基于肌电变化评估肾着汤对腰椎间盘突出症腰背伸肌群功能的影响

Evaluating the Effect of Shenzhao Decoction on the Function of Lumbar and Dorsal Extensor in Patients with Lumbar Intervertebral Disc Herniation Based on Changes of Electromyography

目的应用肾着汤治疗腰椎间盘突出症,并通过分析肌电变化评估患者腰背伸肌群功能及总体疗效。方法选取2014年6月—2019年3月期间郑州市骨科医院颈肩腰腿痛科收治的80例腰椎间盘突出症的患者作为研究对象。其中对照组40例,接受常规治疗、腰椎牵引、小针刀等治疗;治疗组40例,在对照组治疗方案的基础上,联合口服肾着汤。记录并比较两组患者临床症状、腰椎功能以及腰背伸肌群功能等指标。结果两组患者治疗后直腿抬高角度(ASLR)明显增加、视觉疼痛量表(VAS)评分明显降低与治疗前比较,差异有统计学意义(P<0.05),且治疗组患者直腿抬高角度(ASLR),视觉疼痛量表(VAS)评分改善程度明显优于对照组(P<0.05)。两组患者治疗后JOA评分明显增加、腰椎功能障碍指数(ODI)明显降低与治疗前比较,差异有统计学意义(P> 0.05),且治疗组治疗后JOA评分、腰椎功能障碍指数(ODI)明显优于对照组(P<0.05)。两组患者治疗后平均肌电波幅(AEMG)和平均功率频率(MPF)明显增加,中位频率斜率(MFs)绝对值明显降低与治疗前比较,差异有统计学意义(P<0.05),且治疗组各参数明显优于对照组(P<0.05)。治疗后对照组患者治疗总有效率为75.00%(30/40),治疗组患者总有效率为85.00%(34/40),治疗组明显优于对照组(P<0.05)。结论腰椎间盘突出症患者的治疗方案中联合肾着汤治疗有着确切的疗效,能有效减轻患者腰腿部疼痛症状,改善腰背部肌群的协调性,平衡伸、屈肌的肌力与肌张力,减轻肌肉疲劳程度,提高腰背伸肌群放电频率,有利于恢复腰椎间盘突出症患者腰背伸肌群的生理功能及生物力学特性,具有满意的临床应用价值。

Objective To apply Shenzhu Decoction to treat lumbar intervertebral disc herniation,and to evaluate the function of the patient’s low back extensor muscles and overall curative effect by analyzing the changes of electromyography.Methods 80 patients with lumbar disc herniation treated in Zhengzhou Orthopaedic Hospital from June 2014 to March 2019 were selected as subjects.Among them,40 cases in the control group were treated with routine treatment,lumbar traction and small needle knife,and 36 cases in the observation group were treated with oral Shenzhao decoction on the basis of the treatment scheme in the control group.The clinical symptoms,lumbar function and lumbar extensor group fucntion of the two groups were recorded and compared.Results After treatment,the straight leg elevation(ASLR) and the visual pain scale(VAS) score of the two groups were significantly increased.Compared with the pre-treatment,the difference was statistically significant(P <0.05),and the treatment group had straight leg lift.The improvement of high angle(ASLR) and visual pain scale(VAS) scores was significantly better than that of the control group(P <0.05).After treatment,the JOA score and the lumbar spine dysfunction index(ODI) of the two groups were significantly increased.Compared with before treatment,the difference was statistically significant(P> 0.05),and the JOA score and lumbar spine dysfunction index(ODI) of the treatment group after treatment Significantly better than the control group(P <0.05).After treatment,the average myoelectric wave amplitude(AEMG) and mean power frequency(MPF) of the two groups of patients increased significantly,and the absolute value of the median frequency slope(MFs)was significantly reduced.Compared with before treatment,the difference was statistically significant(P<0.05),and the parameters of the treatment group were significantly better than those of the control group(P <0.05).After treatment,the total effective rate of patients in the control group was75.00%(30/40),and the total effective rate of patients in the treatment group was 85.00%(34/40).The treatment group was significantly better than the control group(P <0.05).Conclusion The treatment plan for patients with lumbar intervertebral disc herniation combined with Shenzhu Decotion has a definite effect.It can effectively alleviate the symptoms of waist and leg pain,improve the coordination of the waist and back muscles,and balance the strength and tension of the extensors and flexors,Reduce muscle fatigue,increase the discharge frequency of low back extensor muscle group,help to restore the physiological function and biomechanical properties of low back extensor muscle group in patients with lumbar disc herniation,and have satisfactory clinical application value.