肌筋膜松解疗法干预慢性非特异性下腰痛疗效的随机对照研究  

A Randomized Controlled Trial of Myofascial Release Therapy in Patients with Chronic Nonspecific Lower Back Pain

作　　者：冉清智 李傲霜 陈恒文[1] 张剑梅 何本祥 RAN Qingzhi;LI Aoshuang;CHEN Hengwen;ZHANG Jianmei;HE Benxiang(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Dongzhimen Hospital Beijing University of Chinese Medicine,Beijing 100700,China;National Institute of Sports Medicine,Beijing 100061,China;Sichuan Academy of Chinese Medical Sciences,Chengdu 610042,China)

机构地区：[1]中国中医科学院广安门医院,北京市100053 [2]北京中医药大学东直门医院,北京市100700 [3]国家体育总局运动医学研究所,北京市100061 [4]四川省中医药科学院,四川省成都市610042

出　　处：《中国全科医学》2024年第20期2451-2457,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(No.82074396);国家重点研发项目(2019YFF0301700);中国中医科学院科技创新工程重大攻关项目(CI2021A05011);中国中医科学院科技创新工程创新团队项目(CI2021B017-05)。

摘　　要：背景慢性非特异性下腰痛(CNLBP)已成为导致活动受限的常见病因之一,严重威胁患者身心健康和生活质量。有研究表明肌筋膜组织的敏感性和紧绷性是慢性疼痛障碍的主要因素。肌筋膜松解疗法(MFR)主要通过缓解筋膜的紧张以减轻疼痛,但目前缺乏高质量临床证据。目的观察MFR对非手术治疗的CNLBP的疗效。方法2022年在成都体育学院附属体育医院招募了56例CNLBP患者为研究对象,采用随机数字表法将患者分为两组,MFR组患者接受MFR干预(腰腹部MFR干预),对照组(CG组)患者接受假MFR干预(相同部位假MFR干预),20 min/次,1次/周,干预4周。比较两组干预前后视觉模拟评分法(VAS)评分、日常生活活动能力量表(ADL)评分、Oswestry功能障碍指数(ODI)、腰椎关节活动度[腰椎前屈度(ALF)、腰椎后伸度(LR)、两侧腰椎旋转度(LSR)]、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、炎性因子[肿瘤坏死因子α(TNF-α)]变化。结果本研究共纳入56例受试者,其中失访8例,自动退出8例,最终完成随访40例,其中MFR组20例,CG组20例。两组患者干预前VAS评分、ADL评分、ODI评分、ALF、SAS评分、SDS评分、TNF-α水平比较,差异无统计学意义(P>0.05);MFR组患者干预前LR、LSR小于CG组(P<0.05)。MFR组患者干预4周后VAS、ODI、SAS、SDS评分和TNF-α水平低于CG组,ADL评分高于CG组,ALF、LR、LSR大于CG组(P<0.05)。干预4周后MFR组患者VAS、ODI、SAS、SDS评分及TNF-α水平低于组内干预前,ADL评分高于组内干预前,ALF、LR、LSR大于组内干预前(P<0.05)。结论MFR可能改善CNLBP患者焦虑与抑郁等负性心理状态,降低疼痛阈值,增加腰椎关节活动度,且安全性较好。Background Chronic non-specific low back pain(CNLBP)has become one of the common causes of limited activity,which seriously threatens the physical and mental health and quality of life of patients.According to certain studies,sensitivity and tension in the myofascial tissue play an important role in chronic pain disorders.By releasing fascial tension,myofascial release theropy(MFR)is primarily used to relieve pain;however,there is a lack of high-quality clinical evidence to support this application.Objective To investigates the effectiveness of MFR in CNLBP cases treated nonsurgically.Methods From January to December 2022,56 patients with CNLBP were recruited as study subjects by Chengdu Sports Institute Sports Hospital.The patients were then divided into two groups using a randomised number table.The MFR group received MFR intervention(lumbar-abdominal MFR intervention)and the patients in the control group(CG group)received pseudo-MFR intervention(pseudo-MFR intervention in the same area)for the duration of 4 weeks,once a week for 20 minutes each time.The following variables were measured:Visual Analogue Scale(VAS)scores,Activities of Daily Living(ADL)scores,Oswestry Dysfunction Index(ODI),lumbar joint mobility[including anterior lumbar flexion(ALF),posterior lumbar extension(LR)and lumbar spine rotation(LSR)on both sides],scores on the SAS,and changes in tumour necrosis factor α(TNF-α).Results A total of 56 subjects were enrolled in this study.Of these,8 cases were lost,8 cases were automatically withdrawn and 40 cases-20 in the MFR group and 20 in the CG group eventually completed follow-up.There were no significant difference in VAS scores,ADL scores,ODI scores,ALF scores,SAS scores,SDS scores and TNF-αlevel between two groups before intervention(P>0.05).LR and LSR in MFR group were lower than those in CG group before intervention(P<0.05).After 4 weeks of intervention,VAS,ODI,SAS,SDS scores and TNF-α levels in MFR group were lower than those in CG group,ADL scores were higher than those in CG group,ALF,LR

关 键 词：腰痛 慢性非特异性下腰痛 肌筋膜松解疗法 物理治疗 随机对照试验 

分 类 号：R274.34[医药卫生—中医骨伤科学]