肌力训练对腰椎间盘突出症病人腰椎功能及预防复发的作用

【摘要】  目的探讨肌力训练对腰椎间盘突出症病人腰椎功能及预防复发的作用。方法将47例腰椎间盘突出症临床症状缓解的病人随机分为2组：实验组24例，对脊柱各种运动的作用肌进行肌力训练,每周3次，每次90 min，时间6个月;对照组23例，自然发展不做针对性肌肉训练。试验结束后对2组病人的腰椎功能进行评定。结果训练前实验组与对照组腰椎功能评分差异无显著性。训练后实验组腰椎功能评分明显提高(t=2.83,P<0.05)，而对照组试验前后腰椎功能评分差异无显著性(t=0.93,P>0.05)。训练后实验组腰椎功能评分明显高于对照组(t=2.87，P<0.05)。训练结束后随访半年, 实验组复发率明显低于对照组(χ2=6.23,P<0.05)。结论肌力训练对改善腰椎间盘突出症病人的腰椎功能及预防复发有很好效果。 
【关键词】  腰椎;椎间盘移位;运动疗法;复发
　[ABSTRACT]ObjectiveTo assess the effect of exercise for power on lumbar function and its recurrence prevention in patients with lumbar intervertebral disc protrusion (LIDP).MethodsForty-seven LIDP patients with clinically symptomatic relief were evenly randomized to two groups. The patients in the treatment group were conducted exercise for power, three times a week, 90 min each time, for six months; for those in the control group, no training aiming directly at exercise for power was undertaken. Upon completion of the training, the lumbar function was appraised.ResultsBefore training, no significant difference of lumbar function between the two groups was noted; After training, the lumbar function score of those in the experiment group was markedly elevated (t=2.83,P<0.05), and that of those in the control, no significant difference was recorded between before and after the training (t=0.93,P>0.05). The lumbar function score of those in the experiment after instruction was obviously higher than that in the control (t=2.87,P<0.01). A follow-up of six months showed that the recurrence rate in the experiment was significantly lower than that in the control (χ2=6.23,P<0.05).ConclusionThe exercise for power is of great effect on improving lumbar function and preventing recurrence in patients with LIDP.
　　[KEY WORDS]lumbar vertebrae; intervertebral disk displacement; exercise therapy; recurrence
　　腰椎间盘突出症(LIDP)是由于椎间盘退变或损伤破裂，髄核突出压迫神经根产生的一系列神经根压迫刺激症状。经过手术或非手术治疗后症状多可消失，但易复发。为防止复发，病人惧怕身体锻炼，反而加重肌肉萎缩，使脊柱的稳定性减弱。传统的肌力训练方法对LIDP病人功能改善和缓解疼痛有一定临床意义[1]，但对病人肌肉的形态结构影响不大，从而不能持久地改善肌力。本研究采用针对性的训练措施增强病人腰背和腹部肌肉的功能，观察肌力增强对LIDP病人腰椎功能和预防复发的作用，现报告如下。
　　1对象与方法
　　1.1对象
　　选择曾被确诊患有LIDP并且临床症状缓解的我校在校师生47例，病程1~10年，均无下肢、脊柱手术史，无脊柱骨折、明显畸形或肿瘤，无运动疗法禁忌症，经测试肌力均大于2级[2]。把研究对象随机分2组：实验组24例，男20例，女4例，年龄20~51岁，平均(28.79±11.19)岁;对照组23例，男19例，女4例，年龄20~50岁，平均(29.01±11.11)岁。两组年龄、性别比较差异无显著性(P>0.05)。
　　1.2治疗方法
　　对实验组进行肌力训炼，而对照组不进行干预。当两组出现复发者，排除手术治疗后，均接受针刺或电针治疗, 取穴腰夹脊、肾俞、患侧环跳、秩边、承扶、殷门、委中、阳陵泉、承山、昆仑等, 每次20 min;针后拔罐 3～5 min;常规腰椎牵引15 min,推拿点按上述穴位各1～2 min;腰腿部按、揉、滚及腰部斜扳等手法治疗15～20 min [3]。

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