动态神经肌肉稳定技术治疗慢性腰痛的疗效研究

Study on the effect of dynamic neuromuscular stabilization technique for chronic low back pain

目的探索动态神经肌肉稳定技术治疗慢性非特异性下腰痛的疗效。方法前瞻性选取2019年7月—2020年6月浙江大学医学院附属邵逸夫医院门诊行康复治疗的慢性非特异性下腰痛患者60例,采用随机数字表法将所有患者分为试验组和对照组,每组各30例,对照组采用康复教育和核心肌肉力量训练,试验组在对照组治疗方案的基础上加用动态神经肌肉稳定胸腹联合呼吸控制训练。比较两组患者的视觉模拟评分法(Visual Analogue Scale,VAS)得分、Oswestry腰椎功能障碍指数(Oswestry Dability Index,ODI)、腹压稳定值、剑突水平胸廓活动度和腋窝水平胸廓活动度差异。结果60例患者均完成试验,治疗过程中、治疗后和随访时均无复发个案。两组患者年龄、性别、身高、体重、体质量指数及病程差异无统计学意义(P>0.05)。VAS得分的广义估计方程结果显示,VAS得分在试验组和对照组间差异有统计学意义(χ^(2)=4.132,P=0.042),在随访12周时和治疗8周时分别与治疗前比较差异均有统计学意义(χ^(2)=1618.814,P<0.001;χ^(2)=1573.419,P<0.001);不同时点组间比较,随访12周时组间差异有统计学意义(P<0.001),其余时点组间差异均无统计学意义(P>0.05)。ODI总分的广义估计方程结果显示,ODI总分在试验组和对照组间差异有统计学意义(χ^(2)=11.063,P=0.001),在随访12周时和治疗8周时分别与治疗前比较差异均有统计学意义(χ^(2)=524.694,P<0.001;χ^(2)=717.236,P<0.001);不同时点组间比较,治疗8周时和随访12周时组间差异均有统计学意义(P<0.001)。治疗前后试验组腹压稳定值的改善程度[(-4.93±8.14)vs.(-1.33±4.78)mm Hg(1 mm Hg=0.133 kPa)]、剑突水平胸廓活动度的改善程度[(1.87±0.62)vs.(1.52±0.70)cm]和腋窝水平胸廓活动度的改善程度[(1.78±0.62)vs.(0.92±0.45)cm]均优于对照组(P<0.05)。结论动态神经肌肉稳定技术可改善慢性非特异性下腰痛患者的功能障碍,缓解症状,值得推广。

Objective To explore the effect of dynamic neuromuscular stabilization technique for chronic nonspecific low back pain.Methods From July 2019 to June 2020,60 patients with chronic non-specific low back pain who underwent rehabilitation at the outpatient clinic of Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine were prospectively selected.All patients were divided into trial group and control group by random number table method.There were 30 cases in each group.The control group used rehabilitation education and core muscle strength training.The trial group used dynamic neuromuscular stabilization of chest and abdomen combined with breathing control training on the basis of the treatment plan of the control group.The Visual Analogue Scale(VAS)score,Oswestry Dability Index(ODI),abdominal pressure stability,xiphoid level thoracic mobility and axillary level thoracic mobility were compared between the two groups of patients.Results All the 60 patients in this study completed the trial,and there was no recurrent case during treatment,after treatment or during follow-up.There was no statistically significant difference in age,gender,height,weight,body mass index,or course of disease between the two groups(P>0.05).Taking VAS score as the dependent variable,the result of generalized estimating equations showed that the difference in VAS score between the trial group and the control group was statistically significant(χ^(2)=4.132,P=0.042),and the VAS scores at 12 weeks of follow-up and at 8 weeks of treatment differed significantly from that before treatment(χ^(2)=1618.814,P<0.001;χ^(2)=1573.419,P<0.001);the between-group comparisons at different time points showed that the difference in VAS score between the two groups at 12 weeks of follow-up was statistically significant(P<0.001),and the remaining between-group differences were not statistically significant(P>0.05).Taking ODI score as the dependent variable,the result of generalized estimating equations showed that the difference in total ODI score between the two groups was statistically significant(χ^(2)=11.063,P=0.001),and the ODI scores at 12 weeks of follow-up and at 8 weeks of treatment differed significantly from that before treatment(χ^(2)=524.694,P<0.001;χ^(2)=717.236,P<0.001);the between-group comparisons at different time points showed that there were statistically significant differences between the two groups at8 weeks of treatment and at 12 weeks of follow-up(P<0.001).After treatment,the improvement of stability value of abdominal pressure[(-4.93±8.14)vs.(-1.33±4.78)mm Hg(1 mm Hg=0.133 kPa)],the improvement of xiphoid level thoracic mobility[(1.87±0.62)vs.(1.52±0.70)cm]and the improvement of axillary level thoracic mobility[(1.78±0.62)vs.(0.92±0.45)cm]in the trial group were better than those in the control group(P<0.05).Conclusion The dynamic neuromuscular stabilization technique can improve the dysfunction and relieve the symptoms of patients with chronic non-specific low back pain,and it is worthy of promotion.