运动训练性下腰痛患者肌肉及腰椎组织的生物力学变化

Biomechanical changes in the muscle and lumbar vertebrae tissue in patients with low back pain caused by sport training

目的:以运动训练所致下腰痛患者为对象,观察运动疗法治疗下腰痛患者肌肉及腰椎组织的生物力学变化。方法:试验于2006-06/2007-01在广州体育学院康复中心完成。①试验对象:经运动训练引起下腰痛的患者18例,均对本试验知情同意。纳入标准:经骨科专科体检诊断为慢性下腰痛,除外骨关节性及椎管性下腰痛病变,症状持续在3个月以上,近5年内无腰部手术或心血管、神经系统方面的疾病。拍摄腰椎正侧位X光片,未见脊柱、腰椎异常,但可见腰椎前凸过度(54.89±6.12)°,超过正常。经视觉类比法确定疼痛程度在5以下。②试验方法:18例患者随机分为运动组和对照组,每组各9例,运动组按体疗方案实施运动疗法;对照组以服用止痛药为主。③试验评估:采用问卷法和试验法,所有受试者分别于试验前后填写中文版的《Roland-Monrris下腰痛功能障碍调查表(RMDQ)》和《Oswestry功能障碍指数(ODI)》。同时在试验前、后测试腹背肌耐力、腰部活动度、腰椎前凸曲度及运动疗法后的疼痛改善等指标。结果:纳入18名下腰痛患者,均进入结果分析,无脱落。①试验前,RMDQ和ODI得分、腹背肌耐力、腰部活动度、腰椎前凸曲度两组间差异无显著性,试验后差异有显著性(P<0.05,P<0.01)。②试验前后,运动组RMDQ和ODI得分、腹背肌耐力、腰部活动度、腰椎前凸曲度差异有显著性(P<0.05,P<0.01),而对照组差异无显著性(P>0.05)。③试验后,运动组9人中有8人疼痛得到了不同程度的缓解,且病情都有一定程度的改善;对照组只有3人疼痛得到缓解,没有病情改善情况。结论:①重点加强腹背肌力量训练的运动疗法对下腰痛有明显疗效。②采用RMDQ和ODI相结合的方法,对下腰痛患者进行综合评估,准确性较高,同时便于比较。

AIM： With the low back pain patients caused by sports as the subjects, to observe the biomechanical changes in the muscle and lumbar vertebrae tissue in them after sport therapy. METHODS： The experiment was carried out in the Rehabilitation Center of Guangzhou Institute of Physical Education from June 2006 to January 2007. （1）Eighteen patients with low back pain caused by sports training were selected with the informed consent according to the inclusive criteria： diagnosed as chronic low back pain after orthopedics faculty physical examination with an exception of the joint and discogenic low back pain pathological change; the symptom continued in 3 months or more, and no waist surgery or cardiovascular, nervous system diseases was found in near 5 years; no spinal column or lumbar abnormity was found the X film at low back pain vertebra side position, but lumbar lordotic curve was （54.89±6.12）°; the visual analogue scale results showed the ache degree was below 5. （2）They were randomly divided into training group and control group with 9 people in each group. Training group was treated according to the implementation of sport therapy, and the control group took pain killer primarily. （3）All subjects filled in the Roland-Morris disability questionnaire （RMDQ） and Oswestry Disability Index （ODI） before and after treatment. Meanwhile, abdominal and back muscles endurance, the waist movements, lumbar lordotic curve and ache improvement after sports therapy were detected. RESULTS; All 18 patients with low back pain were involved in the result analysis. （1）Before the experiment, there was no significant difference in RMDQ and ODI scores, abdominal and back muscles endurance, waist movements, and lumbar lordotic curve between two groups, but after the experiment, there were significant differences （P 〈 0.05, P 〈 0.01 ）. （2） RMDQ and ODI points, abdominal and back muscles endurance, the waist movements, and lumbar lordotic curve were remarkably different in the experimental group before and after the experiment （P 〈 0.05, P 〈 0.01）, but no difference was found in control group （P 〉 0.05）. （3）After the experiment, the pain in 8 of 9 people in the experimental group was alleviated, and the illness condition was improved; however, in control group, only 3 persons＇ ach was alleviated, but the condition was not improved. CONCLUSION： （1）The sport therapy that pays more attention to strengthen the abdominal and back muscles strength has obvious curative effect on low back pain. （2）The evaluation of RMDQ and ODI for the patients with low back pain is of high accuracy and convenience for the comparison.