运动疗法在软组织所致下腰痛术后康复治疗中的应用

目的：影响下腰痛治疗效果的原因很多，探讨由腰骶部慢性骨筋膜间隔综合征所致慢性腰痛术后的运动疗法，对患者术后腰部功能恢复的效果。方法：腰骶部慢性骨筋膜间隔综合征所致慢性腰痛患者58例，男27例，女31例；年龄18～66岁；慢性腰痛时间2～42年，平均29年。治疗采用腰骶部骨筋膜间隔切开减压及术后竖脊肌功能训练的方法。结果：58例患者术后经1～28个月，平均1、5个月康复功能训练后，术前久坐、久站、长时间行走、长时间固定姿势卧床及长时间弯腰后腰痛症状及阳性体征消失55例，缓解3例。术前腰骶部骨筋膜间隔内压在静息、运动中和运动后6min内分别为(1．4&;#177;0．1)，(24、9&;#177;1．5)和(1．8&;#177;0．2)kPa．术后分别为(0．9&;#177;0、1)，(21．6&;#177;1．6)和(0．9&;#177;0．1)kPa，手术前后比较差异有显著性意义(t值分别为2．04，2．32，3．21，P&;lt;0．05或0、01)。超声多普勒表明腰骶部骨骼肌内最大血流速度和平均血流速度较术前分别增加(0．17&;#177;0．02)kHzR(o、09&;#177;0．01)kHz(P&;lt;0．05)。结论：腰骶部慢性骨筋膜间隔综合征所致慢性腰痛采用骨筋膜间隔切开减压及术后竖脊肌功能训练的方法是可行的。     

慢性骨筋膜间隔综合征所致下腰痛的临床诊治

目的 :探讨由腰骶部慢性骨筋膜间隔综合征所致慢性腰痛的临床诊治方法。方法 :腰骶部慢性骨筋膜间隔综合征所致慢性腰痛患者 6 5例 ,男 31例 ,女 34例 ,年龄 18～ 6 6岁 ,慢性腰痛时间 2～ 4 2年 ,平均 19年。诊断采用竖脊肌内压测定 ,治疗采用腰骶部骨筋膜间隔切开减压的方法。结果 :6 5例患者术后经 1～ 2 8个月、平均 1.5个月康复功能训练后 ,术前久坐、久站、长时间行走、长时间固定姿势卧床及长时间弯腰后腰痛症状及阳性体征 ,5 7例消失 ,8例缓解。术前腰骶部骨筋膜间隔内压在静息、运动中和运动后 6min内统计结果分别为 (1.4± 0 .1)、(2 4 .9± 1.5 )和 (1.8± 0 .2 )kPa ,术后分别为 (0 .9± 0 .1)、(2 1.6± 1.6 )和 (0 .9± 0 .1)kPa(P <0 .0 5 )。超声多普勒表明腰骶部骨骼肌内最大血流速度和平均血流速度较术前分别增加 (0 .17± 0 .0 2 )kHz和 (0 .0 9± 0 .0 1)kHz(P <0 .0 5 )。结论 :采用骨筋膜间隔内压测定的方法诊断腰骶部慢性骨筋膜间隔综合征所致慢性腰痛和采用骨筋膜间隔切开减压的方法治疗该疾病是可行的。     

腰骶部慢性骨筋膜间隔综合征所致慢性下腰痛的临床诊断

目的：综合分析腰骶部慢性骨筋膜间隔综合征所致慢性腰痛的临床诊断方法。 资料来源：应用计算机检索万方数据库2000-06／2005-07有关腰骶部慢性骨筋膜间隔综合征所致慢性腰痛临床诊断方面的文献，检索词“腰骶部，慢性骨筋膜间隔综合征，慢性腰痛，诊断”，并限定文章语言种类为中文。同时应用计算机检索Ovid 2000-06／2005-07有关腰骶部慢性骨筋膜间隔综合征所致慢性腰痛临床诊断方面的文献，检索词“chronic,low back pain，compartment syndrome,diagnosis”，并限定文章语言种类为English。 资料选择：对检索到的有关腰骶部慢性骨筋膜间隔综合征所致慢性腰痛临床诊断方面的有关信息进行整理，选取针对性强的文章。同一领域的文献则选择近期发表或权威杂志的文章。 资料提炼：共检索到36篇相关文献，其中26篇文章符合要求，排除10篇，其中4篇系重复同一研究。 资料综合：目前腰骶部慢性骨筋膜间隔综合征所致慢性下腰痛的临床诊断方法主要包括以下几种：①临床症状与体征。②实验室检查：均属非特异性。③影像学检查。④超声多普勒检查。⑤骨筋膜间隔内压测量。⑥近红外线分光镜检查。⑦骨骼肌组织病理和超微结构的变化。⑧其他：如肌电图检查、骨密度测定等，但均为非特异性。 结论：目前临床症状与体征检查和骨筋膜间隔内压测定是诊断腰骶部慢性骨筋膜间隔综合征所致慢性腰痛的主要标准，同时，一些无创性、无痛性检查如近红外线分光镜等已运用于诊断，但应用仍有限，而且现在依然缺乏有助诊断的实验室检查指标，有待进一步研究。     

