慢性腰痛患者静止站立时躯干肌的激活特征及足底压力分布  

Characteristics of trunk muscle activation and plantar pressure distribution in patients with chronic low back pain in static standing

作　　者：徐钊强 李岩 彭嘉慧 谢浩宇 陈宇 王楚怀[1] XU Zhaoqiang;LI Yan;PENG Jiahui;XIE Haoyu;CHEN Yu;WANG Chuhuai(Department of Rehabilitation Medicine,the First Affiliated Hospital,Sun Yat-Sen University,Guangzhou,Guangdong 510062,China;School of Pharmacy,Wenzhou Medical University,Wenzhou,Zhejiang 325035,China;Department of Rehabilitation,Guangzhou Angel Children's Hospital,Guangzhou,Guangdong 510160,China)

机构地区：[1]中山大学附属第一医院康复医学科,广东广州市510062 [2]温州医科大学药学院,浙江温州市325035 [3]广州天使儿童医院康复科,广东广州市510160

出　　处：《中国康复理论与实践》2025年第4期466-475,共10页Chinese Journal of Rehabilitation Theory and Practice

基　　金：粤港科技创新联合资助项目(No.2023A0505010014);国家重点研发计划项目(No.2022YFC2009700);国家自然科学基金项目(No.82172532)。

摘　　要：目的比较慢性腰痛(cLBP)患者与健康受试者在静止站立时躯干肌肉激活、肌肉共同收缩水平与足底压力分布的差异。方法2021年7月至2022年7月,于中山大学附属第一医院康复医学科招募17例健康受试者(健康对照组)和18例cLBP患者(cLBP组),采集两组人口信息和cLBP组的疼痛程度、功能障碍程度及静止站立时身体质心位移参数。采用足底压力平板记录两组受试者执行静止站立任务时的足底压力分布情况,并同步使用无线表面肌电图记录腹横肌(TrA)、竖脊肌(ES)和腰椎多裂肌(LM)的活动,分析各肌肉的激活水平以及各肌肉对之间的共收缩指数(CCI)。结果与健康对照组比较,cLBP组双侧LM激活水平升高(∣t∣>2.479,P<0.05),腰腹部肌肉对左LM-左TrA(t=2.212,P=0.042)、左LM-右TrA(t=2.868,P=0.008)、右LM-右TrA(U=75.000,P=0.009)CCI升高。cLBP组右拇趾区域压力下降(t=2.825,P=0.009),右内和左外足跟区域压力升高(U<77.000,P<0.05)。结论在静止站立期间,cLBP患者需要更高水平的躯干肌肉激活和肌肉共收缩,足底压力分布后移,可能因为采取了不同的姿势补偿策略来维持静态姿势的稳定性。Objective To compare trunk muscle activation,muscle co-contraction levels and plantar pressure distribution between patients with chronic low back pain(cLBP)and healthy subjects during static standing.Methods From July,2021 to July,2022,17 healthy subjects(healthy control group)and 18 cLBP patients(cLBP group)were recruited from the Department of Rehabilitation Medicine,the First Affiliated Hospital of Sun Yat-sen University.Demographic information was collected for both groups,as well as the pain intensity,functional disability,and center of pressure displacement parameters of the cLBP group in static standing.A plantar pressure plate was used to record plantar pressure distribution in static standing task.Simultaneously,a wireless surface electromyography(sEMG)system was used to record the activity of the transverse abdominis(TrA),erector spinae(ES)and lumbar multifidus(LM).The activation levels of each muscle and the co-contraction index(CCI)between trunk muscle pairs were analyzed.Results Compared with the healthy control group,the cLBP group showed higher activation levels of the bilateral LM(∣t∣>2.479,P<0.05)and higher lumbar-abdominal muscle CCI of left LM-left TrA(t=2.212,P=0.042),left LM-right TrA(t=2.868,P=0.008)and right LM-right TrA(U=75.000,P=0.009).In the cLBP group,pressure decreased in the right big toe region(t=2.825,P=0.009),and increased in the right medial and left lateral heel regions(U<77.000,P<0.05).Conclusions During static standing,patients with cLBP require higher level of trunk muscle activation and co-contraction,with a posterior shift in plantar pressure distribution,which might be due to the adoption of different postural compensation strategies to maintain postural stability.

关 键 词：慢性腰痛 表面肌电 共收缩指数 足底压力 静止站立任务 

分 类 号：R681.5[医药卫生—骨科学]