椎间微分动力系统联合脊柱评估训练对腰椎间盘突出症疼痛及功能的影响

关键词：椎间微分动力系统  腰椎间盘突出症  脊柱评估训练系统

Keywords:intervertebral differential dynamic system  lumbar disc herniation  spinal assessment training system

摘要：

      摘要 目的：探讨椎间微分动力系统（intervertebral differential dynamics，IDD）联合脊柱评估训练对腰椎间盘突出症患者的临床治疗效果。 方法：筛选L4—L5或L5—S1旁中央型腰椎间盘突出症（lumbar disc herniation，LDH）患者60例，通过随机数字表法，将其随机分为试验组和对照组，每组各30例。两组患者均接受健康教育，对照组每天执行1次IDD疗法，每周治疗5次，共治疗4周。试验组在对照组基础上联合脊柱评估训练系统训练；脊柱评估训练系统每周训练3次，共训练4周，12个单元。采用视觉模拟评分表（VAS）评估患者腰痛、腿痛的严重程度，应用奥斯沃斯特残疾指数（Oswestry disability index，ODI）和日本骨科协会下背痛评定量表（Japanese Orthopaedic Association Score，JOA）评估腰部功能障碍，采用脊柱评估训练系统测量腰椎前屈、背伸最大角度和最大肌力值，同时采用彩色多普勒超声诊断系统测量腰椎多裂肌的横截面积，分别于治疗前，治疗后进行评估。 结果：治疗前两组患者腰痛VAS、腿痛VAS评分、ODI评分、JOA评分及腰椎前屈、背伸最大角度和最大肌力值, 以及多裂肌横截面积组间均无显著性差异（P>0.05）；治疗后两组腰痛VAS、腿痛VAS、ODI、JOA、腰椎前屈背伸活动度以及试验组的前屈背伸最大肌力值、多裂肌横截面积均优于治疗前，且试验组各项指标均优于对照组，具有显著性差异（P<0.05）。 结论：IDD联合脊柱评估训练可有效缓解L4—L5或L5—S1旁中央型腰椎间盘突出症患者的腰腿疼痛，改善躯体活动受限程度，增加腰椎活动度和肌力，改善腰椎功能。

Abstract:

      Abstract Objective： To investigate the clinical efficacy of Intervertebral Differential Dynamics （IDD） combined with spinal assessment training system on the patients with lumbar disc herniation. Method： Sixty patients with L4—L5 or L5—S1 paramedian Lumbar Disc Herniation （LDH） were selected and randomly divided into a test group and a control group with 30 patients in each group through the random number table method. Both groups received health education. The control group was given IDD therapy once a day， 5 times a week for a total of 4 weeks. The test group was given additional spinal assessment training system training on the basis of the control group； Spinal assessment training system training was conducted 3 times a week for a total of 4 weeks， 12 units. The visual analog scale（VAS） was used to evaluate the severity of low back pain and leg pain. The ODI（Oswestry Disability Index） and the Japanese Orthopaedic Association（JOA） Low Back Pain Rating Scale were used to evaluate the lumbar dysfunction. Spinal assessment training system was used to measure the maximum angle and maximum muscle strength of lumbar flexion and dorsiflexion. At the same time， the cross-sectional area of the lumbar multifidus muscle was measured by a color Doppler ultrasound diagnostic system before and after treatment. Result： Before treatment， there were no significant differences between the two groups in terms of VAS scores for low back pain and leg pain， ODI scores， JOA scores， maximum lumbar flexion and dorsiflexion， maximum muscle strength values， and cross-sectional area of multifidus muscle （P>0.05）. After treatment， VAS scores for low back pain and leg pain， ODI， JOA， lumbar flexion and dorsiflexion range of motion， as well as the maximum muscle strength values for flexion and extension in the experimental group were better than those before treatment， and all indicators in the experimental group were better than those in the control group， with significant differences （P<0.05）. Conclusion： IDD combined with spinal assessment training system can effectively relieve back and leg pain in patients with L4—L5 or L5—S1 paracenteral lumbar disc herniation， improve the degree of physical activity limitation， increase lumbar motion and muscle strength， and improve lumbar function.