肌骨超声评价呼吸训练改善慢性非特异性下背痛患者多裂肌的形态学改变

Respiratory training improves morphological changes of the multifidus muscle in patients with chronic nonspecific lower back pain assessed by musculoskeletal ultrasound

背景:已有研究证实腰椎稳定训练可以改善慢性下背痛患者多裂肌的肌肉形态,呼吸训练是否影响慢性下背痛患者的多裂肌形态暂无临床研究。目的:观察呼吸训练对慢性非特异性下背痛患者的腰椎稳定肌(多裂肌)肌肉厚度与横截面积改变的影响。方法:96例符合纳入标准的慢性非特异性下背痛患者随机分为试验组(n=32)、呼吸对照组(n=32)和核心对照组(n=32),呼吸对照组接受呼吸训练,核心对照组接受核心稳定训练,试验组接受呼吸训练合并核心稳定训练,治疗1次/d,20 min/次,5 d/周,持续10周。3组患者治疗前后均采用肌骨超声观察记录患者腰椎稳定肌(多裂肌)的肌肉厚度与横截面积,对3组患者治疗前后多裂肌的形态学变化进行评价。结果与结论:(1)治疗后双侧L5多裂肌厚度和呼吸对照组与核心对照组无明显差异,试验组显著大于其他两组;治疗后双侧L5多裂肌横截面积和试验组>呼吸对照组>核心对照组,差异有显著性意义(P <0.001);(2)应用肌骨超声观察治疗前后3组患者多裂肌的形态学变化,证实呼吸训练对腰椎多裂肌的厚度和横截面积均有改善作用,同时肌骨超声技术作为新的疗效观察工具,可以作为慢性非特异性下背痛患者评估及辅助治疗的有效手段。

BACKGROUND:Studies have confirmed that lumbar spine stabilization training can improve muscle morphology of the multifidus muscle in patients with chronic low back pain.There is no clinical study on whether respiratory training affects the multifidus muscle morphology in patients with chronic lower back pain.OBJECTIVE:To investigate the effect of respiratory training on the changes of muscle thickness and cross-sectional area of lumbar stable muscle(multifidus muscle) in patients with chronic nonspecific lower back pain.METHODS:Totally 96 patients with chronic nonspecific lower back pain who met the inclusion criteria were randomly divided into trial group(n=32),respiratory training control group(n=32) and core training control group(n=32).The respiratory training and core training control groups received respiratory training and core stabilization training,respectively.The trial group received respiratory training combined with core stabilization training.The treatment was performed once a day,20 minutes every time,5 days per week,for 10 consecutive weeks.Before and after treatment,musculos keletal ultrasound was used to observe and record the thickness and cross-sectional area of the lumbar stabilizing muscle(multifidus muscle) in the three groups.The morphology of the multifidus muscle was evaluated before and after treatment in the three groups.RESULTS AND CONCLUSION:(1) After treatment,there was no significant difference in bilate ral L;multifidus muscle thickness sum between the res piratory training control group and the core training control group,but the multifidus muscle thickness sum was significantly thicker in the trial group than that in the other two groups.After treatment,there were significant differences in cross-sectional area sum of bilateral L;multifidus muscle among groups(trial group>res piratory training control group> core training control group)(P <0.001).(2) Musculoskeletal ultrasound results of the morphological changes of the multifidus muscle in the three groups before and after treatment confirmed that res piratory training could improve the thickness and cross-sectional area of the lumbar multifidus muscle.Musculos keletal ultrasound technology,as a new curative effect observation tool,can be used as an effective means for the evaluation and adjuvant therapy in patients with chronic nonspecific lower back pain.