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.     

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6min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&;#177;0．5)&;#176;和(7&;#177;0．7)&;#176;。术前腰骶部骨筋膜室内压在静息、运动中和运动后6min以内分别为(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(t值分别为2．04，2．32，3．2l，P&;lt;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。     

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±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,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<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±0.02)kHz和(0.09±0.01)kHz(P<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。     

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。     

端粒长度与腰骶部慢性骨筋膜间隔综合征

背景:端粒的长度与细胞老化、永生化、痛变有密切的关系.目的:探讨端粒长度变化在腰骶部慢性骨筋膜间隔综合征中的意义.设计、时间及地点:对比观察,实验于2007-07/2008-02在上海交通大学医学院医学基因组学国家重点实验室完成.对象:25份竖脊肌组织标本取自2007-05/09,年龄29-49岁,平均(34.7±12.6)岁,其中10份为正常人标本,15份为腰骶部慢性骨筋膜间隔综合征所致慢性腰痛患者标本,根据年龄正常标本分为30-37岁和38-45岁2个对照组;非正常标本分为29～34岁、35～43岁和44～49岁组,每组5例.方法:取各组标本提取DNA,采用Southen Blotting杂交技术,测量各组标本竖脊肌组织骨骼肌细胞端粒长度.主要观察指标:患者竖脊肌组织与jF常组织端粒酶长度.结果:腰骶部慢性骨筋膜间隔综合征所致慢性腰痛患者竖脊肌细胞平均端粒长度明显比正常人竖脊肌细胞平均端粒长度短,且有显著性差异(P<0.05),44～49岁组最短,29～34岁组其次.结论:端粒的异常状态参与腰骶部慢性骨筋膜间隔综合征的发生.在腰骶部慢性骨筋膜间隔综合征病变的过程中,端粒长度明显变短,与年龄有关.     

慢性骨筋膜室综合征致慢性腰痛患者的护理33例

2001年7月～2002年9月,我院最先采用腰骶部骨筋膜室切开减压的方法治疗由腰骶部慢性骨筋膜室综合征所致慢性腰痛患者33例,经术后护理、腰腹肌功能锻炼及有效的出院指导,确保了手术疗效,患者的腰痛症状、步行能力和腰部的前屈、后伸活动度得到了明显改善,现将护理体会报告如下.     

腰骶部慢性骨筋膜间隔综合征解剖及临床研究现状

目的:总结近年来腰骶部慢性骨筋膜间隔综合征的研究现状,以期提高人们对腰骶部骨筋膜间隔综合征的认识、诊断及治疗。方法:应用计算机检索CNKI1994-01/2007-03及万方数据库2000-01/2007-03相关腰骶部慢性骨筋膜间隔综合征方面的文献,检索词"下腰痛,腰肌劳损,腰骶部骨筋膜间隔综合征",限定文章语言种类为中文。同时计算机检索PubMed、Medline、Springerlink2000-01/2007-03及Embase数据库2003-01/2007-03相关腰骶部慢性骨筋膜间隔综合征方面的文献,检索词"LBP,lumbar muscle strain,Chronic Compartment syndrome",并限定文章语言种类为English。对资料进行初审,选取包括腰骶部慢性骨筋膜间隔综合征的文献,开始查找全文,并查看每篇文献后的引文。纳入标准:文章所述内容应与慢性骨筋膜室综合征、慢性下腰痛、肌内压测定有关。排除标准:重复研究或Meta分析类文章。结果:共检索到45篇关于腰骶部慢性骨筋膜间隔综合征的文献,最终纳入15篇符合标准的文献。腰骶部骨筋膜间隔综合征目前尚未被普遍认识,但是1981年Peck就首次报道腰部骨筋膜间隔综合征,并提出该病可能是下腰痛原因之一。腰骶部骨筋膜间隔综合征与其他部位的骨筋膜间隔综合征病理变化相似,若得不到及时治疗就会引起肌肉的变性、坏死及纤维化,这是腰肌劳损形成的重要病理原因之一。诊断腰骶部慢性骨筋膜间隔综合征需要在排除其他疾病的基础上结合骨筋膜间隔内压力测定。骨筋膜间隔内压力的直接测定仍然是骨筋膜间隔综合征诊断的金标准。目前骨筋膜间隔综合征治疗四肢部位都趋向于行解压手术治疗,腰骶部的骨筋膜间隔综合征治疗意见不一,保守治疗虽然可以暂时缓解酸痛症状但疗效没有确切的统计学依据,并且不能预防阻止受压的骨骼肌变性。筋膜切开解压术是针对此病的基本疗法,有关专家的研究表明术前术后效果明显。因此对腰骶部骨筋膜间隔综合征的认识、诊断及治疗,对预防或减少慢性腰肌劳损所致的慢性腰痛具有重要意义。结论:腰骶部慢性骨筋膜间隔综合征可引起下腰痛,保守治疗虽然可以暂时起效但不能根本解决问题,手术治疗仍是基本的治疗手段。     

