高能量激光联合特定运动疗法对特发性脊柱侧凸伴腰痛患者多裂肌超声形态学的影响研究  

Effect of High Intensity Laser Combined with Physiotherapy Scoliosis Specific Exercise Therapy on Ultrasound Morphology of Multifidus Muscles in Idiopathic Scoliosis Patients with Low Back Pain

作　　者：孙晓蕾 雷晓龙 林佳声 李克良[5] 郭澳 张晓辉[6] SUN Xiaolei;LEI Xiaolong;LIN Jiasheng;LI Keliang;GUO Ao;ZHANG Xiaohui(Department of Rehabilitation Medicine,the Fifth Hospital of Harbin City,Harbin 150000,China;Graduate School,Harbin Sport University,Harbin 150000,China;Department of Physical Diagnostics,the Fifth Hospital of Harbin City,Harbin 150000,China;Department of Spinal Surgery,the Fifth Hospital of Harbin City,Harbin 150000,China;Teacher Development Centre,Harbin Sport University,Harbin 150000,China;Department of Sports Medicine,Guangzhou Sport University,Guangzhou 510500,China)

机构地区：[1]黑龙江省哈尔滨市第五医院康复医学科,150000 [2]哈尔滨体育学院研究生院,黑龙江省哈尔滨市150000 [3]黑龙江省哈尔滨市第五医院物理诊断科,150000 [4]黑龙江省哈尔滨市第五医院脊柱外科,150000 [5]哈尔滨体育学院教师教学发展中心,黑龙江省哈尔滨市150000 [6]广州体育学院运动医学室,广东省广州市510500

出　　处：《中国全科医学》2023年第27期3456-3462,共7页Chinese General Practice

基　　金：黑龙江省卫生健康委课题(20212020010383);广东省2019年度普通高校重点科研平台和项目(2019GCZX009);广东省重大科技协同创新专项子课题(2019B110210004)。

摘　　要：背景青少年特发性脊柱侧凸(AIS)是影响脊柱活动及躯干对称性的进展性三维骨骼畸形,有研究认为AIS不伴有疼痛,但最近的研究显示约有31.5%的患者伴有腰背疼痛。腰背痛产生的原因可能是由于椎旁肌失衡及疲劳等因素所致。目的应用肌骨超声观察AIS伴腰部疼痛患者在高能量激光疗法(HILT)联合脊柱侧凸特定运动疗法(PSSE)治疗后主弯顶椎旁多裂肌形态变化,评价联合治疗对椎旁肌失衡纠正的临床效果。方法选取2020年12月—2021年12月哈尔滨市第五医院脊柱侧弯矫治中心收治的AIS Rigo E1型患者30例进行随机单盲对照试验,将患者随机分为试验组(n=15)和对照组(n=15);试验组采用HILT联合PSSE,对照组仅采用HILT。两组分别于治疗前与治疗4周后进行肌骨超声检查、视觉模拟量表评分(VAS)、患者腰椎关节活动范围检查、Roland-Morris腰椎功能障碍问卷(RDQ)评分。采用Pearson相关性分析探究治疗后多裂肌的变化与治疗效果是否存在相关性。结果治疗后试验组多裂肌凹侧横截面积、前屈度、左侧屈度、左旋转度、右旋转度高于对照组(P<0.05),试验组治疗后多裂肌凹侧横截面积、凹侧厚度、凹凸侧横截面积比、凹凸侧厚度比、伸展度高于治疗前(P<0.05)。两组治疗后VAS评分、RDQ评分均低于治疗前,前屈度、左侧屈度、右侧屈度、左旋转度、右旋转度高于治疗前(P<0.05);对照组治疗后伸展度低于治疗前(P<0.05)。Pearson相关性分析显示,治疗后凹凸侧多裂肌横截面积比与治疗后腰椎右旋转度呈负相关(r=-0.660,P<0.01),治疗后凹凸侧多裂肌厚度比与治疗后腰椎右侧屈度呈负相关(r=-0.614,P<0.05)。结论HILT联合PSSE可使脊柱侧凸顶椎凹侧多裂肌形态改变,减轻腰部疼痛,增加腰椎活动度及降低腰椎功能障碍,提高日常生活能力;单独使用HILT虽对多裂肌形态变化影响不明显,但可有效缓解脊柱侧凸引起的下Background Adolescent idiopathic scoliosis(AIS)is a progressive three-dimensional skeletal deformity that affects spinal mobility and trunk symmetry.It was previously believed that AIS was not accompanied with pain,but recent studies have shown that approximately 31.5%of the patients complain of low back pain,which may due to factors such as paravertebral muscle imbalance and fatigue.Objective To observe morphological changes of paravertebral multifidus muscles at the top of the main curvature after high energy laser therapy(HILT)combined with physiotherapy scoliosis specific exercise(PSSE)in AIS patients with low back pain by using musculoskeletal ultrasound.and evaluate the clinical effect of treatment on the correction of paravertebral muscle imbalance.Methods A total of 30 patients with AIS RigoE1 admitted to the Scoliosis Correction Center of the Fifth Hospital of Harbin from December 2020 to December 2021 were selected for a randomized singleblind controlled trial and divided into the experimental group(n=15)and control group(n=15),the experimental group was treated with HILT combined with PSSE,and the control group was only treated with HILT.Musculoskeletal ultrasound,visual analogue scale(VAS)scores,range of motion of the patient's lumbar joints and Roland-Morris lumbar spine dysfunction questionnaire(RDQ)were performed before and 4 weeks after treatment in both groups.Pearson correlation analysis was used to investigate whether there was a correlation between the changes in the multifidus muscles after treatment and the treatment effect.Results The cross-sectional area of the convex side of multifidus muscles,anterior flexion,left lateral flexion,left rotation and right rotation of the experimental group were higher than those of the control group after treatment(P<0.05),the crosssectional area and thickness of multifidus muscles on the concave side,the cross-sectional area and thickness ratios of multifidus muscles on the concave and convex sides,extension after treatment were higher than those before t

关 键 词：脊柱侧凸 青少年 脊柱疾病 激光疗法 运动疗法 腰痛 超声检查 椎旁肌 

分 类 号：R682.3[医药卫生—骨科学]