运动疗法在下腰痛康复中的应用

下腰痛 (ｌｏｗｂａｃｋｐａｉｎ ,ＬＢＰ)是人类最常见的疾患 ,被说成是人类由四肢爬行到直立行走所付出的代价。ＬＢＰ主要包括腰椎间盘突出症、腰椎小关节紊乱、腰椎骨关节病、椎体滑脱症等。流行病学调查显示 ,不同人群ＬＢＰ的发病率从 7.6 %到 37%不等[1] ,而青少年的年累计发病率接近 30 % [2 ] 。青岛医学院郑英刚调查我国 5个行业 10 0 87名职工 ,腰背痛的患病率为 11.5 % [3 ] 。在美国 ,ＬＢＰ仅次于上呼吸道感染而位居第二位[4] ;接受物理治疗的门诊患者中有 2 5 %是ＬＢＰ患者[5] 。ＬＢＰ不仅发病率高 ,而且对工时和医药费造…     

腰骶部慢性骨筋膜间隔综合征所致慢性下腰痛的临床诊断

目的:综合分析腰骶部慢性骨筋膜间隔综合征所致慢性腰痛的临床诊断方法。资料来源:应用计算机检索万方数据库2000-06/2005-07有关腰骶部慢性骨筋膜间隔综合征所致慢性腰痛临床诊断方面的文献,检索词“腰骶部,慢性骨筋膜间隔综合征,慢性腰痛,诊断”,并限定文章语言种类为中文。同时应用计算机检索Ovid2000-06/2005-07有关腰骶部慢性骨筋膜间隔综合征所致慢性腰痛临床诊断方面的文献,检索词“chronic,lowbackpain,compartmentsyndrome,diagnosis”,并限定文章语言种类为English。资料选择:对检索到的有关腰骶部慢性骨筋膜间隔综合征所致慢性腰痛临床诊断方面的有关信息进行整理,选取针对性强的文章。同一领域的文献则选择近期发表或权威杂志的文章。资料提炼:共检索到36篇相关文献,其中26篇文章符合要求,排除10篇,其中4篇系重复同一研究。资料综合:目前腰骶部慢性骨筋膜间隔综合征所致慢性下腰痛的临床诊断方法主要包括以下几种:①临床症状与体征。②实验室检查:均属非特异性。③影像学检查。④超声多普勒检查。⑤骨筋膜间隔内压测量。⑥近红外线分光镜检查。⑦骨骼肌组织病理和超微结构的变化。⑧其他:如肌电图检查、骨密度测定等,但均为非特异性。结论:目前临床症状与体征检查和骨筋膜间隔内压测定是诊断腰骶部慢性骨筋膜间隔综合征所致慢性腰痛的主要标准,同时,一些无创性、无痛性检查如近红外线分光镜等已运用于诊断,但应用仍有限,而且现在依然缺乏有助诊断的实验室检查指标,有待进一步研究。     

