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悬吊推拿运动技术在改善青少年特发性脊柱侧弯患者椎旁肌不对称性中的作用OACSTPCD

Role of Sling Tuina Exercise Technique in Improving Paraspinal Muscle Asymmetry in Patients with Adolescent Idiopathic Scoliosis

中文摘要英文摘要

目的 探讨悬吊推拿运动技术在改善青少年特发性脊柱侧弯(AIS)患者椎旁肌不对称性中的作用.方法 选取2021年10月—2023年8月于山东中医药大学第二附属医院康复科就诊并符合纳入标准的AIS患者88例作为研究对象,采用随机数字表法分为对照组和试验组,每组44例.对照组参照德国Schroth脊柱侧弯三维矫正疗法进行常规康复训练,包括手法放松侧弯凹侧椎旁肌肌肉,"臀桥""小燕飞"力量练习,施罗特体操包括"肌肉圆柱""旋转坐位运动""伸展运动"配合成角呼吸.试验组运用悬吊推拿运动技术治疗,主要包括在悬吊设备辅助下调节脊柱位置恢复脊柱中立位,以弹拨、按推等推拿手法往返作用于督脉、膀胱经行整体治疗和凸凹侧椎旁辨证补泻治疗,仰卧位、俯卧位和侧卧位的中立位控制训练,躯干屈伸、旋转、侧屈闭链运动训练.在治疗前和治疗4周后运用肌电生物反馈仪测量患者站立负重时椎旁肌的表面肌电图(sEMG),通过自带软件进行分析,采集均方根(RMS),并计算椎旁肌肉对称指数(PMSI=RMS凸/RMS凹);采用Cobb角评估患者脊柱侧弯的严重程度;采用躯干旋转角度(ATR)评估躯干的旋转程度、脊柱的功能和形态.结果 治疗前,2组PMSI值、Cobb角、ATR值比较,差异均无统计学意义(P>0.05).治疗4周后,试验组PMSI值为1.08(1.04,1.14),Cobb角为5(2,9)°,ATR值为2(1,3)°;对照组PMSI值为1.12(1.09,1.17),Cobb角为8.5(6,10)°,ATR值为2(2,3)°.组内比较,治疗后2组PMSI值均更接近1(P<0.05),Cobb角、ATR值均下降(P<0.05).组间比较,治疗后试验组PMSI值、Cobb角改善效果均优于对照组,试验组PMSI值更接近1(P<0.05),Cobb角明显更低(P<0.05),但治疗后2组ATR值差异无统计学意义(P>0.05).结论 悬吊推拿运动技术可有效改善椎旁肌不对称性,达到降低患者的Cobb角的矫形目的,值得临床推广应用.

Objective To investigate the impact of technique of sling exercise with Tuina therapy on improving paravertebral muscle asymmetry in patients with adolescent idiopathic scoliosis(AIS).Methods A total of 88 patients with AIS who met the in-clusion criteria and received treatment at the Rehabilitation Department of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from October 2021 to August 2023 were recruited for this study.They were randomly divided into control group and experimental group,with 44 cases in each group.Routine rehabilitation training was performed in the control group with reference to the German Schroth scoliosis three-dimensional corrective therapy,including manipulation to relax the con-cave side of the paraspinal muscles,"hip bridge",and"small swallow fly"and other strength exercises.Schroth gymnastics included"muscle column","rotational sitting movement","stretching exercise"with angular breathing.The experimental group was treated with sling Tuina exercise technique which mainly included adjusting the position of the spine to restore the neutral position,the methods of plucking,pressing and pushing and other techniques to act back and forth on the Governor vessel,bladder meridian and the convex-concave side of the paravertebral muscle dialectical tonifying and reducing therapy,neutral position control training in supine,prone and lateral position,trunk flexion,extension,rotation and lateral flexion closed chain movement training with the assis-tance of sling equipment.Before treatment and after 4 weeks of treatment,the surface electromyography(sEMG)was used to mea-sure the paraspinal muscles of the patients during standing weight-bearing position,and the root mean square(RMS)was calculated and analyzed through the included software,and the paraspinal muscle symmetry index was calculated(PMSI=RMSconvex/RMSconcave);Cobb's angle was used to assess the severity of the patients'scoliosis;and the angle of trunk rotation(ATR)was used to assess the de-gree of rotation of the trunk.Results Before treatment,the PMSI values,Cobb's angle,and ATR values of the two groups were com-pared,and the differences were not statistically significant(P>0.05).After 4 weeks of treatment,the PMSI values of the experimen-tal group was 1.08(1.04,1.14),the Cobb's angle was 5(2,9)°,and the ATR value was 2(1,3)°,while the PMSI value of the control group was 1.12(1.09,1.17),the Cobb's angle was 8.5(6,10)°,and the ATR value was 2(2,3)°.The intra-group comparison results showed that the Cobb's angle and ATR values decreased in both groups after treatment(P<0.05),and PMSI values were closer to 1(P<0.05).The intra-group comparison results showed that the improvement of PMSI value and Cobb's angle in the experimental group was better than that in the control group after treatment,and the PMSI value was closer to 1 in the experimental group(P<0.05),and the Cobb's angle was significantly lower(P<0.05);however,there was no statistically significant difference of the ATR value between the two groups after treatment(P>0.05).Conclusion technique of sling exercise with Tuina therapy can effectively improve the asymmetry of paravertebral muscles and achieve the orthopedic purpose of reducing the Cobb's angle and trunk rotation angle of patients,which is recommended for clinical application.

刘敏;马兆水;许强强;李丽

山东大学护理与康复学院,山东 济南 250012山东中医药大学第二附属医院,山东 济南 250001

青少年特发性脊柱侧弯悬吊推拿运动技术椎旁肌不对称性表面肌电图

adolescent idiopathic scoliosistechnique of sling exercise with Tuina therapyparavertebral musclesasymmetrysurface electromyography

《康复学报》 2024 (003)

262-269 / 8

山东省重点研发计划项目(2017GSF19114);山东省中医药科技项目(2021M006);山东省社科联人文社会科学课题(2023JKZX02);山东省中医药发展计划项目(Q-2023067);山东省医药卫生科技项目(202316011069)

10.3724/SP.J.1329.2024.03007

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