腰椎间盘突出症患者的腰背等速肌力评定(英文)

Isokinetic evaluation of patients with lumbar disc herniation

背景:躯干生物力学的变化可能是腰椎间盘突出症发病和病后不愈的重要因素。目的:通过对腰椎间盘突出症患者进行腰背肌力测试,以了解其躯干生物力学变化。设计:以患者为研究对象,非随机化同期对照的回顾性研究。单位:解放军第二军医大学长海医院康复医学科。对象:2001-02/2002-01在第二军医大学长海医院康复医学科门诊治疗的腰椎间盘突出症患者30例为测试组,同期治疗非腰椎间盘突出症患者30例做对照组,均知情同意。方法:利用多关节等速测试系统对受试者躯干的等速力矩进行测试。观察记录指标为腰背屈伸肌群的峰力矩(PT)、相对峰力矩(PT/BW)、到达峰力矩的时间(TPT)、0.2s的力矩(T@0.2)、总功(TW)和平均功率(AP)。同时测试了腰背屈/伸比值(F/E)。结果利用SPSS9.0软件包分析,采用t检验进行统计学处理。主要观察指标:主要结局:腰背部屈肌、伸肌等速肌力评定结果。次要结局:腰背部屈伸比值评定结果。结果:各种收缩速度时测试组患者的屈、伸肌力量均显著下降,肌肉的爆发力和做功的效率指标也变化明显,屈肌力量的下降比伸肌力量的下降更严重。F/E评定测试组等速向心收缩60°/s,180°/s分别为57.99±5.68,65.74±8.12;对照组分别为95.25±5.18,83.03±7.61,两组比较差异有显著性意义(P<0.01)。结论:腰椎间盘突出症患者其力学改变是明确的,康复治疗应在准确评定这种改变的基础上,制订合适的、有针对性的训练方案,彻底纠正这种力学平衡,打断恶性循环。

BACKGROUND:Biomechanical changes of the trunk might be an important factor contributing to the pathogenesis and poor recovery of lumbar disc herniation. OBJECTIVE:To study the biomechanical changes of the trunk of patients with lumbar disc herniation by isokinetic test of the protruded lumbar disc. DESIGN:Non-randomized controlled retrospective study of concurrent patients. SETTING:Department of Rehabilitation Medicine,Changhai Hospital,Second Military Medical University of Chinese PLA. PARTICIPANTS:Thirty patients with lumbar disc herniation, admitted in the clinic of Department of Rehabilitation,Changhai Hospital affiliated to Second Military Medical University between February 2001 and January 2002,were enrolled in this study,with another 30 concurrent patients without lumbar disc herniation serving as the control group.Informed consent was obtained from all patients involved. METHODS:A Biodex Multi-joint Testing System was employed for measuring the peak torque(PT),peak torque to body weight(PT/BW),time to peak torque(TPT),torque at 0.2 s(T@0. 2),total work(TW),average power(AP) and flexion to extension(F/E) ratio of the trunk muscles of the patients.The results were analyzed by t test using SPSS 9.0 software. MAIN OUTCOME MEASURES:Main outcome:isokinetic evaluation of the lumbar and dorsal flexors and extensors;secondary outcome: F/E ratio. RESULTS:The strength of the trunk flexors and extensors decreased significantly in patients with lumbar disc herniation at each testing speed of retraction,and the bursting strength and indices for work efficiency of the muscles also exhibited obvious changes.The flexors showed greater reduction in muscle strength than the extensors.The F/E ratios during isokinetic concentric contraction at 60°/s and 180°/s were 57.99±5.68 and 65.74±8.12,respectively,in patients with lumbar disc herniation, in comparison with the ratios of 95.25±5.18 and 83.03±7.61 in the control patients,showing significant difference between the two patient groups(P< 0.01). CONCLUSION:Biomechanical changes of the trunk muscles of patients with lumbar disc herniation are definite,and proper rehabilitative treatment of these patients should consists of specific training protocols to restore the mechanical balance of the trunk and break the vicious cycle on the basis of accurate evaluation of such changes.