温针灸夹脊穴联合核心肌群训练治疗椎旁肌脂肪浸润腰痛临床研究

Clinical efficacy of Jiaji(Ex-B2)point warm acupuncture combined with core muscle training for low back pain caused by paravertebral muscle fat infiltration

目的观察温针灸夹脊穴联合核心肌群训练治疗椎旁肌脂肪浸润腰痛的临床疗效。方法将75例椎旁肌脂肪浸润腰痛患者按照随机数字表法分为3组,针灸对照组25例单纯予温针灸夹脊穴治疗,训练对照组25例予核心肌群训练治疗,联合组25例予温针灸夹脊穴联合核心肌群训练治疗。2组均治疗2周。比较2组治疗前后疼痛视觉模拟评分法(VAS)评分、腰椎Oswetry功能障碍指数(ODI)(包括疼痛、单项功能及综合功能)评分、脂肪浸润情况[采用椎旁肌群与相应节段椎体间的横截面积比(MVR)分级评价]及椎旁肌功能[包括背伸力量、前屈力量及中位频率斜率(MFs)]水平变化情况。结果与本组治疗前比较,3组治疗后疼痛VAS评分均降低(P<0.05),且联合组治疗后疼痛VAS评分均低于针灸对照组、训练对照组(P<0.05)。与本组治疗前比较,3组治疗后ODI疼痛、单项功能、综合功能评分及总分均降低(P<0.05),且联合组治疗后ODI疼痛、单项功能、综合功能评分及总分均低于针灸对照组、训练对照组(P<0.05)。与本组治疗前比较,3组治疗后MVR分级情况比较差异均有统计学意义(P<0.05),脂肪浸润情况均有明显改善,且联合组治疗后MVR分级情况与针灸对照组、训练对照组比较差异均有统计学意义(P<0.05),联合组脂肪浸润改善情况优于针灸对照组及训练对照组。与本组治疗前比较,3组治疗后背伸力量增强(P<0.05),MFs水平降低(P<0.05),且联合组治疗后背伸力量均高于针灸对照组、训练对照组(P<0.05),MFs水平均低于针灸对照组、训练对照组(P<0.05),但3组治疗前后前屈力量比较差异均无统计学意义(P>0.05)。结论温针灸夹脊穴联合核心肌群训练治疗椎旁肌脂肪浸润腰痛疗效确切,可以更好地减轻患者腰背部疼痛症状,提高腰椎功能,减少椎旁肌脂肪浸润,提高椎旁肌背伸力量和耐力。

Objective To observe the clinical efficacy of Jiaji(Ex-B2)point warm acupuncture combined with core muscle training for low back pain(LBP)caused by paravertebral muscle fat infiltration.Methods Seventy-five patients with LBP caused by paravertebral muscle fat infiltration were randomly assigned to receive Jiaji(Ex-B2)point warm acupuncture(the acupuncture control group,n=25),core muscle training(the training control group,n=25),or Jiaji(Ex-B2)point warm acupuncture+core muscle training(the combination group,n=25).Treated for 2 weeks,the visual analogue scale(VAS)scores,Oswestry disability indexes(ODI)(pain,single function and comprehensive function)were compared.The cross-sectional area of lumbar paravertebral muscles,vertebral body,and muscle/vertebra ratio(MVr),as well as fat infiltration of the muscles were recorded.The paravertebral muscle function(back extension strength,anterior flexion strength,median frequency slope[MFs])was counted.The curative effect was assessed.Results After treatment,VAS and ODI scores in the three groups were decreased(all P<0.05),which were common in the combination group compared with the other two groups(all P<0.05).Fat infiltration was significantly improved,and differences were significant in MVR grading in the three groups between before and after treatment(P<0.05),and the improvements of fat infiltration and MVR grading in the combination group were significantly better than the other two groups(P<0.05).The back extension strength in the three groups was increased(P<0.05),while MFs was decreased(P<0.05).The combination group were superior to the other two groups for back extension strength and MFs(all P<0.05).None of the anterior flexion strength differed significantly among groups(P>0.05).Conclusion The jiaji(Ex-B2)point warm acupuncture combined with core muscle training has a definite curative effect in treating LBP caused by paravertebral muscle fat infiltration,which can better relieve low back pain,improve lumbar spine function,reduce fat infiltration,and improve back extension strength and paravertebral muscles endurance.