基于DAVID脊柱生物力学测训系统对强直性脊柱炎核心肌群评估研究

Evaluation of core muscle groups in ankylosing spondylitis based on DAVID spinal biomechanics training system

目的基于DAVID脊柱生物力学测训系统对AS核心肌群评估以了解AS的核心肌群功能变化。方法收集我院AS患者100例,健康对照组31名,分别收集其人口学资料、临床症状,BASDAI、BASFI、Bath强直性脊柱炎计量指数(BASMI)、强直性脊柱炎疾病活动度(ASDAS),并采用DAVID脊柱生物力学测训系统检测其脊柱力学功能,以及简易核心肌适能测试:八级腹桥、PLANK平板运动、腹部静态肌耐力测试、背部静态肌耐力测试,采用t检验比较2组之间的差异,以及Spearman相关分析探讨AS的核心肌力情况。结果①男性AS组与健康对照组在脊柱活动度比较中,前屈度、向右旋转度、向左旋转度(42±13和48±1,52±14和69±12,52±13和58±11;P值均<0.05),在脊柱肌肉力量比较中,前屈力、向右旋转力、向左旋转力、向右侧屈力(103±42和146±17,87±34和104±13,80±35和101±13,161±55和186±19;P值均<0.05),在脊柱平衡力量比较中,左/右旋转力量(1.17±0.21和1.02±0.11,P<0.05),差异均有统计学意义。②女性AS组与健康对照组在脊柱肌肉力量比较中,前屈力(49±23和77±10,P<0.05),在脊柱平衡力量比较中,前屈/后伸力量、左右旋转力量(0.32±0.11和0.58±0.21,1.29±0.21和1.03±0.11,P值均<0.05);③AS患者脊柱活动度与年龄(后伸度数r=-0.28,向右侧屈度数r=-0.268,向左侧屈度数r=-0.404,向右旋转度数r=-0.367,向左旋转度数r=-0.235,P值均<0.05);病程(后伸度数r=-0.354,前屈度数r=-0.283,向右侧屈度数r=-0.204,向左侧屈度数r=-0.284,向右旋转度数r=-0.339,向左旋转度数r=-0.23,P值均<0.05);BMI(后伸度数r=-0.23,前屈度数r=-0.288,向右侧屈度数r=-0.22,向左侧屈度数r=-0.201,向右旋转度数r=-0.26,向左旋转度数r=-0.29,P值均<0.05),骶髂关节分期(后伸度数r=-0.375,前屈度数r=-0.446,向右侧屈度数r=-0.331,向左侧屈度数r=-0.367,向右旋转度数r=-0.368,向左旋转度数r=-0.314,P值均<0.05),BASDAI相关(后伸度数r=-0.381,前屈度数r=-0.374,P值均<0.05);脊柱肌肉力量与性别相关(后伸肌力r=0.344,前屈肌力r=0.507,向右旋转力r=0.376,向左旋转力r=0.399,向右侧屈力r=0.433,向左侧屈力r=0.445,P值均<0.05);脊柱左/右旋转力量与性别相关(r=0.271,P<0.05);④简易核心肌适能测试中,八级腹桥与脊柱肌肉力量相关(后伸力量r=0.234,向右旋转r=0.290,向左旋转r=0.219,向右侧屈r=0.35,向左侧屈r=0.327,P值均<0.05);PLANK运动与脊柱肌肉力量相关(后伸力量r=0.26,向右旋转r=0.20,向右侧屈r=0.347,P值均<0.05);腹部静态肌耐力测试与前屈力量相关(r=0.341,P<0.05);背部静态肌耐力测试与脊柱活动度相关(后伸度数r=0.262,前屈度数r=0.23,向右旋转度数r=0.455,向左旋转度数r=0.426,向右侧屈度数r=0.387,向左侧屈度数r=0.46,P值均<0.05);与脊柱力量相关(向右侧屈r=0.256,向左侧屈r=0.272,P值均<0.05)。结论AS患者较健康人群在脊柱核心肌群活动度、肌力,肌力平衡性有下降,其中男性AS在脊柱活动度及肌力下降方面明显,女性AS在肌力失衡方面尤甚,而临床常用简易核心肌适能测试指标可初略反应AS患者核心肌群功能的改变。