骨筋膜室综合征致慢性腰痛的临床研究

背景目前对骨筋膜室综合征所致慢性腰痛的诊断、治疗以及骨骼肌病理变化还缺乏足够的认识.目的探讨和介绍腰骶部骨筋膜室综合征致慢性腰痛的临床诊断、治疗方法及骨骼肌的病理变化.设计非随机、自身对照、回顾性研究.地点和对象本院收治的慢性骨筋膜室综合征患者33例,男15例,女18例,年龄18～66岁,平均42 3岁,慢性腰痛时间2～42年,平均27年.方法采用微创方法行腰骶部竖脊肌骨筋膜室切开减压术,术后进行腰、腹肌功能锻炼并进行疗效评价.选择平L3棘突竖脊肌外侧缘微进针点,用自行设计的带有侧孔及微压力感受装置的测压针,直接刺入竖脊肌内,分别测量竖脊肌内的静息压、运动中压和运动后6 min以内的压力改变.主要观察指标下腰痛症状,步行能力,腰部前屈、后伸活动度,超声多普勒腰骶部血流的改变及腰骶部骨筋膜室内压在静息、运动中、运动后的改变.结果术后下腰痛临床症状较术前明显好转,步行能力明显增加,腰部前屈、后伸活动度较术前分别增加(15±0.5)°和(7±0.7)°术前腰骶部骨筋膜室内压在静息、运动中和运动后6 min以内分别为(1.4±0.1),(24.9±1.5)和(1.8±0.2)kPa,术后分别为(0.9±0.1),(21.6±1.6)和(0.9±0.1)kPa(t值分别为2.04,2.32,3.21,P＜0.05或0.01).竖脊肌病理改变为退行性变、灶状萎缩和坏死,电镜表现为散在性的骨骼肌纤维排列紊乱,多处骨骼肌纤维变性.超声多普勒结果表明腰骶部骨骼肌内血流量较术前明显增加.结论应用临床检查及骨筋膜室内压测定的方法诊断由腰骶部慢性骨筋膜室综合征所致慢性腰痛是可靠的.治疗上可采用骨筋膜室切开减压术.     

慢性骨筋膜室综合征所致慢性腰痛的临床诊断、治疗与康复

目的探讨由腰骶部慢性骨筋膜室综合征所致慢性腰痛的临床诊断、手术治疗和康复方法. 方法对慢性腰痛患者采用临床检查、腰骶部竖脊肌骨筋膜室内压测量方法诊断为慢性骨筋膜室综合征者39例,其中男17例,女22例;年龄18～66岁,平均40.6岁;慢性腰痛时间2～42年,平均25.5年.采用微创方法行腰骶部竖脊肌骨筋膜室切开减压术,术后2d开始进行腰、腹肌功能训练. 结果治疗后腰痛临床症状较术前明显好转、步行能力明显增加,腰部前屈、后伸活动度较术前分别增加(15±0.5)°和(7±0.7)°,腰骶部骨筋膜室内压在静息、运动中和运动后6 min以内,统计结果分别为(6.6±0.7),(160.3±11.15)和(6.9±0.8)mmHg[术前分别为(11.1±0.7),(188.1±12.08)和(14.1±1.2)mmHg],两组相比较差异均有统计学意义(P<0.05).超声多普勒表明腰骶部骨骼肌内最大血流速度和平均血流速度较术前分别增加(0.17±0.02)和(0.09±0.01)kHz. 结论应用临床检查及骨筋膜室内压测定的方法诊断由腰骶部慢性骨筋膜室综合征所致慢性腰痛是可靠的.治疗上可采用骨筋膜室切开减压术.术后腰、腹肌康复训练是必要的.     

下腰痛的运动疗法

下腰痛(lowbackpain,LBP)是骨科、运动医学和康复医学中常见的疾患,其主要特点为发病时间早、发病率高、容易复发,极大地影响患者的生存质量和劳动能力[1,2]。急性LBP患者中,1周内约33％患者疼痛消失,3周内为75％,2个月内超过90％[3]。因此,急性LBP的治疗应以对症处理为主。     

推拿治疗急性腰痛在康复临床中的应用

急性腰痛是临床常见病，多发病，康复门诊非常多见，我们对1280例急性腰痛病人进行了推拿治疗，疗效满意。报告如下。     

下腰痛的诊断与康复

下腰痛不是病名 ,而是由多种疾病引起的一系列症状 ,在骨科门诊患者中 ,以下腰痛为主诉症状的约占2 0 %— 30 % ,其中大部分为中老年人。近年来 ,随着参加体育运动的人群不断扩大 ,部分体育爱好者出现下腰痛的也不少见。对腰痛患者 ,如何给予正确的诊断 ,选择何种检查 ,进而采取何种适合的治疗 ,这是社区医生经常要面临和解决的问题。1致病因素1.1脊柱疾患1.1.1创伤 :①急、慢性腰部扭伤 :扭伤是腰痛最常见的病因 ,在日常生活中 ,抬物不当、摔倒或体育运动等都可能扭伤腰部 ,特别是人到中年后 ,体重增加、运动减少 ,所以扭伤很常见。扭伤造…     