急性胸主动脉夹层瘤术后早期并发症及其监护16例

2001年7月-2002年9月，我院最先采用腰骶部骨筋膜室切开减压的方法治疗由腰骶部慢性骨筋膜室综合征所致慢性腰痛患者33例，经术后护理、腰腹肌功能锻炼及有效的出院指导，确保了手术疗效，患者的腰痛症状、步行能力和腰部的前屈、后伸活动度得到了明显改善，现将护理体会报告如下。     

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。     

槐甙胶囊防治绝经后骨质疏松症的疗效观察

目的:观察槐甙胶囊防治妇女绝经后骨质疏松疗效。方法:22例腰椎(L1,L2,L3,L4)骨密度低于一个标准差以下的绝经后患者入选,每日口服槐甙胶囊60mg,连续3个月。治疗前后检查腰椎和前臂骨密度;血清雌二醇、睾酮、尿促卵泡素(folliclestimulatinghormone,FSH)、骨钙素、血浆I型胶原羧基前体肽(procollagentypeIC-terminalpeptide,PICP)、尿脱氧吡啶酚(deoxypyridinoline,Dpyr);观察治疗前后腰背静息痛和运动痛。结果:槐甙胶囊治疗前后绝经后患者腰椎骨密度差异有显著性意义:犤(0.769±0.206),(0.816±0.212)g/cm2,t=-2.855,P=0.009;L3:(0.915±0.188),(0.958±0.205)g/cm2,t=-2.137,P=0.044;L2-4:(0.889±0.197),(0.92±0.204)g/cm2,t=-2.256,P=0.035犦;睾酮犤(0.283±0.131),(0.236±0.133)ng/mL犦和FSH犤(52.988±23.113)mIU/mL,(44.225±18.144)mIU/ml犦均有显著下降(t=2.9864,P=0.007;t=2.624,P=0.016);骨吸收指标尿Dpyr显著下降(t=3.856,P=0.001);治疗后患者的腰背静息痛和运动通有显著性意义(静息痛:t=9.566,P=0.001;运动痛:t=6.797,P=0.001)。结论:槐甙胶囊有改善绝经后患者腰椎骨密度和抑制骨吸收的作用,能明显减轻患者的腰背疼痛。     

The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients

[Purpose] The aim of this study was to examine the effects of exercise to strengthen the muscles of the hip together with lumbar segmental stabilization exercise on the lumbar disability index, lumbar muscle strength, and balance. [Subjects and Methods] This study randomly and equally assigned 40 participants who provided written consent to participate in this study to a lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus group (SMG + LES group) and a lumbar segmental stabilization exercise group. [Results] Each evaluation item showed a statistically significant effect. [Conclusion] Clinical application of exercise in this study showed that lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus resulted in a greater decrease in low back pain disability index and increase in lumbar muscle strength and balance ability than lumbar segmental stabilization exercise in chronic low back pain patients receiving the exercise treatments during the same period.     

Aeolus myth: chronic obstructive lung disease and nocturnal lumbosacral pain in association with lumbar spinal stenosis and pulmonary hypertension

OBJECTIVE: To describe an association between the syndromes of lumbar spinal stenosis and chronic obstructive pulmonary disease (COPD) in patients presenting with symptoms of nocturnal lumbosacral radiculopathy. DESIGN: Retrospective review of 46 sequential inpatients referred with complaints of lumbosacral radicular pain associated with lumbar spinal stenosis. Half (23) were experiencing sleep disruptive nocturnal pain. Each had been hospitalized with a primary diagnosis of COPD. They were subsequently compared with another group of inpatients (23) who were also experiencing lumbar pain not necessarily increased at night. Each was also identified as having lumbar spinal stenosis without an antecedent history of COPD. In each case, lumbar spinal imaging studies (computed tomography or magnetic resonance imaging) were obtained. Pulmonary function tests were performed in those with COPD, and two-dimensional echocardiograms were obtained in all 46 patients. RESULTS: The ratio of women to men, their ages, surgical interventions, severity of lumbar spinal stenosis, and left ventricular function as compared one group with another was not significantly different. However, pulmonary artery pressures were notably elevated (i.e., pulmonary hypertension) in those with COPD and nocturnal lumbosacral radiculopathy. CONCLUSION: This study suggests that in patients with COPD and lumbar spinal stenosis, pulmonary hypertension may be the dynamic link exacerbating nocturnal lumbosacral pain.     

