经皮中频电刺激配合三维正骨推拿治疗腰椎间盘突出症对腰背伸肌群生物力学特性的影响  

Effect of Percutaneous Medium Frequency Electrical Stimulation Combined with Three-dimensional Bone-setting Massage on Biomechanical Properties of Lumbar Extensor Muscle Group in the Treatment of Lumbar Protrusion

作　　者：李曌嫱 王乐[1] 蔡栋斌 张宇辰 裴昆 姜俊杰[2] LI Zhaoqiang;WANG Le;CAI Dongbin;ZHANG Yuchen;PEI Kun;JIANG Junjie(Beijing Gulou Hospital of Traditional Chinese Medicine,Beijing 100009,China;Institute of Clinical Basic Medicine,China Academy of Traditional Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京市鼓楼中医医院,北京100009 [2]中国中医科学院中医临床基础医学研究所,北京100700

出　　处：《辽宁中医药大学学报》2025年第2期146-152,共7页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：中国中医科学院科技创新工程项目(CI2021A05305)。

摘　　要：目的 探究中频经皮神经电刺激(TENS)配合三维正骨推拿治疗腰椎间盘突出症(LDH)对腰背伸肌群生物力学特性的影响。方法 选择2021年1月—2023年12月于该院针灸科及骨科就诊的LDH患者280例为研究对象,根据随机数字表法分为两组,对照组(140例)行单纯中频TENS治疗,观察组(140例)行中频TENS配合三维正骨推拿治疗。比较两组患者临床资料,临床疗效,治疗前后的椎基底动脉血流动力学、炎症因子水平、腰背伸肌群肌力、腰背伸肌群表面肌电和生物力学,以及腰椎功能、疼痛情况评分。采用广义估计方程(GEE)分析两组患者各指标的改善情况。结果 与对照组比较,观察组治疗效果显著增加(P<0.05)。与治疗前比较,治疗后两组患者平均流速(MV)、疼痛调节因子β-内啡肽(β-EP)、各腰背伸肌群肌力、平均功率频率(MPF)、积分肌电(IEMG)、峰力矩(PT)、平均功率(AP)、日本骨科协会(JOA)评分显著增加(P<0.05),阻力指数(RI)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、前列腺素E2(PGE2)、基质金属蛋白酶3(MMP-3)、腰背屈伸比(F/E)、Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)显著降低(P<0.05)。治疗后与对照组比较,观察组MV、各腰背伸肌群肌力、MPF、IEMG、PT、AP、JOA显著增加(P<0.05),RI、TNF-α、IL-1β、IL-1、MMP-3、F/E、ODI、VAS显著降低(P<0.05)。GEE分析结果显示,与治疗前比较,治疗后患者的PT、AP显著增加(P<0.05),F/E显著降低(P<0.05);与对照组比较,治疗后观察组患者的PT、AP显著增加(P<0.05),F/E显著降低(P<0.05)。结论 中频TENS配合三维正骨推拿治疗LDH可显著改善患者腰椎功能,缓解其疼痛情况,主要作用机制包括促进血液循环,清除炎症因子,提高腰背伸肌群肌力,缓解腰背伸肌群疲劳程度,改善腰部肌群协调平衡能力,缓解背部肌力的异常改变。Objective To explore the effect of mid-frequency transcutaneous electrical nerve stimulation(TENS)combined with three-dimensional bone manipulation on the biomechanical properties of lumbar intervertebral disc herniation(LDH).Methods A total of 280 LDH patients who were treated in the Department of acupuncture and orthopedics of our hospital from January 2021 to December 2023 were selected as the study objects.According to the random number table method,they were divided into two groups.The control group(n=140)received medium-frequency TENS therapy alone,and the observation group(n=140)received medium-frequency TENS therapy combined with three-dimensional bone manipulation.Compared with clinical data,clinical efficacy,vertebrobasilar hemodynamics,levels of inflammatory factors,muscle strength of lumbar extensor muscles,surface electromyography and biomechanics of lumbar function and pain before and after treatment between the two groups.Generalized estimating equation(GEE)was used to analyze the improvement of each index in the two groups.Results Compared with the control group,the therapeutic effect of the observation group was significantly increased(P<0.05).Compared with before treatment,mean velocity(MV),pain regulatory factorβ-endorphin(β-EP),muscle strength of each lumbar extensor group,mean power frequency(MPF),integrated electromyogram(IEMG),peak torque(PT),average power(AP),Japanese orthopaedic association(JOA)score increased significantly(P<0.05)and resistance index(RI),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),IL-1,IL-6,C-reactive protein(CRP),prostaglandin E2(PGE2),matrix metalloproteinase 3(MMP-3),flexion to extension(F/E),Oswestry disability index(ODI),visual analogue pain score(VAS)decreased significantly(P<0.05)in both groups after treatment.After treatment,compared with control group,MV,muscle strength of each lumbar extensor group,MPF,IEMG,PT,AP and JOA in observation group were significantly increased(P<0.05),while RI,TNF-α,IL-1β,IL-1,MMP-3,F/E,ODI and VAS were significantly

关 键 词：经皮中频电刺激 三维正骨推拿 腰椎间盘突出症 腰背伸肌群 生物力学特性 

分 类 号：R274[医药卫生—中医骨伤科学]