Objective To evaluate and describe the changes of core muscle groups based on DAVID spine biomechanics training system in ankylosing spondylitis(AS)patients.Methods The clinical data of 100 patients of AS and 31 healthy controls were collected.Clinical symptoms,Bath ankylosing spondylitis disease activity index(BASDAI),Bath ankylosing spondylitis function index(BASFI),Bath ankylosing spondylitis measurement index(BASMI),ankylosing spondylitis disease activity(ASDAS),and simultaneous detection of DAVID spine biomechanics training system,simple core muscle fitness test:Eight-grade abdominal bridge,PLANK exercise(flat support),Abdominal static muscle endurance test,Back static muscle endurance test were compared using t-test analysis and spearman correlation analysis.Results①Between AS and healthy male control o group,there were significant differences of spinal mobility in forward flexion,right rotation,left rotation(42±13 vs 48±1,52±14 vs 69±12,52±13 vs 58±11;all P values<0.05);and significant differences of spinal muscle strength in forward bending force,right rotation force,left rotation force,right bending force(103±42 vs 146±17,87±34 vs 104±13,80±35 vs 101±13,161±55 vs 186±19;all P values<0.05),and significant differences in the left/right rotational force(1.17±0.21 vs 1.02±0.111,P<0.05)of spine balance strength comparison.②Between AS and healthy controls of female group,there were differences in forward bending force(49±23 vs 77±10,P<0.05)of spinal muscle strength;and significant differences in forward bending/backward extension strength,left and right rotation strength(0.32±0.11 vs 0.58±0.21,1.29±0.21 vs1.03±0.11,all P values<0.05)of spine balance strength;③In AS group,the spinal mobility was correlated with age(Rear extension r=-0.28,right flexion r=-0.268,left flexion r=-0.404,right rotation r=-0.367,left rotation r=-0.235;all P values<0.05),course of disease(Rear extension r=-0.354,forward flexion r=-0.283,right flexion r=-0.204,left flexion r=-0.284,right rotation r=-0.339,left rotation r=-0.23;all P values<0.05),body mass index(BMI)(Rear extension r=-0.23,forward flexion r=-0.288,right flexion r=-0.22,left flexion r=-0.201,right rotation r=-0.26,left rotation r=-0.29;all P values<0.05),sacroiliac joint stage(Rear extension r=-0.375,forward flexion r=-0.446,right flexion r=-0.331,left flexion r=-0.367,right rotation r=-0.368,left rotation r=-0.314;all P values<0.05)and BASDAI(Rear extension r=-0.381,forward flexion r=-0.374;all P values<0.05).Spinal muscle strength was correlated with gender(Posterior extensor force r=0.344,flexor force r=0.507,right rotation force r=0.376,left rotation force r=0.399,right flexion force r=0.433,left flexion force r=0.445;all P values<0.05);the left/right spine rotation strength was correlated with gender(r=0.271,P<0.05).④In the simple core muscle fitness test,eight-grade abdominal bridge was correlated with spinal muscle strength(Rear extension force r=0.234,right rotation r=0.290,left rotation r=0.219,right flexion r=0.35,left flexion r=0.327;all P values<0.05);PLANK exercise was correlated with spinal muscle strength(Rear extension force r=0.234,right rotation r=0.290,left rotation r=0.219,right flexion r=0.35,left flexion r=0.327;all P values<0.05);abdominal static muscle endurance test was correlated with forward flexion strength(r=0.341,P<0.05);back static muscle endurance test was correlated with spinal mobility(Rear extension r=0.262,forward flexion r=0.23,right rotation r=0.455,left rotation r=0.426,right flexion r=0.387,left flexion r=0.46;all P values<0.05);correlated with spine strength(right flexion r=0.256,left flexion r=0.272;all P values<0.05).Conclusion Compared with healthy people,AS patients have decreased activity,strength and balance of spinal core muscle.There are significant decline in spinal mobility and muscle strength of male AS patients and muscle imbalance of female AS patients.Simple core muscle fitness test could be used in clinic to measure the changes of AS patients'core muscle group.