脊柱微调手法治疗腰椎间盘突出症的腰背肌生物力学性能评价

The biomechanical evaluation of lumbodorsal muscle in spine micro-adjusting manipulation treating lumbar intervertebral disc protrusion

目的:观察脊柱微调手法对腰椎间盘突出症患者腰背伸肌群生物力学性能的影响。方法:2008年8月—2011年4月,采用电脑随机数字表法,将65例腰椎间盘突出症患者随机分为治疗组(微调手法组)与对照组(牵引组),治疗组30例,牵引组30例,脱落5例。应用美国Biodexsystem-Ⅲ等速测试系统测试两组治疗前后腰背伸肌群生物力学性能。结果:治疗后二组患者视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)改善均有显著性意义(P<0.001),微调手法组改善更加明显,优于牵引组(P<0.05);腰部肌群生物力学性能:两组治疗前峰力矩(PT)、平均功率(AP)、腰背屈/伸峰力矩比值(F/E)比较无显著性差异(P>0.05);治疗后PT(60°/s)、AP(120°/s)比较,治疗组优于对照组(P<0.05);治疗组治疗前后PT、AP、F/E比较有显著性差异(P<0.05)。结论:脊柱微调手法治疗腰椎间盘突出症临床疗效显著,可以改善腰椎间盘突出症患者腰背伸肌群收缩力量、做功效率,改善腰部屈、伸肌群的协调能力,从而有利于恢复腰椎间盘突出症患者腰背伸肌的生物力学性能。

Objective： To observe the biomechanical effects of lumbodorsal extensors in spine micro-adjusting manipulation treating lumbar intervertebral disc protrusion. Method： From August 2008 to April 2011, 65 patients with lumbar intervertebral disc protrusion were divided in- to treated group and control group by a randomizing digital table, of which 30 patients in treated group treated with micro-adjusting manipulation, 30 patients in control group treated with traction, 5 cases dropped-out. The biomechanical properties of lumbodorsal extensors were tested by Biodex-m isokinetic testing system. Result： The melioration of scores of visual analogue scale（VAS） and Oswestry disability index（ODI） of patients in two groups all had obvious statistical significance after treatment （P〈0.001）, the effection treated group was better than that in control group（P〈 0.05）. Before treatment there was no significant difference of biomechanical properties in peak torque （PT）, average power （AP）, peak torque of flexor/extensor peak torque ratio （F/E） between two groups（P〉O.05）. After treatment treated group improved better than control group in PT and AP （P〈 0.05）. Compared with before treatment there were significant differences of PT, AP, F/E in treated group after treatment（P 〈 0.05）. Conclusion： Micro-adjusting manipulation may improve contraction forces and work efficiency of lumbodorsal ex- tensors improve coordination ability of flexors and extensors, and then improve biomeehanical properties of lum- bodorsal extensors and provide obvious clinical effect, for the patients with lumbar intervertebral disc protrusion. Author＇s address Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medi- cine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437