腰椎间盘突出症伴神经异常屈、伸膝的肌力变化

The change of peak torque of knee flexion and extension of the patient with protrusion of lumbar intervertebral disc

目的为制定腰椎间盘突出症患者的康复训练计划提供依据。方法腰椎间盘突出症患者１６例，根据肌电图检查分为Ｌ_４和 Ｌ_５／Ｓ_１神经损伤组。用 Ｃｙｂｅｘ ３３０型等速运动测试装置，测试６０°／ｓ、１８０°／ｓ、３００°／ｓ ３种速度屈、伸膝向心性等速运动峰力矩，选用ｔ检验比较双侧屈、伸膝的峰力矩和屈／伸膝比值有无差异。结果患侧３种速度屈、伸膝的峰力矩均低于健侧，屈膝时相差１７．１％～２２．５％，伸膝相差１１．８％～１７．３％，差异均显著（Ｐ＜０．０５－０．００１）；Ｌ_４组患侧３种速度的屈／伸比值均大于健侧，而Ｌ_５／Ｓ_１组患侧３种速度的屈／伸比值均小于健侧。结论腰椎间盘突出症患者患侧屈、伸膝肌力均明显下降，当患者症状缓解，进行康复治疗训练腰背肌的同时，不要忽略屈、伸膝肌力的训练。

Objective To provide basis for rehabilitation programs of the patients with protrusion of lumbar intervertebral disc. Methods Sixteen subjects with lumbar intervertebral disc protrusion(divided into L_4 and L_5/S_1 nerve root abnormality groups)were measured with Cybex 330 isokinetic dynamometer at three angular velocities(60 °/s, 180 °/s, 300 °/s). A t-test for dependent samples was done with data on the peak torque of knee flexion and extension muscles, flexor/extensor ratios between involved and uninvolved limb of the patients with lower back pain seperately. Results The torque values of involved flexors and extensors at the three speeds separately decreased 17. 1%, 18. 4%, 22. 5% and 17. 3%, 12. 9%, 11. 8%. There were significant differences between the involved and uninvolved extremities(P < 0. 05 - 0. 001 ). The flexor/extensor torque ratios of involves limb at the three speeds were greater than those of uninvolved limb in L_4 po up were. On the contrary, the flexor/extensor torque ratios of involves limb were lower than those of uninvolved limb in L_5/S_1 group were. Conclusion it is necessary to train knee flexor and extensor of involved extremity as well as lumbar flexor and extensor in patients with lumbar intervertebral disc protrusion.