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冲击波联合核心稳定性训练对脑卒中非特异性腰背痛疗效观察

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目的 观察冲击波联合核心稳定性训练对脑卒中非特异性腰背痛(NLBP)的临床疗效.方法 选取2022年1月—2023年11月于苏州市相城人民医院就诊的70例脑卒中后NLBP患者为研究对象,采用随机数字表法将其分为对照组和试验组,每组35例.对照组接受常规治疗方案,根据患者病情选用红外线、脉冲调制中频电进行刺激,每项20 min/次;以及上下肢肌力、坐站位平衡、日常生活活动能力(ADL)和步行常规康复训练,40 min/次,5次/周,共治疗3周.试验组在对照组常规治疗的基础上接受冲击波训练,2次/周,共治疗3周;再进行核心稳定性训练,30 min/次,1次/d,5 d/周,共治疗3周.2组在治疗前、首次治疗后和治疗3周后应用视觉模拟疼痛量表(VAS)、Berg平衡量表(BBS)进行评估;使用超声波实时剪切波弹性成像技术在治疗前和治疗3周后评估腰部肌肉僵硬度的变化:使用足迹分析法测量患者的步行参数变化,比较2组的治疗效果.结果 与治疗前比较,首次治疗后和治疗3周后2组休息和步行状态下的VAS评分均降低,且试验组的VAS评分低于对照组(P<0.05).与对照组比较,试验组首次治疗后和治疗3周VAS评分明显下降(P<0.05),试验组首次治疗后步行状态VAS评分下降(P<0.05),治疗3周后步行状态VAS评分显著下降(P<0.001).治疗3周后,2组的腰方肌、竖脊肌、腰大肌硬度、BBS评分、步行参数(患侧平均步长、步幅及步速)均较本组治疗前改善,且试验组的改善幅度明显高于对照组(P<0.05).结论 冲击波联合核心稳定性训练能够减轻脑卒中后NLBP患者的疼痛症状,有效缓解腰背部肌肉的僵硬状态,并显著提升患者的平衡能力、改善步行表现.
Efficacy of Shock Wave Therapy Combined with Core Stability Training on Non-Specific Low Back Pain after Stroke
Objective To investigate the clinical efficacy of shock wave therapy combined with core stability training on non-specific low back pain(NLBP)after stroke.Methods A total of 70 patients with post-stroke NLBP who visited Suzhou Xiangcheng People's Hospital from January 2022 to November 2023 were selected as the subjects of the study.They were randomly assigned to control group and experimental group,wich 35 cases in each group.The control group received conventional treatment,which included infrared and pulse-modulated medium-frequency electrical stimulation,20 minutes per session;as well as regular rehabilita-tion training for muscle strength of upper and lower limbs,sitting and standing balance,activities of daily living(ADL),and walk-ing,40 minutes per session,5 times per week,for a total of 3 weeks.The experimental group,in addition to the conventional treat-ment of the control group,received shock wave therapy,2 times per week for a total of 3 weeks;followed by core stability training,30 minutes per session,once a day,5 days per week,for a total of 3 weeks.Visual analogue scale(VAS)for pain,Berg balance scale(BBS)were assessed before treatment,after the first treatment,and after 3 weeks of treatment in both groups,and changes in the stiffness of waist muscles(E-mean)assessed by ultrasound real-time shear wave elastography were compared before treatment and after 3 weeks of treatment in both groups.Additionally,gait parameters were measured using footprint gait analysis to compare the therapeutic effects of the two groups.Results Compared with those before treatment,VAS scores of both groups decreased at rest and during walking after the first treatment and after 3 weeks of treatment,with the experimental group showing significantly lower VAS scores than the control group(P<0.05).Compared with the control group,the VAS scores of the experimental group decreased significantly after the first treatment and 3 weeks of treatment(P<0.05),and the VAS scores of the experimental group decreased sig-nificantly after the first treatment(P<0.05)and after 3 weeks of treatment(P<0.001).After 3 weeks of treatment,the hardness of the quadratus lumborum,erector spinae,and psoas major muscles,BBS scores,and gait parameters(average step length,step width,and walking speed on the affected side)of both groups improved compared to those before treatment,with the experimental group show-ing a significantly greater improvement than the control group(P<0.05).Conclusion The combination of shock wave therapy and core stability training can effectively alleviate pain symptoms in patients with post-stroke NLBP,significantly reduce the stiffness of the lumbar and back muscles,and markedly improve balance ability and walking performance.

strokenon-specific low back painradial shock wavecore stability traininggait ability

戴亚圆、王晓军、尹杰、朱文娟、苏敏

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苏州市相城人民医院,江苏 苏州 215131

苏州大学附属第四医院,江苏 苏州 215004

苏州大学康复研究所,江苏 苏州 215123

脑卒中 非特异性腰背痛 冲击波 核心稳定性训练 步行能力

2024

康复学报
福建中医药大学

康复学报

CSTPCD
影响因子:0.545
ISSN:2096-0328
年,卷(期):2024.34(5)