发散式体外冲击波治疗慢性非特异性腰痛的效果及腰椎MRI变化

Curative effect of diffused extracorporeal shock wave therapy on chronic nonspecific low back pain and changes of lumbar MRI

目的探发散式体外冲击波(ESWT)治疗慢性非特异性腰痛(CNLBP)的效果及腰椎磁共振成像(MRI)变化情况。方法选取单侧发病CNLBP患者110例,根据治疗方式分组,将行发散式ESWT治疗的患者设为ESWT组(n=55),将行核心肌群稳定性训练法(CSE)的患者设为训练组(n=55)。比较两组治疗前后的最大伸展角度(Ext)、最大弯曲角度(Fle)、疼痛数字评价量表(NRS)评分和Oswestry功能障碍指数(ODI)的差异。两组治疗前与治疗2疗程后均行腰椎MRI检查,比较两组治疗前后健侧与患侧的腰3/腰4、腰5/骶1二个节段椎旁肌的脂肪浸润率(FSF)值。结果治疗后,ESWT组患者的NRS评分、ODI均明显低于训练组,Fle明显高于训练组,差异均有统计学意义(t分别=4.83、3.60、-2.27,P均<0.05),两组Ext比较,差异无统计学意义(t=0.40,P>0.05)。ESWT组与训练组患者治疗后患侧腰3/腰4和腰5/骶1 FSF值均明显高于健侧(t分别=2.31、4.66、10.72、14.26,P均<0.05),但治疗后ESWT组健侧与患侧腰3/腰4和腰5/骶1 FSF值均明显低于训练组,差异均有统计学意义(t分别=9.75、17.66、11.27、23.90,P均<0.05)。结论发散式ESWT对CNLBP患者具有良好治疗效果,可明显减轻患者疼痛感,加快缓解腰椎功能障碍,改善多裂肌脂肪浸润情况。

Objective To explore the curative effect of diffused extracorporeal shock wave therapy(ESWT)on chronic nonspecific low back pain(CNLBP)and the changes of lumbar magnetic resonance imaging(MRI).Methods A total of 110 patients with unilateral CNLBP were divided into ESWT group who treated with diffused ESWT and training group who treated with core stabilization exercises(CSE),with 55 cases in each.who treated with.The maximum extension angle(Ext),maximum bending angle(Fle),scores of numerical rating scale(NRS)and oswestry disability index(ODI)were compared between the two groups before and after treatment.All underwent lumbar MRI examination before and after 2 courses of treatment.The fat signal fraction(FSF)findings of lumbar paravertebral muscles at L3/L4 and L5/S1 segments in MRI images were obtained were compared between the two groups before and after treatment.Results After treatment,NRS and ODI scores in ESWT group were lower than those in training group,while Fle was higher than that in training group(t=4.83,3.60,-2.27,P<0.05).There was no significant difference in Ext between the two groups(t=0.40,P>0.05).After treatment,FSF values of L3/L4 and L5/S1 in affected side were greater than those of healthy side in both groups(t=2.31,4.66,10.72,14.26,P<0.05).After treatment,FSF values of L3/L4 and L5/S1 in healthy and affected sides in ESWT group were significantly lower than those in training group(t=9.75,17.66,11.27,23.90,P<0.05).Conclusion Diffused ESWT is effective in treating CNLBP,which can significantly relieve pain of patients,accelerate the remission of lumbar dysfunction and improve fat infiltration of multifidus.