远程康复联合门诊治疗在轻度青少年特发性脊柱侧凸中的效果研究

Efficacy of Remote Rehabilitation Combined with Outpatient Treatment in Mild Adolescent Idiopathic Scoliosis

背景脊柱侧凸是脊柱常见的畸形之一,门诊物理治疗是轻度侧凸患者最常采取的治疗方式。有效的治疗需要保证充足的治疗时间和频次,但线下医疗资源有限,还可能会受到患者时间和空间等因素的影响,远程康复则可解决时空等因素的限制,使训练更为简单方便。目的探讨远程康复联合门诊治疗轻度青少年特发性脊柱侧凸(AIS)的疗效。方法选取2020年9月至2021年9月就诊于天津医院康复科门诊且符合纳入标准的轻度AIS患者58例。依据AIS患者及其家长治疗意愿将其分为线上组(n=18)、结合组(n=20)及线下组(n=20)。线上组通过微信和腾讯会议APP进行远程脊柱侧凸特定物理运动疗法(PSSE)治疗,结合组采用门诊+线上方式进行特定PSSE治疗,线下组采用门诊方式进行特定PSSE治疗。比较三组患者治疗前后主弯Cobb角、冠状面平衡距离(CBD)、胸椎后凸角(TK)、腰椎前凸角(LL)、脊柱矢状轴(SVA)、躯干旋转角(ATR)、Raimondi值、骨盆投射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、顶椎双侧椎旁肌肌肉激活率(MAR)、顶椎双侧椎旁肌均方根肌电值比值(RMSR)和脊柱侧凸研究学会-22(SRS-22)量表评分的变化。结果三组患者治疗后主弯Cobb角、TK、SVA、ATR、Raimondi值、SS、顶椎椎旁肌MAR、RMSR及SRS-22量表评分中自我形象评分、心理健康评分较治疗前改善(P<0.05);结合组在改善ATR、治疗满意度方面优于线上组和线下组,在改善主弯Cobb角方面优于线上组;结合组与线下组椎旁肌MAR的改善优于线上组(P<0.05)。结论远程康复联合门诊治疗的方式可以有效减缓轻度AIS弯弧的进展,改善脊柱矢状位异常、体态异常及椎体旋转,提高顶椎椎旁肌MAR并改善顶椎双侧椎旁肌平衡性,对轻度AIS患者的生活质量也有积极作用。

Background Scoliosis is a common abnormal curvature of the spine.Patients with mild scoliosis are usually treated with outpatient physiotherapy,but satisfactory efficacy is associated with appropriate treatment time and frequency.The efficacy of offline physiotherapy may be affected by limited medical resources and patients'treatment time and geographical location.Remote rehabilitation may save patients'treatment time and increase the geographical accessibility of physiotherapy,making the therapy more simple and convenient.Objective To explore the efficacy of remote rehabilitation combined with outpatient treatment in mild adolescent idiopathic scoliosis(AIS).Methods Fifty-eight eligible mild AIS patients were selected from Department of Rehabilitation Medicine,Tianjin Hospital from September 2020 to September 2021,and divided into three groups according to patients and their parents'selection of treatment:online group(n=18),combined group(n=20)and offline group(n=20).The online group received WeChat-and Tencent Video-based physiotherapeutic scoliosis specific exercise(PSSE),the combined group received both outpatient and WeChat-and Tencent Video-based PSSE treatment,and the offline group received outpatient PSSE treatment.Data of three groups were collected,including the main curve Cobb angle,coronal balance(CB),thoracic kyphosis(TK)angle,lumbar lordosis(LL)angle,sagittal vertical axis(SVA),angle of axial trunk rotation(ATR),parietal vertebra rotation(Raimondi),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),muscle activation rate(MAR)on both sides of paraspinal vertebrae,root mean square ratio(RMSR)of paraspinal muscles on both sides of paraspinal vertebrae,and the score of SRS-22 before and after treatment.Results The main curve Cobb angle,TK,SVA,ATR,Raimondi,SS,MAR on paraspinal vertebrae,RMSR on the concave side of the parietal vertebra and SRS-22 self-image and mental health domain scores were significantly different from those before treatment in all groups(P<0.05).Specifically,the combined group was superior to the other two groups in improved ATR and treatment satisfaction.The combined group had significantly improved main curve Cobb angle after treatment than the online group.The improvement of the concave MAR in either the combined group or offline group was significantly better than that in the online group(P<0.05).Conclusion In mild AIS patients,remote rehabilitation combined with outpatient treatment could effectively slow down the progression of AIS curve,improve sagittal abnormality of spine,abnormal posture and vertebral rotation,increase the activation rate of paraspinal muscles on the concave side of paraspinal vertebra and improve the balance of paraspinal muscles on both sides of paraspinal vertebrae.Moreover,the combined therapy also improved the quality of life.