摘要
目的:观察核心稳定性训练联合体外冲击波治疗腰椎间盘突出症的临床疗效。方法:将90例腰椎间盘突出症患者按照随机数字表法分为核心稳定训练组、体外冲击波组及联合组,每组各30例。体外冲击波组给予体外冲击波治疗,参数:电压为6 kV,频率为10~15 MHz,压力为1.5~2.5 bar,每次冲击次数为2 000次,能量强度为0.16 mJ/mm2,每周2次,连续3个月。核心稳定训练组给予核心稳定性训练。应用SPS-F11多点多轴悬吊康复训练系统,在同一个康复医师指导下完成;遵循循序渐进的原则,慢慢增加训练时间及次数,由易到难,由简至繁,包括仰卧位、侧卧位、俯卧位训练;每次40 min,每周5次,连续治疗3个月。联合组在体外冲击波治疗的基础上给予核心稳定性训练。分别于治疗前、治疗3个月、治疗后6个月时采用视觉模拟评分法(VAS)评估3组患者疼痛程度;采用Oswestry功能障碍指数(ODI)评估3组患者腰椎功能;采用SF-36生活质量评价量表(SF-36)评估3组患者整体健康状况;计算治疗3个月时3组患者有效率,并记录治疗过程中不良反应发生情况;治疗结束后随访1年,观察3组患者的复发情况。结果:3组治疗前VAS、ODI及SF-36评分比较,差异均无统计学意义(P>0.05),治疗3个月、治疗后6个月时,3组VAS评分、ODI评分均低于治疗前,SF-36评分均高于治疗前(P<0.05),且联合组VAS评分、ODI评分的改善分别优于核心稳定训练组和体外冲击波组,差异有统计学意义(P<0.05);治疗3个月时,联合组治疗有效率高于核心稳定训练组(P<0.05),两者均高于体外冲击波组(P<0.05);治疗结束后1年,联合组复发率明显低于核心稳定训练组、体外冲击波组(P<0.05);治疗过程中3组均未发生严重不良反应。结论:核心稳定性训练联合体外冲击波治疗腰椎间盘突出症效果好,可增强患者腰椎功能、减轻腰部疼痛,安全且不易复发。
Objective: To investigate the effects of core stability training combined with extracorporeal shock wave on patients with lumbar disc herniation. Methods: A total of 90 patients with lumbar disc herniation treated in Beijing Rehabilitation Hospital affiliated to Capital Medical University were randomly assigned to the Core stability training group, the Extracorporeal shock wave group and the Combined group, with 30 cases in each group. The Extracorporeal shock wave group was given extracorporeal shock wave treatment with parameters of voltage 6 kV, frequency of 10 to 15 MHz, pressure of 1.5 to 2.5 bar, 2 000 times of impact, energy intensity of 0.16 m J/mm2, 2 times per week, 3 consecutive months. The Core stability training group received core stability training.SPS-F11 multi-point multi-axis suspension rehabilitation training system was applied, under the guidance of the same rehabilitation doctor. Following the principle of gradual progression, the training time and frequency were slowly increased, from easy to difficult,from simple to complex, including supine position, lateral position and prone position training, 40 minutes each time, 5 times a week,continuous treatment for 3 months. The Combined group was given core stability training and extracorporeal shock wave therapy, and the method was the same as above. The pain degree was evaluated by visual analogue score(VAS) before treatment, 3 months of treatment and 6 months after treatment. The lumbar spine function was evaluated by Oswestry dysfunction index(ODI). SF-36 quality of life scale(SF-36) was used to evaluate the overall health status of the patients. The effective rate was calculated at 3 months of the treatment. The adverse reactions were recorded and all the patients were followed up for one year after the treatment. The recurrence of the three groups was observed. Results: There was no significant difference in VAS, ODI and SF-36 scores among the three groups before the treatment(P>0.05). At 3 months of treatment and 6 months after treatment, the VAS score and ODI score in the three groups were lower than those before the treatment(P<0.05), the SF-36 score were higher than those before the treatment(P<0.05), and the changes of VAS score and ODI score in the Combined group were most obvious compared with the Core stability training group and the Extracorporeal shock wave group(P<0.05). After 3 months of treatment, the effective rate in the Combined group was higher than that in the Core stability training group(P<0.05), and the effective rate in the two groups was higher respectively than that in the Extracorporeal shock wave group(P<0.05). One year after the treatment, the recurrence rate in the Combined group was significantly lower than that in the Core stability training group and the Extracorporeal shock wave group(P<0.05). No serious adverse reactions occurred in the three groups during the treatment. Conclusion: Core stability training combined with extracorporeal shock wave treatment has the better effect on lumbar disc herniation, and can enhance lumbar function and relieve lumbar pain, which is safe and not easy to relapse.
作者
李硕
刘丽爽
周金娜
项巧云
栾婷婷
王文文
LI Shuo;LIU Lishuang;ZHOU Jinna;XIANG Qiaoyun;LUAN Tingting;WANG Wenwen(Beijing Rehabilitation Hospital,Capital Medical University,Beijing 100114,China)
出处
《康复学报》
CSCD
2019年第6期16-20,共5页
Rehabilitation Medicine
基金
北京市科技计划课题(Z141107002514092)
关键词
腰椎间盘突出症
核心稳定性训练
体外冲击波治疗
腰椎功能
lumbar disc herniation
core stability training
extracorporeal shock wave therapy
lumbar function
