:采用问卷法和试验法,所有受试者分别于试验前后填写中文版的《Roland-Monrris下腰痛功能障碍调查表(RMDQ)》和《Oswestry功能障碍指数(ODI)》。同时在试验前、后测试腹背肌耐力、腰部活动度、腰椎前凸曲度及运动疗法后的疼痛改善等指标。结果:纳入18名下腰痛患者,均进入结果分析,无脱落。①试验前,RMDQ和ODI得分、腹背肌耐力、腰部活动度、腰椎前凸曲度两组间差异无显著性,试验后差异有显著性(P<0.05,P<0.01)。②试验前后,运动组RMDQ和ODI得分、腹背肌耐力、腰部活动度、腰椎前凸曲度差异有显著性(P<0.05,P<0.01),而对照组差异无显著性(P>0.05)。③试验后,运动组9人中有8人疼痛得到了不同程度的缓解,且病情都有一定程度的改善;对照组只有3人疼痛得到缓解,没有病情改善情况。结论:①重点加强腹背肌力量训练的运动疗法对下腰痛有明显疗效。②采用RMDQ和ODI相结合的方法,对下腰痛患者进行综合评估,准确性较高,同时便于比较。     

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     

针灸治疗腰背肌筋膜炎研究进展

<正>腰背肌筋膜炎是临床常见病症,常涉及肌肉、筋膜、滑膜、肌腱、神经纤维膜等,本病虽不危及生命,但严重影响患者生活质量。中医学认为,其发病机制多由于外感风寒湿邪或外伤、劳损等导致经络不通、气血阻滞,不通则痛。针灸可以疏通经络、调和阴阳,临床针刺效果明显,又可结合药物以及各种综合性治疗方法,疗效显著,现就近年来针灸治疗腰背肌筋膜炎的进展综述如下。     

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...     

Isokinetic trunk extension discriminates uninjured subjects from subjects with previous low back pain

This investigation compared the ability of a previously defined, non-standard isokinetic variable set to that of standard isokinetic variables to discriminate trunk extension performance of control subjects from subjects with a history of low back pain. Ten male subjects with history of low back pain, asymptomatic at the time of the test, and nine subjects without history of low back pain participated in a single session, test-retest protocol. The test and retest each consisted of five maximum effort isokinetic trunk extension-flexion repetitions at 60, 120, and 180 deg s⁻¹. At each isokinetic speed, eight isokinetic trunk extension performance variables were extracted and the mean value for each calculated from Trials 2, 3, and 4. The set of 48 variables was reduced to seven, demonstrating intergroup differences at the selected criterion probability level (P<0.025). These variables were submitted to a stepwise discriminant analysis that eliminated one variable, generated a significant discriminant function (P = 0.005), and correctly categorized 100% of the control and low back pain patients. The variables satisfying the entry criterion into the discriminant analysis were from the 120 and 180 deg s⁻¹ conditions, suggesting that residual functional deficits related to trunk extensor muscular power generation are associated with low back pain. For comparison purposes, secondary discriminant analyses using standard isokinetic variables were conducted but the results were statistically and clinically inferior to those of the initial discriminant function. The results of this study imply that rehabilitation from low back dysfunction should include a component of muscular power restoration. The present results can offer no resolution to the clinical question related to the cause of the power deficit. This type of inquiry will require the use of additional technologies such as electromyography that can lend insight into agonist-antagonist relationships.     

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。     

慢性腰痛患者表面肌电图临床特征及数据分析

目的:分析慢性腰痛住院患者治疗前的表面肌电图临床特征及数据,进一步阐明表面肌电生物反馈在慢性腰痛诊疗过程中的临床意义。方法:本研究回顾性分析401例慢性腰痛患者的表面肌电图相关信息,比较了腰痛发病部位与相关肌肉肌电的关系,以及腰背后伸、下肢后伸、足部背屈过程中肌肉肌电变化情况。结果:401例慢性腰痛患者接受了表面肌电图检查,年龄16—85岁,平均(51.78±13.69)岁,主要集中在51—60岁阶段。男性160例(39.90%),女性241例(60.10%),男女性别比为0.66∶1。双侧发病162例(40.40%),单侧发病239例(59.60%),其中右侧发病120例(29.93%),左侧发病119例(29.68%)。单侧发病慢性腰痛患者疼痛侧臀中肌与臀大肌的肌电平均振幅值均低于非疼痛侧,差异有显著性意义(P0.05或P0.01)。而慢性腰痛患者腰背后伸、下肢后伸、足部背屈过程中,非疼痛侧和疼痛侧竖脊肌腰段、多裂肌、股二头肌、胫骨前肌与腓骨肌的肌电平均振幅值无显著差异(P0.05)。结论:51—60岁是慢性腰痛的高发年龄,此后随着年龄增加,腰痛发病有趋缓现象;在慢性腰痛的诊疗过程中患者的主观感觉只是指导临床工作的一部分,表面肌电水平更能客观地反映患者的肌肉功能,慢性腰痛患者存在特有的表面肌电图特征。     

The effects of a back rehabilitation programme for patients with chronic low back pain

AIM: The aim of this paper was to perform a pragmatic before-after analysis of a back rehabilitation programme (BRP) for patients with chronic low back pain (LBP). A total of 877 patients were recruited onto the BRP, which were carried out at four centres within the Wrightington, Wigan and Leigh NHS Trust. The BRP consisted of nine 2-hour group sessions of therapy run over 5 weeks and included 1 hour of exercise and 1 hour of education, advice problem solving and goal setting. METHOD: Using the Wilcoxen signed rank tests and paired t-tests levels of pain, disability, anxiety and depression were significantly reduced pre-post programme (P < 0.001). In addition, the levels of fitness and perceived control improved significantly (P < 0.001) suggesting that participants were better able to manage their LBP. CONCLUSION: Overall, the BRP proved to be effective in reducing pain, disability, anxiety and depression levels for people with chronic LBP. However, despite significant improvements in outcome measures only 50% of the patients completed the BRP and questionnaires post BRP. The implications of the findings are discussed with respect to modified programmes and alternative management for patients within different subgroups of LBP.     

