本体感觉训练联合盆底电刺激生物反馈对产后盆底功能障碍性疾病的治疗效果

Therapeutic effect of proprioception training combined with pelvic floor electrical stimulation biofeedback on postpartum pelvic floor dysfunction

目的:盆底肌腱、筋膜、韧带中含有丰富的本体感受器,本体感觉训练可以通过刺激局部的本体感受器,增强有关神经肌肉反应,促进肌肉及筋膜韧带功能的恢复。本研究旨在观察本体感觉训练联合盆底电刺激生物反馈治疗产后盆底功能障碍性疾病(pelvic floor dysfunction,PFD)的效果,为产后PFD的治疗提供参考。方法:选取108例患有PFD的产妇作为研究对象,并将其分为对照组(n=50)和试验组(n=58)。对照组和试验组分别采用盆底电刺激生物反馈治疗和本体感觉训练联合盆底电刺激生物反馈治疗,2组均治疗1疗程。比较2组治疗前后盆底肌肌力、肌耐力、重复收缩能力、快速收缩能力、阴道后壁抬高正常所占百分比、下腹部肌肉协同收缩正常所占百分比、咳嗽时反射性收缩正常所占百分比、压力性尿失禁(stress urinary incontinence,SUI)发生率和盆腔脏器脱垂(pelvic organ prolapse,POP)分期情况。结果:治疗后,2组各项指标均优于治疗前;试验组盆底肌肌力、肌耐力、重复收缩能力、快速收缩能力优于对照组(均P<0.05);试验组下腹部肌肉协同收缩、咳嗽时反射性收缩正常所占百分比均高于对照组(均P<0.05);试验组SUI发生率低于对照组(均P<0.05);试验组POP II期所占百分比明显低于对照组(P<0.05)。治疗后2组的阴道后壁抬高正常所占百分比差异无统计学意义(P>0.05)。结论:本体感觉训练联合盆底电刺激生物反馈治疗能显著提高产后PFD的康复效果,促进盆底功能的恢复,具有重要的临床应用价值。

Objective:Pelvic floor tendons,fascia,and ligaments are rich in proprioceptors.Proprioceptive training can stimulate local proprioceptors to increase neuromuscular responses and promote the recovery of muscle and fascial ligament functions.This study aims to observe the therapeutic effect of proprioception training combined with pelvic floor electrical stimulation biofeedback on postpartum pelvic floor dysfunction(PFD),and to provide evidence for the treatment of postpartum PFD.Methods:A total of 108 puerpera with postpartum PFD were selected and divided into a control group(n=50)and an experimental group(n=58).Puerpera in the control group received pelvic floor electrical stimulation biofeedback treatment.Puerpera in the experimental group received proprioception training combined with pelvic floor electrical stimulation biofeedback treatment.After one course of treatment,the pelvic floor muscle strength,muscle endurance,repetitive contraction ability,rapid contraction ability,percentage of normal vaginal posterior wall elevation,percentage of normal lower abdominal muscle synergistic contraction,percentage of normal reflex contraction during coughing,incidence of stress urinary incontinence(SUI),and staging of pelvic organ prolapse(POP)were compared before and after treatment between the 2 groups.Results:After treatment,all indexes of the 2 groups were better than those before treatment;the pelvic floor muscle strength,muscular endurance,repetitive contraction ability,and rapid contraction ability of the experimental group were better than those of the control group(all P<0.05);the percentage of normal lower abdominal muscle synergistic contraction and percentage of normal reflex contraction during coughing of the experimental group were higher than those of the control group(both P<0.05);the incidence of SUI in the experimental group was lower than that in the control group(P<0.05);the percentage of POP staging II in the experimental group was significantly lower than that in the control group(P<0.05).There was no significant difference in the percentage of normal posterior vaginal wall elevation after treatment between the 2 groups(P>0.05).Conclusion:Proprioception training combined with pelvic floor electrical stimulation biofeedback could improve the rehabilitation effect of postpartum pelvic floor dysfunction and promote the recovery of pelvic floor function,which possesses important clinical application value.