电动深层肌肉刺激慢性非特异性腰痛患者竖脊肌的张力及硬度变化的数字化肌肉检测

Effect of deep muscle stimulation on muscle tone and stiffness of erector spinaes in patients with chronic nonspecific low back pain:a digital muscle testing

背景:电动深层肌肉刺激主要是通过特定频率产生机械波击打痛点,松解肌肉筋膜粘连,缓解疼痛的一种局部肌肉振动刺激疗法,但其对慢性非特异性腰痛患者作用后,其竖脊肌的张力和硬度改变的研究报道相对不足。目的:利用数字化肌肉检测仪检测深层肌肉刺激慢性非特异性腰痛后患者竖脊肌张力、硬度变化和临床疗效。方法:选择2019年9月至2021年6月在广东药科大学附属第一医院就诊的慢性非特异性腰痛患者60例,采用随机单盲对照试验设计,按随机数字表法分成对照组和试验组,每组各30例。对照组给予常规物理治疗,包括核心肌群练习、立体动态干扰电疗法和健康宣教,试验组在对照组治疗的基础上增加深层肌肉刺激治疗,每周5次,连续4周。统计分析两组治疗前、第一次治疗后、全部治疗后及治疗后4周的疼痛程度、腰部功能、竖脊肌的张力和硬度变化及临床疗效。结果与结论:①首次治疗后,对照组中振荡频率(F值)无明显降低(P>0.05),试验组的振荡频率及两组患者的目测类比评分、动态刚度(S值)均较治疗前显著降低(P<0.05);全部治疗后,两组患者的目测类比评分、振荡频率、动态刚度和魁北克腰痛障碍评分(QBPDS)均较治疗前显著降低(P<0.05),且试验组均优于对照组(P<0.05);治疗结束后4周回访,两组魁北克腰痛障碍评分较全部治疗后有提高(P<0.05),但对照组较试验组有明显提升(P<0.05);②全部治疗后,试验组显效例数和总有效例数均优于对照组(P<0.05),试验组总有效率(97%)优于对照组(80%)(P<0.05);4周后回访时,试验组显效例数和总有效例数均优于对照组(P<0.01),而对照组的总有效率下降明显(63%),试验组虽有下降(93%)(P<0.05),但总体能够维持疗效;③深层肌肉刺激联合常规疗法治疗慢性非特异性腰痛能更有效地缓解疼痛,降低竖脊肌张力、改善肌肉硬度,提高和保持临床疗效。

BACKGROUND:As a local vibration therapy,deep muscle stimulation therapy can relieve pain and loose fascia adhesion through a specific frequency of mechanical wave by hitting pain points,but less is reported on the changes of muscle tone and stiffness of erector spinaes after its effect on chronic nonspecific low back pain.OBJECTIVE:To observe the effect of deep muscle stimulation on muscle tone and stiffness of erector spinaes as well as clinical efficacy in patients with chronic non-specific low back pain by a digital muscle detector.METHODS:A total of 60 patients with chronic non-specific low back pain admitted to the First Affiliated Hospital of Guangdong Pharmaceutical University from September 2019 to June 2021 were enrolled and randomly divided into two groups(n=30 per group):a control group and an experimental group.Patients in the control group received the routine physical therapies,including core muscle group practice,stereodynamic interference electrotherapy and health education,and patients in the experimental group received deep muscle stimulation therapy based on the routine physical therapies,five times per week,for 4 consecutive weeks.Pain degree,waist function,changes of muscle tone and stiffness of the erector spinae muscle,and clinical efficacy were statistically analyzed before treatment,after the first treatment,after the completion of all treatments,and 4 weeks after treatment.RESULTS AND CONCLUSION:After the first treatment,the oscillation frequency(F value),visual analog scale scores and stiffness values of the two groups were significantly lowered(P<0.05),except for the oscillation frequency of the control group(P>0.05).After the completion of all treatments,the visual analog scale scores,oscillation frequency,dynamic stiffness,and Quebec Baclain Disability Scale scores of the two groups were significantly lower than before treatment(P<0.05),while the experimental group was better than the control group(P<0.05).Four weeks after treatment,the Quebec baclain disability scale scores of two groups were improved compared with those after the completion of all treatments(P<0.05),and the Quebec baclain disability scale score in the control group was significantly improved compared with that in the experimental group(P<0.05).The number of effective and total effective cases in the experimental group were both better than those in the control group(P<0.05)after the completion of all treatments.The overall efficiency of the experimental group(97%)was higher than that of the control group(80%;P<0.05).Four weeks after treatment,the number of effective and total effective cases in the experimental group were also better than those in the control group(P<0.01).The overall efficiency of the control group(63%)was significantly decreased(P<0.05).Although the overall efficiency of the experimental group(93%)decreased(P<0.05),the clinical efficacy was mainly maintained.To conclude,deep muscle stimulation with routine physical therapies can effectively relieve pain,reduce muscle tone and stiffness of erector spinaes,and improve and keep the clinical efficacy in patients with chronic non-specific low back pain.