慢性腰痛患者功能障碍与生存质量的研究

目的:探讨慢性腰痛(CLBP)患者功能障碍与生存质量(QOL)的关系。方法:选取CLBP患者60例(男22例,女38例),分别采用目测类比定级法(VAS)、Oswestry功能障碍指数(ODI)、日本骨科学会(JOA)腰痛评估表及健康状况调查问卷(SF-36)评定患者的疼痛程度、功能状况及QOL。结果:男性CLBP患者总体健康(GH)和心理健康(MH)评分明显高于女性(P0.05)。SF-36及其中躯体功能(PF)、生理职能(RP)、躯体疼痛(BP)、患者自控镇静(PCS)项的评分与VAS和ODI评分呈负相关(P0.05),与JOA评分呈正相关(P0.05)。GH、活力(VT)、社会功能(SF)及精神健康总评(MCS)项的评分与ODI评分呈负相关(P0.05),与JOA评分呈正相关(P0.05)。结论:腰痛及功能障碍在一定程度上影响CLBP患者的QOL,应加以干预,使其能够正确对待疾病,提高QOL。     

不同振动条件对慢性下背痛患者腰腹部肌群表面肌电信号的影响

目的:通过施加不同条件下的振动刺激,探讨振动训练对于慢性下背痛患者腰腹部肌群表面肌电信号的影响。利用表面肌电分析的方法,寻求最佳的振动频率和运动方式。方法:采用Myo Research XP Master Software Version 1.07.17表面分析系统测试21例慢性下背痛患者腰腹部肌肉的肌肉电信号。所有受试者分别在振动频率为0Hz、5Hz、10Hz、15Hz下完成平板支撑、侧撑、V字支撑三个动作。结果:(1)竖脊肌的表面肌电值:在不同动作之间均有显著性差异(P0.05),在平板支撑和V字支撑的情况下,不同频率之间具有显著性差异(P0.05)。(2)腹外斜肌的表面肌电值:在四种频率的情况下,不同动作之间均有显著性差异(P0.05),平板支撑和侧撑的情况下,不同频率之间具有显著性差异(P0.05)。(3)腹直肌的表面肌电值:在0Hz和5Hz的情况下,不同动作之间均有显著性差异(P0.05),在三组动作的情况下,不同频率之间均没有显著性差异(P0.05)。结论:不同振动条件的刺激,对慢性下背痛患者腰腹部肌群影响不同。竖脊肌最佳的振动频率为15Hz,最佳的振动动作为侧撑;腹外斜肌最佳的振动频率为15Hz,最佳的振动动作为V字支撑;腹直肌的振动动作为V字支撑,就不同频率而言,虽然腹直肌随着频率的增高,放电量逐渐增加,但是不会对肌肉产生显著性影响。     

Are childhood adversities relevant in patients with chronic low back pain?

Previous studies have found a high number of childhood adversities in patients with chronic low back pain, particularly in patients reporting persisting problems after back surgery. Our aim was to reproduce these results.Within the framework of a comprehensive diagnostic assessment and psychometric evaluation, 109 inpatients who had been treated for low back pain were examined in the orthopedics department of a German university hospital. Five risk factors investigated by Schofferman and his staff (Schofferman et al., 1993) were re-assessed in all of our patients using a structured biographical interview. The German chronic low back pain group was also compared with an age- and gender-matched control group of 109 non-chronic pain patients with respect to these childhood adversities and additional ones.Only approximately 11% of the German chronic low back pain sample demonstrated three or more risk factors, compared with more than 50% in Schofferman's sample, and 47.7% showed none of the five risk factors, compared to only 11% in the Schofferman sample. Moreover, no significant differences in distribution either in terms of the individual risk factors or their cumulative frequency were found in the German chronic low back pain group compared with an age and gender-matched control group without chronic pain.Childhood adversities do not occur frequently in a non-selected group of patients with chronic low back pain. Earlier results showing an increased likelihood of the occurrence of psychosocial risk factors could not be confirmed. As a consequence, further psychic or psychosomatic diagnostics of patients with chronic low back pain are needed to define diagnostic subgroups.     

Cognitive distortion and disability in chronic low back pain

Numerous authors have suggested that cognitions play an important role in the development, maintenance, and treatment of chronic low back pain (CLBP). However, little evidence exists to support the association between cognitive variables and the CLBP problem. The present study examined the relationship of cognitive distortion, as measured by the Cognitive Error Questionnaire, to disability, as measured by the Sickness Impact Profile, in a sample of 138 CLBP patients. As predicted, cognitive distortion was consistently related to several aspects of disability. The cognitive variables accounted for variance in disability beyond that accounted for by severity of pain, number of pain treatments, and depression. Also as predicted, cognitive distortion concerning low back pain situations was more closely correlated with disability than was distortion concerning general, nonpain situations. Overgeneralization was the specific cognitive error most closely and consistently correlated with disability. The results are interpreted as consistent with a cognitive-behavioral model of CLBP.The authors would like to thank Holly Waldron, Dennis Turk, and several anonymous reviewers for their comments on an earlier version of this paper.