Effect of acupuncture and medicine combined with core stability training in treating nonspecific low back pain
-
摘要:目的
观察针药结合核心稳定训练治疗非特异性腰痛患者的临床效果。
方法选取106例非特异性腰痛患者作为研究对象, 随机分为对照组和观察组，每组53例。对照组采用核心稳定训练治疗，观察组采用针药结合核心稳定训练治疗，持续4周，比较2组患者治疗前后Oswestry功能障碍指数(ODI)评分、视觉模拟评分法(VAS)评分、多裂肌表面肌电图指标[平均肌电值(AEMG)、均方根值(RMS)、中位频率(MF)、平均功率频率(MPF)]水平、腰部肌耐力评估结果、腰椎活动度和临床疗效、治疗期间不良反应发生情况。
结果治疗后，观察组ODI评分、VAS评分依次为(22.56±2.63)、(2.29±0.28)分，分别低于对照组的(29.11±3.14)、(2.85±0.26)分，且2组ODI评分、VAS评分均低于治疗前，差异有统计学意义(P < 0.05)。治疗后，观察组多裂肌AEMG、RMS依次为(579.92±40.36)、(279.91±21.35)μV, 分别高于对照组的(530.87±36.81)、(256.27±17.16)μV, 且2组AEMG、RMS均高于治疗前，差异有统计学意义(P < 0.05);治疗后，观察组MF、MPF依次为(184.89±12.15)、(179.84±13.67)Hz, 分别低于对照组的(218.35±13.42)、(207.41±13.38)Hz, 且2组MF、MPF均低于治疗前，差异有统计学意义(P < 0.05)。治疗后, 2组腰部肌耐力评估中的静态保持时间、动态完成次数分别长于、多于治疗前，且观察组长于、多于对照组，差异有统计学意义(P < 0.05)。治疗后, 2组腰椎前屈、后伸、左侧屈、右侧屈、左旋转、右旋转活动度均大于治疗前，且观察组大于对照组，差异有统计学意义(P < 0.05)。治疗后，观察组临床治疗总有效率为88.68%, 高于对照组的71.70%, 差异有统计学意义(P < 0.05)。治疗期间, 2组患者均未发生明显不良反应。
结论针药结合核心稳定训练可降低非特异性腰痛患者疼痛评分，改善腰部神经肌肉功能，增加腰椎活动度，且整体安全性较高。
Abstract:ObjectiveTo observe the clinical efficacy of acupuncture and medicine combined with core stability training in the treatment of patients with nonspecific low back pain.
MethodsA total of 106 patients with nonspecific low back pain were selected as study subjects, and they were randomly divided into control group and observation group, with 53 cases in each group. The control group was treated with core stability training, while the observation group was given acupuncture and medicine combined with core stability training, and both groups were continuously treated for 4 weeks. Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) score and multifidus surface electromyography indicators [average electromyography (AEMG), root mean square (RMS), median frequency (MF), mean power frequency (MPF)] before and after treatment, assessment of lumbar muscle endurance, lumbar range of motion, clinical efficacy and adverse reactions during treatment were compared between the two groups.
ResultsAfter treatment, the scores of ODI and VAS were (22.56±2.63) and (2.29±0.28) in the observation group, which were lower than (29.11±3.14) and (2.85±0.26) in the control group(P < 0.05). The scores of ODI and VAS of two groups were lower than those before treatment(P < 0.05). AEMG and RMS in two groups were higher than those before treatment (P < 0.05). After treatment, the AEMG and RMS of multifidus were (530.87±36.81) μV and (256.27±17.16) μV in the control group, which were lower than (579.92±40.36) μV and (279.91±21.35) μV in the observation group(P < 0.05). After treatment, MF and MPF of the observation group were (184.89±12.15) Hz and (179.84±13.67) Hz, respectively, which were lower than (218.35±13.42) and (207.41±13.38) Hz in the control group, and MF and MPF of the two groups were lower than those after treatment, the static holding time and dynamic completion frequency of lumbar muscle endurance test in both groups were lengthened or increased, and were longer or higher in the observation group than those in the control group (P < 0.05). After treatment, the ranges of motions of forward flexion, rear protraction, left-right flexion and left-right rotation of lumbar in two groups were larger than before treatment, and the above ranges of motions were higher in the observation group than those in the control group (P < 0.05). After treatment, the total clinical effective rate was 88.68% in the observation group, which was higher than 71.70% in the control group (P < 0.05). No obvious adverse reactions occurred in the two groups during treatment.
ConclusionAcupuncture and medicine combined with core stability training can reduce the pain score of patients with nonspecific low back pain, improve the lumbar nerve function and muscle function, and enhance the lumbar range of motion, and has higher integral security.
