慢性下腰痛患者腰屈伸肌的等速肌力评价

An isokinetic evaluation on strength of trunk muscles in patients with chronic low back pain

目的：通过对慢性下腰痛患者腰屈伸肌进行等速向心、离心肌力测试，定量评价患者腰屈伸肌肌力的变化，为慢性下腰痛患者腰屈伸肌肌肉功能的康复训练提供依据。方法：运用Ｃｙｂｅｘ － ６０００ 型等速测力系统分别对３０ 例慢性下腰痛患者及３０ 例正常人在慢速（３０°／ｓ） 和中速（９０°／ｓ） 条件下进行腰屈伸肌的等速向心和离心肌力测试，评价屈肌与伸肌的峰力矩／ 体重比值，以及腰屈伸肌向心与离心的峰力矩／ 体重比值。结果：两种测试速度下，患者组与正常组相比，腰屈肌向心测试和屈、伸肌离心测试的峰力矩／ 体重值降低，伸肌向心测试的峰力矩／ 体重值较正常组显著下降（ Ｐ＜ ０ ．００１） ；向心测试屈、伸肌峰力矩与体重比值显著增大（ Ｐ＜ ０ ．０１） ，离心测试屈、伸肌峰力矩与体重比值增大；屈肌向心、离心测试的峰力矩与体重的比值降低，伸肌向心、离心测试的峰力矩与体重的比值显著降低（ Ｐ＜ ０ ．０１） 。结论：慢性下腰痛患者腰屈伸肌存在屈伸肌力的下降及失衡，需针对性地进行屈伸肌肌力训练，以恢复屈伸肌对腰椎主动稳定和功能性活动的作用。

Objective: To clarify the difference between concentric and eccentric strength of healthy subjects and those patients with chronic low back pain (CLBP). Method: Flexors and extensors peak torque/body weight (PT/BW) were measured at two angular velocities (30°/s、90°/s) in concentric and eccentric contractions modes in 30 patients with CLBP and 30 healthy subjects with Cybex-6000 isokinetic testing system, to evaluate flexor/extensor peak torque ratio (F/E) during concentric and eccentric contraction and concentric/eccentric peak torque ratios (C/E) of flexors and extensors. Result: At two velocities, concentric PT/BW of extensors in patients were significantly lower than those of healthy subjects (29.6% vs. 25.4%, P <0.001),flexors concentric PT/BW(peaktorque/body weight) decreased, but there were no significant difference between the patients and healthy subjects. F/E ratios of concentric and eccentric in patients were greater than those of healthy subjects , but those of eccentric peak torque were no significant difference. C/E ratios of flexors and extensors declined, and those of extensors were significantly declined. Conclusion: Muscle strength of both flexors and extensors declined.Decline of extensor strength was significantly greater than that of flexor. Itsuggests that muscle strength training in patients with CLBP is necessary in rehabilitation program, and the training of the extensors should be emphasized. Author′s address Dept. of Rehabilitation, Huashan Hospital, Shanghai Medical University,200040