Gender-specific aspects in chronic low back pain rehabilitation

Gender-specific Aspects in Chronic Low Back Pain Rehabilitation.Little is known about gender differences in utilisation, outcomes and evaluation of orthopaedic rehabilitation for chronic low back pain. The purpose of this article is to review and analyse the literature on rehabilitation and recovery of men and women with chronic back pain. In Western societies, chronic back pain is one of the most common causes for utilising medical rehabilitation services. In general no significant gender differences in the prevalences of back pain are found, but men are more sick-listed and early retired due to musculoskeletal diseases. Also, more men than women participate in medical rehabilitation programmes. National and international studies pinpoint the fact that differences exist between women and men with regard to participating in an orthopaedic rehabilitation programme. Additionally there is some evidence that different physical and psychological therapy services have different effects on health status of women and men. Mixed results are available regarding gender differences concerning the outcomes of rehabilitation programmes. Rehabilitation activities after discharge from in-patient programmes and these being performed within the home setting are primary indicators of recovery. Gender differences have been identified regarding various types of activities, apparently because especially family roles interfere with activity. Further research must be conducted so as to increase the understanding of women's and men's experiences relative to orthopaedic diseases and orthopaedic rehabilitation services.     

下腰痛的家庭康复训练介绍

Background:Low back pain is a common and frequent disease,often with severe ischialgia neuralgia.Besides normal ambulatory treatments such as traction of lumbar vertebra, computer middle frequent and massage,training of lumbodorsal myodynamia of family auxiliary treatment is very essential.Placing a supplementary instrument made by ourselves below low back,lying several hours,making lumbar vertebral slide forward and resume the normal biomechanics relations of lumbar vertebra by strenthening physiological lordosis.Improve the pathologic change of joint capsules,ligaments and muscles and alleviating secondary ischialgia neuralgia,changing lumbodorsal appearance.     

Adherence to rehabilitation in patients with low back pain

This study investigated adherence to low back pain rehabilitation in the clinical setting. Adherence was assessed in 105 (71 male and 34 female) patients attending private physiotherapy clinics for rehabilitation of low back pain. Three aspects of adherence were measured over the 4-week study period: attendance at clinic-based rehabilitation sessions, adherence to a home exercise component of rehabilitation, and adherence to activities and advice during clinic-based rehabilitation. Rehabilitation outcome was measured using the Patients' Measure of Perceived Rehabilitation (McDonald & Hardy 1990) and the Physiotherapists' Measure of Perceived Rehabilitation (McDonald & Hardy 1990). It was found that patients attended 87.7% of their scheduled physiotherapy rehabilitation appointments and reported completing 71.6% of their prescribed home exercises. In relation to adherence to clinic-based rehabilitation activities (as measured by the Sport Injury Rehabilitation Adherence Scale, Brewer et al. 2000), patients scored an average of 11.6/15. Although no gender differences were found, compensable patients adhered significantly less to clinic-based rehabilitation activities than did their non-compensable counterparts. Further, it was found that higher levels of adherence to clinic-based activities significantly predicted both the patients' and physiotherapists' perception of degree of rehabilitation at the end of the 4-week rehabilitation period. These findings are discussed in relation to rehabilitation strategies for physiotherapists.     

Comprehensive rehabilitation of patients having chronic low back pain.

Seventy-two patients having chronic back pain, representative of high-risk demographic and personality populations, received a broad range of therapeutic modalities designed around the theme of self-regulation. The self-regulation principle was used in: (1) biofeedback training for teaching self-regulated muscle relaxation; (2) psychological counseling emphasizing self-control techniques for the management of stress and anxiety, including assertion training; (3) patient-regulated medication program; (4) patient involved case conferences; (5) physical therapy program emphasizing reconditoning; (6) comprehensive vocational rehabilitation services; (7) a series of educational lectures; (8) a therapeutic milieu designed for relaxation, recreation and socialization. Utilizing a success criteria of functional physical activity at discharge (average length of stay, 45 days) and levels of vocational restoration (employable, in training, or employed at 30 days postdischarge), 57 of the patients demonstrated unimpaired physical functioning levels and 59 of the patients were at success levels of vocational restoration.     

