基于碎片化时间的功能训练对强直性脊柱炎患者康复期的效果分析

Effect analysis of functional training based on fragmentation time on patients with ankylosing spondylitis during the rehabilitation period

目的探究强直性脊柱炎患者应用基于碎片化时间的功能训练对其脊柱关节活动度及炎症因子的影响。方法选取河南科技大学第一附属医院2021年4月至2022年9月期间强直性脊柱炎患者109例作为研究对象,开展随机对照试验。采用随机数字表法将患者分为两组,对照组54例,男37例,女17例;年龄(53.51±6.83)岁;病程(3.21±1.12)年;疼痛部位:周围关节18例、腰椎14例、骶髂关节22例;给予常规功能训练方案。观察组55例,男36例,女19例;年龄(54.13±6.62)岁;病程(3.33±1.21)年;疼痛部位:周围关节19例、腰椎15例、骶髂关节21例;给予基于碎片化时间的功能训练。比较两组患者症状改善情况[Bath强直性脊柱炎功能指数(BASFI)、Bath强直性脊柱炎疾病活动性指数(BASDAI)、全身关节疼痛程度(Pain-VAS)、全身关节僵硬程度(Stiffness-VAS)]、脊柱关节活动度[脊柱侧弯、改良Schober指数(腰椎前屈功能障碍程度)、扩胸度、颈椎旋转度]、炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、血沉(ESR)]。采用独立样本t检验、配对样本t检验和χ^(2)检验。结果干预后,观察组BASFI评分、BASDAI评分、Pain-VAS评分和Stiffness-VAS评分均低于对照组[(3.87±0.58)分比(5.27±0.62)分、(3.17±0.46)分比(4.23±0.63)分、(1.27±0.56)分比(2.57±0.46)分、(1.73±0.43)分比(3.17±0.51)分],差异均有统计学意义(t=12.177、10.017、13.254、15.948,均P<0.05);观察组脊柱侧弯、改良Schober指数、扩胸度和颈椎旋转度均高于对照组[(17.36±0.77)cm比(13.28±0.65)cm、(4.85±0.18)cm比(3.91±0.17)cm、(4.55±0.17)cm比(3.61±0.15)cm、(58.73±1.96)°比(53.37±1.84)°],差异均有统计学意义(t=29.866、28.020、30.590、14.714,均P<0.05);观察组CRP、TNF-α、ESR水平均低于对照组[(11.74±2.17)mg/L比(14.01±2.45)mg/L、(29.72±4.16)ng/L比(43.15±5.52)ng/L、(19.85±3.22)mm/h比(25.72±3.53)mm/h](t=5.123、14.325、9.073,均P<0.05)。结论基于碎片化时间的功能训练干预强直性脊柱炎患者,可有效改善其临床症状、脊柱功能状态,降低炎症因子水平。

Objective To explore the effects of functional training based on fragmentation time on spinal joint motion and inflammatory cytokines in patients with ankylosing spondylitis.Methods A randomized controlled trial was conducted on 109 patients with ankylosing spondylitis in the First Affiliated Hospital of Henan University of Science and Technology from April 2021 to September 2022.They were divided into two groups by the random number table method.In the control group,there were 37 males and 17 females,the age was(53.51±6.83)years old,the course of disease was(3.21±1.12)years,and the pain sites were peripheral joints in 18 cases,lumbar spine in 14 cases,and sacroiliac joint in 22 cases.In the observation group,there were 36 males and 19 females,the age was(54.13±6.62)years old,the course of disease was(3.33±1.21)years,and the pain sites were peripheral joint in 19 cases,lumbar spine in 15 cases,and sacroiliac joint in 21 cases.The control group was given routine functional training program,and the observation group was given functional training based on fragmentation time.The improvement of symptoms[Bath Ankylosing Spondylitis Functional index(BASFI),Bath Ankylosing Spondylitis Disease Activity Index(BASDAI),total joint Pain(Pain-VAS),and total joint Stiffness(Stiffness-VAS)],spinal joint mobility[scoliosis,modified Schober index(degree of lumbar flexion dysfunction),chest expansion degree,and cervical spine rotation],and inflammatory factors[C-reactive protein(CRP),tumor necrosis factorα(TNFα),and erythrocyte sedimentation rate(ESR)]were compared between the two groups.Independent sample t test,paired sample t test,andχ^(2) test were used.Results After intervention,the BASFI score,BASDAI score,Pain-VAS score,and Stiffness-VAS score in the observation group were lower than those in the control group[(3.87±0.58)points vs.(5.27±0.62)points,(3.17±0.46)points vs.(4.23±0.63)points,(1.27±0.56)points vs.(2.57±0.46)points,(1.73±0.43)points vs.(3.17±0.51)points],with statistically significant differences(t=12.177,10.017,13.254,and 15.948,all P<0.05).The scoliosis,modified Schober index,chest expansion degree,and cervical spine rotation in the observation group were higher than those in the control group[(17.36±0.77)cm vs.(13.28±0.65)cm,(4.85±0.18)cm vs.(3.91±0.17)cm,(4.55±0.17)cm vs.(3.61±0.15)cm,(58.73±1.96)°vs.(53.37±1.84)°],with statistically significant differences(t=29.866,28.020,30.590,and 14.714,all P<0.05).The levels of CRP,TNFα,and ESR in the observation group were lower than those in the control group[(11.74±2.17)mg/L vs.(14.01±2.45)mg/L,(29.72±4.16)ng/L vs.(43.15±5.52)ng/L,(19.85±3.22)mm/h vs.(25.72±3.53)mm/h],with statistically significant differences(t=5.123,14.325,and 9.073,all P<0.05).Conclusion Functional training based on fragmentation time can effectively improve the clinical symptoms and spinal function in patients with ankylosing spondylitis,and reduce the levels of inflammatory factors.