推拿手法治疗腰椎间盘突出症腰背伸肌群生物力学特性评价研究

目的:观察推拿手法对腰椎间盘突出症(简称腰突症)患者腰背伸肌群生物力学特性的影响,探讨手法治疗腰突症的干预机制问题。方法:采用电脑随机数字表法,将65例腰突症患者随机分为治疗组(推拿手法组)与对照组(牵引组);治疗组30例,对照组30例,脱落5例。应用美国Biodex system-Ⅲ多关节等速测试系统和TeleMyo 2400 T表面肌电图仪测试两组治疗前后腰背伸肌群生物力学特性变化情况。结果:腰部肌群力学性能:两组治疗前峰力矩(PT)、平均功率(AP)、腰背屈/伸比值(F/E)比较无统计学差异;治疗后PT(60°/s)、AP(120°/s)比较,治疗组优于对照组(P0.05);治疗组治疗前后PT、AP、F/E比较差异有统计学意义(P0.05)。表面肌电:治疗前组内左右两侧平均功率频率(MPF)、积分肌电(IEMG)比较差异均有统计学意义(P0.05);治疗后,治疗组内左右两侧MPF、IEMG比较无显著差异;对照组治疗后组内左右两侧MPF、IEMG比较差异均有统计学意义(P0.05);治疗组治疗前后右侧MPF、IEMG比较均有显著差异(P0.05);两组治疗后右侧MPF、IEMG(60°/s)比较均有显著差异(P0.05)。结论:改善腰突症患者腰背伸肌群收缩力量、做功效率,改善腰部屈、伸肌的协调性,提高腰背伸肌群的放电频率,缓解腰部肌群的疲劳程度,改善腰突症患者腰背伸肌群失衡状态,从而有利于恢复腰突症患者腰背伸肌的生物力学特性,可能是手法治疗腰突症干预机制之一。

Biomechanical evaluation of waist back muscle for Tuina manipulation treating lumbar intervertebral disc protrusion

Objective: To observe biomechanics influence of waist back extensor in Tuina manipulation treating Lumbar Intervertebral Disc Protrusion,to reveal mechanism of it.Methods: 65 patients with Lumbar Intervertebral Disc Protrusion were divided into treated and control group by a randomizing digital table.30 patients in treated group,30 patients in control group,five cases drop-out.The mechanical properties of waist back extensor were tested by Biodex-Ⅲ Isokinetic Testing System and TeleMyo 2400 T Surface EMG.Results: The mechanical properties of waist back extensor: There were no significant differences in Peak torque(PT),average power(AP),peak torque of flexor/extensor peak torque ratio(F/E) between two groups before treatment,Treated group was better improved than control group in PT(60°/s),AP(120°/s) after treatment(P<0.05),there was significant difference compared with PT,AP,F/E in treated group after treatment(P<0.05).Surface EMG: there were significant differences in MPF and IEMG between left and right in each group before treatment(P<0.05);there were no significant differences in MPF and IEMG between left and right in treated group after treatment,but control group was not(P<0.05).Treated group was better improved than control group in MPF and IEMG on right after treatment(P<0.05),there was significant difference compared with MPF and IEMG in treated group after treatment(P<0.05).Conclusion: Tuina manipulation may improve contraction forces and work efficiency of waist back muscle,improve co-ordination ability of flexors and extensors muscles,increase firing rate of waist back extensor,release fatigue of waist back extensor,and improve imbalance of waist back extensor,to resume biomechanical properties of waist back extensor for the patients with Lumbar Intervertebral Disc Protrusion.