国际功能、残疾和健康分类康复组合（ICF-RS）用于老年非特异性下腰痛患者水中太极效果评价的研究

摘要目的：采用ICF康复组合（ICF-RS）评价非特异性下腰痛（nonspecific low back pain, NLBP）患者的功能状况,初步分析水中太极治疗NLBP的康复疗效。方法：74例NLBP患者随机分配入治疗组（水中太极）和对照组（核心肌力训练）,每组各37例。按照预定的治疗方案进行为期8周的集中康复训练,通过ICF-RS评估NLBP患者的功能改善情况。结果：NLBP患者存在明显身体功能障碍的类目依次为：b152情感功能、b280痛觉、b455运动和耐受能力、b710关节活动能力、b730肌肉力量;存在明显活动与参与功能障碍依次为：d230进行日常事务、d410改变身体基本姿势、d415保持一种身体姿势、d640做家务、d660帮助别人、d710基本的人际交往、d770亲密关系、d850有报酬的就业、d920娱乐与休闲。2组NLBP患者治疗前后通过ICF-RS进行疗效评估,2组患者治疗后30条类目中14条明显改善（b152、b280、b455、b710、b730、d230、d410、d415、d640、d660、d710、d770、d850、d920）,治疗组改善类目评分均较对照组改善明显,具有显著性差异（P＜0.05）。结论：水中太极对NLBP痛患者有明显的临床疗效。ICF-RS可以用于评估NLBP患者的功能状况,指导康复治疗和进行疗效评价。     

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.     

Muscle activation changes after exercise rehabilitation for chronic low back pain

Marshall PW, Murphy BA. Muscle activation changes after exercise rehabilitation for chronic low back pain.

Objective

To investigate the changes in 2 electromyographic measures, flexion relaxation (FR) response and feed-forward activation of the deep abdominals, associated with low back pain (LBP) after different rehabilitation interventions.

Design

A 2×2 factorial design with subjects' self-selecting treatment with randomization after 4 weeks to either the specific exercise group or exercise advice group for a further 12-week period.

Setting

General community practitioners and university training center.

Participants

Subjects with chronic nonspecific LBP were recruited for this study. A total of 112 people were initially screened, and 60 were recruited for the study, with 50 being available for long-term follow-up.

Intervention

Four weeks of treatment (manipulative or nonmanipulation) and 12 weeks of subsequent exercise (supervised Swiss ball training or exercise advice).

Main Outcome Measures

The Oswestry Disability Index, FR response measured at T12-L1 and L4-5, and feed-forward activation of the deep abdominal muscles.

Results

More rapid improvements in disability were identified for subjects who received the supervised exercise program. The FR response at L4-5 also increased more for those who received directly supervised exercise. Long-term follow-up showed that there was still a between-group difference in the FR response, despite no difference in self-rated disability. Long-term changes were observed for the feed-forward activation of the deep abdominals; however, no exercise or treatment effects were identified.

Conclusions

Supervised exercise rehabilitation leads to more rapid improvements in self-rated disability, which were associated with greater improvement in the low back FR response.     

定量有氧运动早期干预对非特异性下腰痛的康复作用

背景非特异性下腰痛的临床治疗方法较多,但多为被动对症治疗,有关主动运动早期干预治疗的报道较少.目的研究定量有氧运动早期干预加功能重建对非特异性下腰痛的治疗效果.设计临床随机对照试验设计.地点和对象资料收集于阿曼首都马斯喀特亚洲医学中心1996-01/1998-12门诊收治非特异性下腰痛(nonspecific low back pain,NLBP)患者189例,其中男112例,女77例(均为阿拉伯人和欧洲人).干预189例非特异性下腰痛患者按就诊顺序随机分成两组A组(137例)主动运动早期干预加推拿治疗,B组(52例)推拿治疗;用视觉模拟量表(VAS)和腰痛问卷调查量表(OSW),对两组患者进行治疗前后分析评估.主要观察指标治疗前后VAS和OSW评分指数变化.结果两组VAS和OSW指数都有下降,A组指数下降明显大于B组[A组VAS治疗前后的值分别为(59.64±1.19),(28.98±0.95),B组为(63.33±1.91),(36.86±1.47),t=36.644,19.785,P＜0.01;A组OSW治疗前后的值分别为(26.781±0.492),(11.649±0.357),B组为(27.098±0.756),(15.625±0.570)(t=42.216,18.202,P＜0.01).6个月～2年随访表明A组复发率(15.08%,19/126)低于B组(35.42%,17/48).结论运动疗法早期介入治疗非特异性下腰痛,可缓解疼痛,改善和重建腰部功能,预防机体功能下降,提高日常生活活动能力.