-
-
表 1 2组患者治疗前后ODI评分、VAS评分比较(x±s)
分 组别 ODI评分 VAS评分 治疗前 治疗后 治疗前 治疗后 对照组(n=53) 41.38±2.17 29.11±3.14* 5.45±0.72 2.85±0.26* 观察组(n=53) 42.04±2.35 22.56±2.63*# 5.29±0.87 2.29±0.28*# ODI: Oswestry功能障碍指数; VAS: 视觉模拟评分法。与治疗前比较, * P < 0.05; 与对照组比较, #P < 0.05。 
下载: 导出CSV
表 2 2组患者治疗前后表面肌电图指标水平比较(x±s)
指标 时点 对照组(n=53) 观察组(n=53) 平均肌电值/μV 治疗前 423.38±31.45 416.75±37.31 治疗后 530.87±36.81* 579.92±40.36*# 均方根值/μV 治疗前 217.90±19.64 220.86±18.29 治疗后 256.27±17.16* 279.91±21.35*# 中位频率/Hz 治疗前 241.48±10.81 243.28±13.55 治疗后 218.35±13.42* 184.89±12.15*# 平均功率频率/Hz 治疗前 234.58±13.26 229.57±14.21 治疗后 207.41±13.38* 179.84±13.67*# 与治疗前比较, * P < 0.05; 与对照组比较, #P < 0.05。
下载: 导出CSV
表 3 2组患者治疗前后腰部肌耐力评估结果比较(x±s)
组别 静态保持时间/s 动态完成次数/次 治疗前 治疗后 治疗前 治疗后 对照组(n=53) 55.71±3.94 70.65±4.96* 17.02±2.16 22.72±2.47* 观察组(n=53) 54.84±2.65 81.77±6.51*# 16.89±2.52 27.49±3.03*# 与治疗前比较, * P < 0.05; 与对照组比较, #P < 0.05。
下载: 导出CSV
表 4 2组患者治疗前后腰椎活动度比较(x±s)
° 组别 时点 腰椎活动度 前屈 后伸 左侧屈 右侧屈 左旋转 右旋转 对照组(n=53) 治疗前 78.19±2.92 25.46±3.84 32.36±2.38 32.93±2.81 33.47±1.53 34.26±1.78 治疗后 82.41±3.69* 31.54±3.71* 36.07±2.71* 36.85±2.71* 38.56±2.18* 39.02±2.25* 观察组(n=53) 治疗前 77.68±2.84 25.85±3.03 32.68±2.93 32.47±2.98 33.37±1.89 34.28±1.97 治疗后 88.78±3.18*# 36.40±2.92*# 39.92±3.12*# 41.95±2.88*# 42.66±1.71*# 42.65±2.07*# 与治疗前比较, * P < 0.05; 与对照组比较, #P < 0.05。
下载: 导出CSV
表 5 2组患者临床疗效比较[n(%)]
组别 痊愈 显效 有效 无效 总有效 对照组(n=53) 11(20.75) 14(26.42) 13(24.53) 15(28.30) 38(71.70) 观察组(n=53) 17(32.08) 21(39.62) 9(16.98) 6(11.32) 47(88.68)* 与对照组比较, * P < 0.05。
下载: 导出CSV
-
[1] KNEZEVIC N N, CANDIDO K D, VLAEYEN J W S, et al. Low back pain[J]. Lancet, 2021, 398(10294): 78-92. doi: 10.1016/S0140-6736(21)00733-9
[2] 施玉博, 郭卫春, 余铃. 非特异性下腰痛: 北美脊柱协会(NASS)循证医学指南解读[J]. 中国修复重建外科杂志, 2021, 35(10): 1336-1340. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXCW202110021.htm [3] 陈元川, 詹红生. 詹红生教授治疗慢性下腰痛经验介绍[J]. 中国中医骨伤科杂志, 2022, 30(2): 78-80. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZG202202018.htm [4] 蒲永棚, 粟漩, 游丽梅. 非特异性腰痛中医治疗研究进展[J]. 中国中医急症, 2022, 31(1): 178-180, 188. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJZ202201048.htm [5] 吴凡, 曹端广, 许权, 等. 竹圈姜灸治疗寒湿痹阻型慢性非特异性腰痛的效果及对患者睡眠质量的影响[J]. 时珍国医国药, 2021, 32(5): 1158-1161. doi: 10.3969/j.issn.1008-0805.2021.05.38 [6] MA K, ZHUANG Z G, WANG L, et al. The Chinese association for the study of pain (CASP): consensus on the assessment and management of chronic nonspecific low back pain[J]. Pain Res Manag, 2019, 2019: 8957847.