腰骶灵活性训练对腰椎间盘突出症患者干预效果的临床研究

目的观察腰骶灵活性训练对于腰椎间盘突出症患者活动度、疼痛和功能障碍的影响。方法前瞻性选取空军特色医学中心收治的腰椎间盘突出症患者51例,按照随机分组方法分为实验组(n=27)和对照组(n=24),两组患者均接受以冯氏脊柱定点旋转复位法为主的保守治疗,试验组患者在此基础上增加腰骶灵活性训练,即改良的腰骶猫式动作、仰卧位骨盆前后倾、骨盆侧屈、骨盆侧旋共4个动作,15个/组,2组/d,5 d/周,为期3周。在干预前后比较两组患者的坐位活动度、站位活动度、腰椎延展性以及主观疼痛(VAS评分)和功能障碍程度(ODI指数)。结果相比于对照组,实验组患者站立位腰椎屈曲延展性显著改善,差异具有统计学意义(t=2.557,P=0.014);站立位屈曲活动度(t=-3.035,P=0.004)、屈曲+右侧屈+右侧旋(t=-3.345,P=0.002)以及屈曲+左侧屈+左侧旋(t=-4.072,P=0.000)活动度均增加;VAS评分(t=2.908,P=0.008)和ODI指数(t=2.095,P=0.047)均显著减小,差异均有统计学意义(P<0.05)。结论腰骶灵活性训练能够改善腰椎间盘突出症患者腰椎的延展性,增加腰椎的活动度,改善腰椎-骨盆节律,改善前屈及前屈对角线动作的功能动作能力,并能够帮助腰椎间盘突出症患者缓解疼痛和主观功能障碍程度。     

Motor Training of the Lumbar Paraspinal Muscles Induces Immediate Changes in Motor Coordination in Patients With Recurrent Low Back Pain

Recurrent low back pain (LBP) is associated with altered motor coordination of the lumbar paraspinal muscles. Whether these changes can be modified with motor training remains unclear. Twenty volunteers with unilateral LBP were randomly assigned to cognitively activate the lumbar multifidus independently from other back muscles (skilled training) or to activate all paraspinal muscles with no attention to any specific muscles (extension training). Electromyographic (EMG) activity of deep (DM) and superficial multifidus (SM) muscles were recorded bilaterally using intramuscular fine-wire electrodes and that of superficial abdominal and back muscles using surface electrodes. Motor coordination was assessed before and immediately after training as onsets of trunk muscle EMG during rapid arm movements, and as EMG amplitude at the mid-point of slow trunk flexion-extension movements. Despite different intentions of the training tasks, the pattern of activity was similar for both. After both training tasks, activation of the DM and SM muscles was earlier during rapid arm movements. However, during slow trunk movements, DM and SM activity was increased, and EMG activity of the superficial trunk muscles was reduced only after skilled training. These findings show the potential to alter motor coordination with motor training of the lumbar paraspinal muscles in recurrent LBP.     

Effects of Push-ups Plus Sling Exercise on Muscle Activation and Cross-sectional Area of the Multifidus Muscle in Patients with Low Back Pain

[Purpose] The purpose of this study was to examine the effect of lumbar stability exercises on chronic low back pain by using sling exercise and push-ups. [Subjects] Thirty adult subjects with chronic back pain participated, with 10 adults being assigned to each of 3 exercise groups: general physical therapy (PT), lumbar stability using sling exercises (Sling Ex), and sling exercise plus push-ups (Sling Ex+PU). Each group trained for 30 minutes 3 times a week for 6 weeks. The Oswestry Disability Index (ODI), surface electromyographic (sEMG) activity of the lumbar muscles, and cross-sectional area of the multifidus muscle on computed tomography (CT) were evaluated before and at 2, 4, and 6 weeks of therapy. [Results] A significant decrease in ODI was seen in all therapy groups, and this change was greater in the Sling Ex and Sling Ex+PU groups than in the PT group. No changes in sEMG activity were noted in the PT group, whereas significant increases in the sEMG activities of all lumbar muscles were found in the other 2 groups. The increases in the sEMG activities of the rectus abdominis and internal and external oblique muscles of the abdomen were greater in the Sling Ex+PU group than in the other 2 groups. [Conclusion] These findings demonstrate that Sling Ex+PU, similar to normal lumbar stabilization exercise, is effective in activating and improving the function of the lumbar muscles. These results suggest that Sling Ex+PU has a positive impact on stabilization of the lumbar region.Key words: Chronic low back pain, Push-up plus, Multifidus muscle     

