矫形鞋辅助手法治疗腰椎间盘突出症的临床研究

Study on the efficacy of orthopedic footwear in treating lumbar intervertebral disc herniation with spinal manipulation

目的:探讨矫形鞋在手法治疗腰椎间盘突出症患者中的作用及机制。方法:选取2009年9月至2010年9月收治的腰椎间盘突出症患者44例(男28例,年龄24～58岁;女16例,年龄21～60岁),首先使用表面肌电图(surface electromyogram,sEMG)技术记录患者左右两侧腰段竖脊肌表面肌电图的平均肌电波幅(average EMG,AEMG)和频谱面积(spectrum area,SPA),并比较穿矫形鞋站立1min与不穿矫形鞋站立1min、穿矫形鞋行走1min与不穿矫形鞋行走1min左右两侧竖脊肌AEMG及SPA差值的绝对值larAEMG和larSPA。然后随机分为实验组和对照组,每组22例。实验组患者接受脊柱定点旋转复位法辅助自制矫形鞋治疗,对照组患者只接受脊柱定点旋转复位法治疗。矫形鞋制作:患者着平底鞋,将髂嵴较低侧下肢所穿鞋,鞋底增高,使患者髂嵴连线与地面平行,保持骨盆的正常位置。脊柱定点旋转复位法为治疗医师用拇指将偏歪的棘突拨正,每周2～3次。比较两组患者的临床治愈时间。结果:患者穿矫形鞋站立1min与不穿矫形鞋站立1min两种体位下测定的larSPA分别为0.12±0.73、0.65±0.61,larAEMG分别为3.43±25.56、21.74±20.34;在穿矫形鞋行走1min与不穿矫形鞋行走1min两种体位下测定的larSPA分别为0.15±0.36、0.57±0.24,larAEMG分别为4.65±12.87、25.18±16.58,组间差异均有统计学意义(P<0.01)。实验组和对照组平均治愈时间分别为(20.36±4.92)d和(28.14±7.13)d,前者治愈时间明显少于后者(P<0.01)。结论:矫形鞋可以明显改善两侧腰部竖脊肌不对称收缩,平衡腰肌,为脊柱定点旋转复位法治愈腰椎间盘突出症创造良好条件,缩短临床治愈时间。

Objective：To observe the efficacy and mechanism of orthopedic footwear in treating lumbar intervertebral disc herniation with spinal manipulation. Methods：From September 2009 to September 2010,44 patients with the lumbar interver- tebral disc herniation with posture change were selected in the study. There were 28 males （aged from 24 to 58 years） and 16 females （aged from 21 to 60 years）. Firstly, the average EMG （AEMG） and spectrum area （SPA） of bilateral lumbar erector spinae of the patients were tested by surface electromyogram （sEMG）, and then absolute value of the difference between AEMG and SPA （larAEMG and larSPA） were compared. After that, they were randomly divided into two groups （experiment group and control group）, each group had 22 cases. The patients of experiment group received the spinal manipulation treatment assisted with orthopedic footwear and the other group received the spinal manipulation treatment only. Orthopedic footwear was put on by leg with lower iliac crest line, sole thickness of which depended on the degree of pelvic tilt. According to mitigation degree of symptom and sign, sole thickness was modified till removal of orthopedic footwear. Manipulative therapeutic method which was manipulative by doctors set spinal process to normal anatomical position. Manipulative treatment was 2 - 3 times every week. The clinical healing time were observed in the two groups. Results：The IarSPA was 0.12±0.73,0.65±0.61 and the IarAEMG was 3.43±25.56,21.74±20.34 in standing 1 minute of two positions of patients with orthopedic footwear and without orthopedic footwear,respectively ;the larSPA was 0.15±0.36,0.57±0.24 and the larAEMG was 4.65±12.87,25.18±16.58 in walking 1 minute of two positions of patients with orthopedic footwear and without orthopedic footwear. There were significant difference between the two groups （P〈0.01）. The time of healing well in experiment group and control group were respectively （20.36±4.92） d and （28.14±7.13） d,experiment group was shorter than that of control group （P〈0.01）. Conclusion：Orthopedic footwear can obviously improve the unsymmetrical shrink of bilateral lumbar erector spinae and balance lumbar muscle. There-fore, orthopedic footwear can create favourable conditions for the spinal manipulation in treatment of lumbar intervertebral disc herniation, which can shorten the healing well.