基于足底静态参数探讨“分节段式”脊柱推拿手法治疗青少年特发性脊柱侧凸的临床疗效

Outcomes of segmental spinal manipulation for treatment of adolescent idiopathic scoliosis:a static plantar parameters-based clinical study

目的:基于足底静态参数探讨“分节段式”脊柱推拿手法治疗青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS)的临床疗效。方法:将60例符合要求的AIS患者随机分为2组,每组30例。常规推拿组采用常规脊柱推拿手法进行治疗,每周2次,共治疗12周;联合推拿组在常规脊柱推拿手法治疗的基础上增加“分节段式”脊柱推拿手法,“分节段式”脊柱推拿手法每周1次,共治疗12周。分别于第1次治疗前和治疗结束后当天,采用USOL三维足底扫描仪采集患者足底静态参数,包括长度参数(足长、足弓长)、宽度参数(前掌宽、后跟宽)、高度参数(足弓内侧高度、外踝高度)及角度参数([足母]趾角度)。结果:(1)长度参数。治疗前及治疗结束后,2组患者双侧足长差值、双侧足弓长差值比较,组间差异均无统计学意义(治疗前:t=1.684,P=0.098;t=0.359,P=0.721;治疗结束后:t=0.263,P=0.081;t=0.240,P=0.811);治疗结束后,2组患者双侧足长差值、双侧足弓长差值均较治疗前减小(双侧足长差值:t=5.079,P=0.000;t=21.891,P=0.000;双侧足弓长差值:t=15.834,P=0.000;t=12.120,P=0.000)。(2)宽度参数。治疗前,2组患者双侧前掌宽差值、双侧后跟宽差值比较,组间差异均无统计学意义(t=-0.748,P=0.457;t=0.372,P=0.711);治疗结束后,2组患者双侧前掌宽差值、双侧后跟宽差值均较治疗前减小(双侧前掌宽差值:t=11.522,P=0.000;t=7.369,P=0.000;双侧后跟宽差值:t=16.745,P=0.000;t=11.486,P=0.000);治疗结束后,联合推拿组患者双侧前掌宽差值、双侧后跟宽差值均小于常规推拿组(t=-2.351,P=0.022;t=-2.699,P=0.009)。(3)高度参数。治疗前,2组患者双侧足弓内侧高度差值、双侧外踝高度差值比较,组间差异均无统计学意义(t=-0.595,P=0.554;t=0.082,P=0.935);治疗结束后,2组患者双侧足弓内侧高度差值、双侧外踝高度差值均较治疗前减小(双侧足弓内侧高度差值:t=9.616,P=0.000;t=10.269,P=0.000;双侧外踝高度差值:t=7.365,P=0.000;t=6.021,P=0.000);治疗结束后,联合推拿组患者双侧足弓内侧高度差值、双侧外踝高度差值均小于常规推拿组(t=-2.790,P=0.007;t=-2.455,P=0.017)。(4)角度参数。治疗前及治疗结束后,2组患者双侧[足母]趾角度差值比较,组间差异均无统计学意义(t=0.382,P=0.704;t=0.273,P=0.786);治疗结束后,2组患者双侧[足母]趾角度差值均较治疗前减小(t=6.277,P=0.000;t=12.049,P=0.000)。结论:“分节段式”脊柱推拿手法可有效改善AIS患者的足底静态参数,相较于常规脊柱推拿手法具有一定优势。

Objective:To explore the clinical outcomes of segmental spinal manipulation in treatment of adolescent idiopathic scoliosis(AIS)based on the static plantar parameters.Methods:Sixty AIS patients were enrolled in the study and were randomized into conventional manipulation group and combination manipulation group,30 ones in each group.All patients in the 2 groups were treated with conventional spinal manipulation,twice a week for consecutive 12 weeks;moreover,the ones in combination manipulation group were further treated with segmental spinal manipulation,once a week for consecutive 12 weeks.Before the first treatment and after the end of treatment,the static plantar parameters,including length parameters(foot length,foot arch length),width parameters(forefoot width,heel width),height parameters(medial arch height,lateral malleolus height),and angle parameter(big toe angle)were collected,respectively,by using a USOL three-dimensional plantar scanner.Results:①Length parameters.The difference between the bilateral foot length and difference between the bilateral foot arch length were compared between the 2 groups before the treatment and after the end of the treatment,and the results revealed no significant differences(pretreatment:t=1.684,P=0.098;t=0.359,P=0.721;after the end of the treatment:t=0.263,P=0.081;t=0.240,P=0.811);the difference between the bilateral foot length and difference between the bilateral foot arch length decreased in the 2 groups after the end of treatment compared to pretreatment(the difference between the bilateral foot length:t=5.079,P=0.000;t=21.891,P=0.000;the difference between the bilateral foot arch length:t=15.834,P=0.000;t=12.120,P=0.000).②Width parameters.The difference between the bilateral forefoot width and the difference between the bilateral heel width were compared between the 2 groups before the treatment,and the results revealed no significant differences(t=-0.748,P=0.457;t=0.372,P=0.711).The difference between the bilateral forefoot width and the difference between the bilateral heel width decreased in the 2 groups after the end of treatment compared to pretreatment(the difference between the bilateral forefoot width:t=11.522,P=0.000;t=7.369,P=0.000;the difference between the bilateral heel width:t=16.745,P=0.000;t=11.486,P=0.000),and they were smaller in combination manipulation group compared to conventional manipulation group(t=-2.351,P=0.022;t=-2.699,P=0.009).③Height parameters.The difference between the bilateral medial arch height and the difference between the bilateral lateral malleolus height were compared between the 2 groups before the treatment,and the results revealed no significant differences(t=-0.595,P=0.554;t=0.082,P=0.935).The difference between the bilateral medial arch height and the difference between the bilateral lateral malleolus height decreased in the 2 groups after the end of treatment compared to pretreatment(the difference between the bilateral medial arch height:t=9.616,P=0.000;t=10.269,P=0.000;the difference between the bilateral lateral malleolus height:t=7.365,P=0.000;t=6.021,P=0.000),and they were smaller in combination manipulation group compared to conventional manipulation group(t=-2.790,P=0.007;t=-2.455,P=0.017).④Angle parameter.The difference between the bilateral big toe angle was compared between the 2 groups before the treatment and after the end of the treatment,and the result revealed no significant difference(t=0.382,P=0.704;t=0.273,P=0.786),and it decreased in the 2 groups after the end of treatment compared to pretreatment(t=6.277,P=0.000;t=12.049,P=0.000).Conclusion:The segmental spinal manipulation can effectively improve the static plantar parameters in AIS patients.It has certain advantages over the conventional spinal manipulation.