墙壁拉力器训练对老年下腰背痛的疗效研究

Effectiveness of wall pulley for the training of low back pain in elderly patients

目的：探讨墙壁拉力器训练对老年下腰背痛的临床疗效。方法前瞻性收集2012年1月至2013年3月收治的符合纳入及排除标准的下腰背痛患者60例，随机分为试验组（n=30）和对照组（n=30）。试验组患者采用墙壁拉力器训练，对照组则采用相同时间的健步走训练。利用超导磁共振扫描机自带系统测量L4～5和L5～S1水平多裂肌与脂肪组织的对比度，并比较两组受试者训练前后的对比度及疼痛视觉模拟评分（visual analogue score，VAS）差异。结果60例患者均获得随访，随访时间11～14个月，平均13个月。训练前试验组与对照组的L4～5和L5～S1水平左右两侧多裂肌与脂肪组织的对比度差异无统计学意义（P＞0.05），而训练后试验组患者的对比度均高于对照组，差异具有统计学意义（P＜0.05）。其中试验组患者的L4～5水平左侧对比度升高了15%，右侧升高了20%，L5～S1水平左侧对比度升高了2%，右侧升高了7%。训练前两组患者VAS差异无统计学意义（t=0.368，P=0.715），而训练后试验组（2.13±0.47）患者的VAS较对照组（3.87±1.96）明显降低（t=-3.204，P=0.003）。结论墙壁拉力器训练可增加老年下腰背痛患者的多裂肌功能，提高腰背部核心肌群的稳定性，缓解下腰背部的疼痛症状。

Objective To investigate the efficacy of wall pulley training in elderly patients with low back pain. Methods 60 patients age from 60 to 75 with low back pain between January 2012 and March 2013 were included in a prospective study. They were divided into two groups randomly, with 30 patients in each group. The patients in experimental group used wall pulley to exercise and those in control group did brisk walking to exercise at the same time. We performed magnetic resonance imaging scan to measure the contrast ratio of multifidus muscle with the adipose tissue. Compared the contrast ratio and visual analogue scale （VAS） of the two groups before and post the training experiment. Results All patients were followed-up with a timespan of 11-14 months （13 months on the average）. There was no statistical significance （P〉0.05） of the contrast ratio of multifidus muscle with the adipose tissue of right and left in the level of L4-5 and L5-S1 between the experimental and control group before training. However, there was statistically significance （P〈0.05） between the two groups after training. The contrast ratio of left in the level of L4-5 of the experimental group increased by 15%, and right increased by 20%, the contrast ratio of left in the level of L5-S1 of the experimental group increased by 2%, and right increased by 7%. The VAS of two groups were not statistically different before training （t=0.368, P=0.715）, while the VAS of the experimental group （2.13±0.47） was significantly lower than the control group （3.87±1.96） after training （t=-3.204, P=0.003）. Conclusion Wall pulley training can increase the function of multifidus, improve the stability of the core muscles and relieve pain in the elderly patients with low back pain.