核心稳定训练联合呼吸训练对腰椎间盘突出症患者多裂肌特性的影响

关键词：腰椎间盘突出症  呼吸训练  核心稳定训练  多裂肌

Keywords:lumbar disc herniation  breathing training  core stabilization training  multifidus muscle

摘要：

      摘要 目的：探讨核心稳定训练联合呼吸训练对腰椎间盘突出症（LDH）患者疗效及多裂肌特性的影响。 方法：将45例LDH患者随机分为电针组（15例）、核心组（16例）、呼吸组（14例）。三组患者均接受健康宣教和电针治疗，核心组加予核心稳定训练，呼吸组加予核心稳定训练和呼吸训练。比较三组患者治疗前后视觉模拟评分（VAS）、改良Oswestry功能障碍指数（ODI）评分、腰背肌肌力，于治疗前后行腰椎MRI测量L4、L5椎体下缘水平面的多裂肌横截面积（CSA）、脂肪浸润（FI）、T2值。 结果：三组患者VAS评分、腰背肌肌力及多裂肌CSA、FI、T2值的组内效应（F>99.588，P<0.001）、组间效应（F>9.747，P<0.001）和交互效应（F>15.584，P<0.001）均显著，ODI评分的组内效应、组间效应显著（F>10.240，P<0.001），交互效应不显著（F=2.898，P=0.066）。治疗后，三组患者VAS、ODI评分、腰背肌肌力及多裂肌FI、T2值均较治疗前改善（P<0.05），且呼吸组改善程度优于另外两组（P<0.05）。治疗后，呼吸组与核心组患者多裂肌CSA较治疗前增加（P<0.05），且呼吸组高于核心组（P<0.05）。 结论：核心稳定训练联合呼吸训练可以改善LDH患者疼痛程度、腰椎功能障碍、腰背肌肌力，增加多裂肌横截面积，减轻多裂肌水肿及脂肪浸润。

Abstract:

      Abstract Objective： To investigate the effects of combined core stabilization training and breathing training on the therapeutic outcomes and multifidus muscle characteristics in patients with lumbar disc herniation （LDH）. Method： Forty-five patients with LDH were randomly assigned to the electroacupuncture group （n=15）， core training group （n=16）， and breathing training group （n=14）. All groups received health education and electroacupuncture treatment. In addition, the core training group underwent core stabilization training， while the breathing training group received both core stabilization training and breathing training. Patients underwent visual analogue scale （VAS）， Oswestry Disability Index （ODI）， and lumbar muscle strength assessments pre- and post-treatment. Lumbar MRI measurements of multifidus cross-sectional area （CSA）， fat infiltration （FI）， and T2 values at the L4 and L5 vertebral body inferior margin were performed pre- and post-treatment. Result： Significant main effects of intra-group effect （F>99.588，P<0.001）， inter-group effect （F>9.747，P<0.001） and interaction effect （F>15.584，P<0.001） for VAS， lumbar muscle strength， multifidus CSA， FI and T2 values in all groups of patients. For ODI scores, significant main effects of the intra-group effect and inter-group effect were observed （F>10.240，P<0.001）， while the interaction effect was not significant （F=2.898，P=0.066）. Following treatment， all three groups showed significant improvements in VAS scores， ODI scores， lumbar muscle strength， multifidus FI， and T2 values compared to pre-treatment （all P<0.05）. The breathing training group demonstrated superior improvement over the other two groups （P<0.05）. Post-treatment， both the breathing training and core training groups showed increased multifidus CSA compared to pre-treatment （P<0.05）， with the breathing training group exhibiting a greater increase than the core group （P<0.05）. Conclusion： Core stabilization training combined with breathing training can effectively reduce pain， improve dysfunction， and enhance the muscle strength of patients with LDH. Furthermore, this intervention increases multifidus cross-sectional area and reduces multifidus edema and fatty infiltration.