In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial

QUESTION: Is low level laser therapy an effective adjuvant intervention for chronic low back pain? DESIGN: Randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: Sixty-one patients who had low back pain for at least 12 weeks. INTERVENTION: One group received laser therapy alone, one received laser therapy and exercise, and the third group received placebo laser therapy and exercise. Laser therapy was performed twice a week for 6 weeks. OUTCOME MEASURES: Outcomes were pain severity measured using a 10-cm visual analogue scale, lumbar range of motion measured by the Schober Test and maximum active flexion, extension and lateral flexion, and disability measured with the Oswestry Disability Index on admission to the study, after 6 weeks of intervention, and after another 6 weeks of no intervention. RESULTS: There was no greater effect of laser therapy compared with exercise for any outcome, at either 6 or 12 weeks. There was also no greater effect of laser therapy plus exercise compared with exercise for any outcome at 6 weeks. However, in the laser therapy plus exercise group pain had reduced by 1.8 cm (95% CI 0.1 to 3.3, p = 0.03), lumbar range of movement increased by 0.9 cm (95% CI 0.2 to 1.8, p < 0.01) on the Schober Test and by 15 deg (95% CI 5 to 25, p < 0.01) of active flexion, and disability reduced by 9.4 points (95% CI 2.7 to 16.0, p = 0.03) more than in the exercise group at 12 weeks. CONCLUSION: In chronic low back pain low level laser therapy combined with exercise is more beneficial than exercise alone in the long term.     

腰椎稳定性训练治疗慢性非特异性腰痛的研究

目的:研究腰椎稳定性训练对慢性非特异性腰痛患者的治疗效果.方法:91名慢性非特异性腰痛患者随机分为治疗组(46人)和对照组(45人).两组患者均接受6周共18次治疗,治疗组患者进行腰椎稳定性训练,对照组患者接受磁热治疗.在患者治疗前、治疗6周后以及随访1年后分别评价其疼痛和功能障碍程度.结果:治疗6周后,治疗组较对照组患者在疼痛和功能障碍方面具有更显著的改善(P<0.05),治疗组疗效在随访1年后仍然得到维持(P<0.05).结论:腰椎稳定性训练是一种有效减轻慢性非特异性腰痛患者疼痛程度并改善其功能障碍的疗法.     

Effects of a therapeutic climbing program on muscle activation and SF-36 scores of patients with lower back pain

[Purpose] This study examined the effects of lumbar stability exercises on chronic lower back pain by using a therapeutic climbing program on lumbar muscle activity and function. [Subjects and Methods] Thirty adult subjects with chronic back pain participated. The subjects were assigned to 2 exercise groups, namely the lumbar stabilization (Mat Ex) and therapeutic climbing exercise groups (TC Ex). Each group trained for 30 minutes, 3 times a week for 4 weeks. The Short-form 36-item Questionnaire (SF-36) was administered and the surface electromyographic (sEMG) activities of the lumbar muscles were measured. [Results] Both therapy groups showed significant increases in the SF-36 score, and the increase was greater in the TC Ex group. Significant increases in the sEMG activities of the lumbar muscles were found in both groups. The increases in the sEMG activities of the rectus abdominis and internal and external oblique muscles of the abdomen were greater in the TC Ex group than in the Mat Ex group. [Conclusion] These findings demonstrate that TC Ex, which is similar to normal lumbar stabilization exercise, is effective at activating and improving the function of the lumbar muscles. These results suggest that TC Ex has a positive impact on the stabilization of the lumbar region.Key words: Chronic lower back pain, Therapeutic climbing, Stabilization exercise     

Neurologic disease presenting as chronic pelvic pain

Neurologic disease as a cause of chronic pelvic pain may be more common than previously reported. We report three cases wherein patients with complaints of pelvic pain were subsequently found to have neurologic disease involving the lumbosacral spine. In all three cases, the presenting features were complaints of cyclic or noncyclic lower abdominal pain attributed to endometriosis, pelvic inflammatory disease, or uterine fibroids. When conventional therapies failed to resolve the pain, magnetic resonance imaging (MRI) of the lumbosacral spine showed a neoplasm in one patient and disk herniation in two patients. Evolving lumbar disk disease or intradural neoplasms in the upper lumbar area can produce symptoms interpreted as pelvic pain. Symptoms consistent with radiculopathy occurred late in the course of each of the three cases reported.