[7] 国家中医药管理局. 中医病证诊断疗效标准[M]. 南京: 南京大学出版社, 1994: 194-195. [8] GARG A, PATHAK H, CHURYUKANOV M V, et al. Low back pain: critical assessment of various scales[J]. Eur Spine J, 2020, 29(3): 503-518. doi: 10.1007/s00586-019-06279-5
[9] 杨森, 罗飞, 许建中. 退变性脊柱畸形患者腰背肌力量耐力水平及与生活质量的相关性分析[J]. 第三军医大学学报, 2019, 41(21): 2074-2079. https://www.cnki.com.cn/Article/CJFDTOTAL-DSDX201921007.htm [10] HLAING S S, PUNTUMETAKUL R, KHINE E E, et al. Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial[J]. BMC Musculoskelet Disord, 2021, 22(1): 998. doi: 10.1186/s12891-021-04858-6
[11] 计静, 陈世宣, 朱斌, 等. 神经肌肉激活技术在慢性非特异性下腰痛中的应用效果分析[J]. 中华全科医学, 2020, 18(6): 965-967, 979. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202006022.htm [12] 刘彬, 赵睿, 韩康, 等. 浮针疗法联合腰腹部核心肌群训练治疗慢性非特异性下腰痛临床观察[J]. 山东中医药大学学报, 2020, 44(5): 544-549. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYX202005019.htm [13] 王林, 盛凌黎, 孔伟, 等. 补肾活血通络方定向透药治疗肾虚血瘀型腰痛研究[J]. 实用临床医药杂志, 2020, 24(14): 23-26, 30. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202014006.htm [14] 吴少祯. 黄帝内经素问全本全译全注[M]. 北京: 中国医药科技出版社, 2022: 176-231. [15] 刘兴星, 尚秀葵, 苑功名, 等. 从趋化因子调节疼痛视角探讨针刺镇痛新机制[J]. 针灸临床杂志, 2021, 37(10): 1-6. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJLC202110001.htm [16] KOPPENHAVER S, GAFFNEY E, OATES A, et al. Lumbar muscle stiffness is different in individuals with low back pain than asymptomatic controls and is associated with pain and disability, but not common physical examination findings[J]. Musculoskelet Sci Pract, 2020, 45: 102078.
[17] BOUTELLIER A, NVESCH C, SUTER P, et al. Trunk muscle function and its association with functional limitations in sedentary occupation workers with and without chronic nonspecific low back pain[J]. J Back Musculoskelet Rehabil, 2022, 35(4): 783-791.
[18] 李绍康, 赵洁, 曹晓雯, 等. 针刺联合核心稳定性训练治疗慢性非特异性腰痛: 前瞻性随机对照研究[J]. 针刺研究, 2022, 47(2): 160-164. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYJ202202011.htm [19] 宋山峰. 独活寄生汤结合手法按摩治疗非特异性下腰痛临床研究[J]. 陕西中医, 2018, 39(11): 1565-1568. https://www.cnki.com.cn/Article/CJFDTOTAL-SXZY201811022.htm -
期刊类型引用(7)
1. 冯晓霞，陈玉仙，张晓萍. 妊娠期肝内胆汁淤积症合并乙型肝炎病毒感染与患者妊娠结局相关性研究. 陕西医学杂志. 2025(02): 227-230 . 
百度学术
2. 刘佳，于雅彬，王兰，李英，于欣，蔡永艳，马娜，阎志新. 重症腺病毒肺炎患儿凝血功能和免疫功能特征及其临床意义. 实用临床医药杂志. 2025(05): 122-126 . 本站查看
3. 王晶晶，李萍，高尚啸，周玥. 阶梯护理决策辅助干预在妊娠期肝内胆汁淤积症患者中的应用. 国际护理学杂志. 2024(09): 1625-1629 . 百度学术
4. 宋对对，牛丽娜，张小娟，马萍，卫晓娟. 妊娠期肝内胆汁淤积症患者不良妊娠结局影响因素. 中国计划生育学杂志. 2024(07): 1586-1590 . 百度学术
5. 潘伟杰，程福安，李婉莹，林炳柱. NLR和凝血四项与妊娠期肝内胆汁淤积症病情程度的相关性及检测价值. 实用检验医师杂志. 2024(03): 222-224 . 百度学术
6. 陈慧. 妊娠期肝内胆汁淤积症孕妇血清总胆酸水平和胎儿心脏功能的相关性. 临床研究. 2023(09): 44-46 . 百度学术
7. 罗钊琰，唐征宇. 茵陈蒿汤加味辅助治疗湿热郁结型妊娠肝内胆汁淤积症的临床效果. 中国社区医师. 2023(36): 64-66 . 百度学术
其他类型引用(1)
计量
- 文章访问数: 135
- HTML全文浏览量: 60
- PDF下载量: 8
- 被引次数: 8
苏公网安备 32100302010246号
