基于表面肌电信号研究McKenzie疗法治疗腰椎间盘突出的临床疗效

Clinical efficacy of surface EMG signals based McKenzie therapy for lumbar disc herniation

目的基于竖脊肌表面肌电信号的变化,观察McKenzie疗法治疗腰椎间盘突出(LDH)的临床疗效。方法选择60例LDH患者,其中男性24例,女性36例;年龄20~60岁,平均年龄为44.67岁。随机分成治疗组(n=30)和对照组(n=30)。治疗组给予McKenzie疗法,对照组给予激光治疗仪治疗,均接受4周治疗,每周不间断治疗5 d。在治疗前和治疗4周后,分别采用竖脊肌表面肌电信号的均方根肌电值(RMS)和屈伸比(FER)、疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分、日本骨科学会(JOA)下腰痛量表及临床疗效进行评定。结果治疗前两组患者VAS评分、ODI评分、JOA评分及肌电指标RMS、FER差异均无统计学意义(P>0.05)。治疗4周后,两组的VAS评分、ODI评分、JOA评分及肌电指标RMS、FER较治疗前均有改善,差异均有统计学意义(P<0.05),且治疗组改善情况均优于对照组[(1.33±0.80)分vs(1.83±0.91)分、(19.96±2.54)分vs(23.41±2.84)分、(26.40±1.30)分vs(25.37±1.77)分、(73.20±22.28)mV vs(89.73±28.36)mV、(10.30±2.79)分vs(8.50±0.97)分。P<0.05]。治疗后治疗组总有效率为83.33%,对照组总有效率为70.00%,治疗组总有效率高于对照组,差异有统计学意义(P<0.05)。结论表面肌电信号可为LDH的临床疗效提供客观依据,Mc Kenzie疗法与激光治疗仪在改善LDH患者的临床症状和功能方面均有疗效,但McKenzie疗法优于激光治疗仪治疗。

Objective To observe clinical effect of McKenzie therapy for lumbar disc herniation(LDH) based on change of surface electromyogram(EMG) signal in vertical spine muscle. Method A total of 60 LDH were enrolled, which included 24 males and 36 females, aged 20-60 years old with mean age of 44.67 years old. All of them were randomly divided into treatment group(n = 30, performed McKenzie therapy) and control group(n = 30, performed laser therapy). All patients received 4-week of treatment, with 5-day-continued treatment per week. Before treatment and 4-week after treatment, the root-meansquare RMS EMG and flexion-extension ratio(FER) of erector spinae surface EMG, pain visual analog scale(VAS) score,Oswestry disability index(ODI) score, Japanese Orthopaedic Association(JOA) low back pain scale and clinical efficacy were evaluated. Results Before treatment, there were no significant differences in VAS score, ODI score, JOA score and EMG index between 2 groups(P > 0.05). Four-week after treatment, VAS pain score, ODI score, JOA score, and EMG index RMS and FER in 2 groups were improved, and improvement of treatment group was statistically significantly better than that of control group[(1.33 ± 0.80) scores vs(1.83 ± 0.91) scores,(19.96 ± 2.54) scores vs(23.41 ± 2.84) scores,(26.40 ± 1.30) scores vs(25.37 ±1.77) scores,(73.20 ± 22.28) mV vs(89.73 ± 28.36) mV,(10.30 ± 2.79) scores vs(8.50 ± 0.97) scores. P < 0.05]. After treatment,the total effective rate of treatment group(83.33 %) was statistically significant higher than control group(70.00 %)(P < 0.05).Conclusion It is demonstrated that surface EMG could provide objective basis for clinical efficacy of LDH, the McKenzie therapy and laser therapy apparatus are both effective in improving clinical symptoms and functions of LDH patient, and the effect of McKenzie therapy is superior to laser therapy.