腰腹与髋周肌群差异训练对股骨头坏死保髋的影响

Effects of lumbar abdominal muscles and hip muscles training on femur head necrosis with nonsurgical hip preservation treatment

目的探究腰椎-骨盆-髋复合体中的腰腹肌群和髋周肌群差异训练对股骨头坏死非手术保髋患者残存肢体功能优化的影响。方法选择2016年12月至2018年12月在广州中医药大学第一附属医院行保髋治疗的患者,纳入首次发现经过X射线及MRI证实的60例中青年国际骨循环研究协会(ARCO)分期Ⅱ~Ⅲ期、日本厚生省骨坏死调查委员会(JIC)分型C1型以内小范围股骨头坏死的患者,将60名患者分为髋周肌群训练组(髋周组)、腰腹肌群训练组(腰腹组)与联合训练组3组,每组20例。3组患者均常规康复治疗手段且持续服用药物复方生脉成骨胶囊,比较3组患者训练前后及3组组间患侧Harris髋关节功能量表评分、视觉模拟评分(VAS评分)、简明健康测试量表评分(SF-12评分)、髋外展等速肌力力矩峰值的差异,以对比患侧肌力、关节活动度、肌肉控制情况变化程度。结果数据采用t检验、卡方检验或秩和检验等进行分析。结果3组患者患侧Harris髋关节功能量表评分(髋周组:t=-8.735,腰腹组:Z=-3.920,联合训练组:Z=-3.924)、VAS评分(髋周组:t=7.511,腰腹组:Z=-3.260,联合训练组:Z=-3.951)、SF-12量表评分(髋周组:t=-9.784,腰腹组:t=-12.585,联合训练组:Z=-3.924)、髋外展等速肌力力矩峰值(髋周组:t=-10.849,腰腹组:t=-10.473,联合训练组:Z=-3.920)治疗前后的差异,均有统计学意义(均为P<0.01),髋周组与联合训练组治疗后SF-12评分差异具有统计学意义(t=-15.975,Z=-2.897,P<0.05),其余结局指标各组间差异均无统计学意义(均为P>0.05)。结论腰腹肌群与髋周肌群在短期差异化训练均能优化股骨头坏死非手术保髋患者的关节残存功能,但其作用不一。

Objective To investigate the effect of lumbar abdominal muscle group training and hip muscle group training involving lumbo-pelvis-hip complex on optimization of residual limb function infemur head necrosis patients with nonsurgical hip preservation treatment.Methods Sixty cases of patients admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine were treated with hip preservation treatment ranging from December 2016,to December,2018,whose X-ray and MRI were diagnosed for the first time with young and middle-aged Association Research Circulation Osseous(ARCO)stageⅡ-Ⅲperiod,Japanese Investigation Committee(JIC)C1 type.Sixty patients were divided into three groups,20 patients each.The hip group received the training plan of hip muscle group.The lumber abdominal group were given the training of lumbar abdominal muscle group.The combined group received the training plan of deep core muscle group combined with hip muscle group.All the patients in the three groups received routine rehabilitation treatment and compound Shengmai Chenggu capsules.By comparing the differences of Harris hip score(HHS),visual analogue scale(VAS)score,12-item short form health survey(SF-12)score,isokinetic peak torque of hip abduction between the three groups before and after the trainings,the changes of muscle strength,joint motion and muscle control of the affected side were observed and compared.The data were statistical analysed by t test,chi-square test or rank sum test,etc.Results Statistically significant differences were showed among the three groups before and after the trainings in Harris hip score(the hip group:t=-8.735,the lumber abdominal group:Z=-3.920,the combined group:Z=-3.924),VAS score(the hip group:t=7.511,the lumber abdominal group:Z=-3.260,the combined group:Z=-3.951),SF-12 score(the hip group:t=9.784,the lumber abdominal group:t=-12.585,the combined group:Z=-3.924),isokinetic peak torque of hip abduction(the hip group:t=-10.849,the lumber abdominal group:t=-10.473,the combined group:Z=-3.920)(all P<0.01).There were statistically significant differences between the hip group and the combined group in terms of SF-12 score(t=-15.975,Z=-2.897,both P<0.05),while other outcomes showed no statistically significant difference among the three groups(all P>0.05).Conclusion Both short-term differential training of lumbar abdominal muscle group and hip muscle group can improve the residual joint function of femur head necrosis patients with nonsurgical hip preservation treatment,but their effects are different.