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[1]張懷栓,潘玉林,郭小偉,等.生物電刺激在腰椎退行性疾病合并足下垂腰椎減壓術(shù)后康復(fù)中的應(yīng)用[J].中醫(yī)正骨,2021,33(05):28-33.
　ZHANG Huaishuan,PAN Yulin,GUO Xiaowei,et al.Application of bio-electric stimulation therapy to postoperative rehabilitation of patients undergoing lumbar decompression surgery for lumbar degenerative diseases and foot drop[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(05):28-33.
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生物電刺激在腰椎退行性疾病合并足下垂腰椎減壓術(shù)后康復(fù)中的應(yīng)用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年05期
頁(yè)碼:
28-33
欄目:
臨床研究
出版日期:
2021-05-20

文章信息/Info

Title:
Application of bio-electric stimulation therapy to postoperative rehabilitation of patients undergoing lumbar decompression surgery for lumbar degenerative diseases and foot drop
作者:
張懷栓; 潘玉林; 郭小偉; 張猛; 李寶田; 尚林; 池紅萬(wàn)
(鄭州市骨科醫(yī)院,河南 鄭州 450052)
Author(s):
ZHANG Huaishuan; PAN Yulin; GUO Xiaowei; ZHANG Meng; LI Baotian; SHANG Lin; CHI Hongwan
Zhengzhou Orthopedic Hospital,Zhengzhou 450052,Henan,China
關(guān)鍵詞:
腰椎;  椎間盤(pán)移位;  椎管狹窄;  脊椎滑脫;  足下垂;  電刺激療法;  臨床試驗(yàn)
Keywords:
lumbar vertebrae;  intervertebral disc displacement;  spinal stenosis;  spondylolysis;  foot drop;  electric stimulation therapy;  clinical trial
摘要:
目的:探討生物電刺激在腰椎退行性疾病合并足下垂腰椎減壓術(shù)后康復(fù)中的應(yīng)用價(jià)值。方法:將102例符合要求的腰椎退行性疾病合并足下垂患者隨機(jī)分為3組。所有患者均行腰椎減壓手術(shù)。術(shù)后常規(guī)鍛煉組(34例)進(jìn)行常規(guī)功能鍛煉,經(jīng)皮電刺激組(36例)在常規(guī)功能鍛煉的基礎(chǔ)上進(jìn)行經(jīng)皮電刺激治療,針刺電刺激組(32例)在常規(guī)功能鍛煉的基礎(chǔ)上進(jìn)行針刺電刺激治療; 經(jīng)皮電刺激治療和針刺電刺激治療均持續(xù)6周。通過(guò)測(cè)定下肢疼痛視覺(jué)模擬量表(visual analogue scale,VAS)評(píng)分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)、脛骨前肌肌力及足下垂康復(fù)率進(jìn)行療效評(píng)價(jià)。結(jié)果:①下肢疼痛VAS評(píng)分。時(shí)間因素和分組因素存在交互效應(yīng)(F=3.558,P=0.002)。3組患者下肢疼痛VAS評(píng)分總體比較,差異無(wú)統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=1.082,P=0.340)。手術(shù)前后不同時(shí)間點(diǎn)之間下肢疼痛VAS評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=275.441,P=0.000); 3組患者下肢疼痛VAS評(píng)分隨時(shí)間延長(zhǎng)均呈逐漸降低趨勢(shì)[(5.59±1.84)分,(3.50±1.52)分,(2.38±1.02)分,(1.76±0.99)分,F=49.742,P=0.000;(6.64±2.05)分,(3.72±1.23)分,(1.86±0.87)分,(1.06±0.86)分,F=123.021,P=0.000;(6.19±1.77)分,(3.44±0.98)分,(1.84±0.81)分,(0.97±0.86)分,F=122.715,P=0.000]; 術(shù)前及術(shù)后2 d,3組患者的下肢疼痛VAS評(píng)分比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(F=2.699,P=0.072; F=0.481,P=0.620); 術(shù)后6周及術(shù)后6個(gè)月,3組患者下肢疼痛VAS評(píng)分的差異均有統(tǒng)計(jì)學(xué)意義(F=3.907,P=0.023; F=7.872,P=0.001),經(jīng)皮電刺激組和針刺電刺激組的下肢疼痛VAS評(píng)分均低于常規(guī)鍛煉組(P=0.018,P=0.017; P=0.001,P=0.001),經(jīng)皮電刺激組和針刺電刺激組下肢疼痛VAS評(píng)分的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P=0.937; P=0.694)。②ODI。時(shí)間因素和分組因素存在交互效應(yīng)(F=2.707,P=0.031)。3組患者ODI總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=14.775,P=0.000)。手術(shù)前后不同時(shí)間點(diǎn)之間ODI的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=189.455,P=0.000); 3組患者ODI隨時(shí)間延長(zhǎng)均呈逐漸降低趨勢(shì)[(30.47±7.33)分,(23.74±6.27)分,(18.29±5.78)分,F=30.017,P=0.000;(29.69±5.73)分,(19.03±4.97)分,(11.86±4.24)分,F=115.087,P=0.000;(29.84±7.03)分,(19.34±5.95)分,(12.16±4.87)分,F=70.049,P=0.000]; 術(shù)前3組患者的ODI比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(F=0.130,P=0.879); 術(shù)后6周及術(shù)后6個(gè)月,3組患者ODI的差異均有統(tǒng)計(jì)學(xué)意義(F=7.181,P=0.001; F=18.057,P=0.000),經(jīng)皮電刺激組和針刺電刺激組的ODI均低于常規(guī)鍛煉組(P=0.001,P=0.002; P=0.000,P=0.000),經(jīng)皮電刺激組和針刺電刺激組ODI的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P=0.821; P=0.808)。③脛骨前肌肌力。時(shí)間因素和分組因素不存在交互效應(yīng)(F=0.693,P=0.655)。3組患者脛骨前肌肌力總體比較,差異無(wú)統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=2.743,P=0.066)。手術(shù)前后不同時(shí)間點(diǎn)之間脛骨前肌肌力的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=81.044,P=0.000); 3組患者脛骨前肌肌力隨時(shí)間延長(zhǎng)均呈逐漸增大趨勢(shì)[(1.38±1.02)級(jí),(2.47±1.35)級(jí),(3.09±1.26)級(jí),(3.68±1.39)級(jí),F=20.484,P=0.000;(1.50±0.97)級(jí),(2.42±1.34)級(jí),(3.78±1.07)級(jí),(4.00±1.10)級(jí),F=39.381,P=0.000;(1.66±1.04)級(jí),(2.50±1.50)級(jí),(3.75±1.16)級(jí),(4.00±1.22)級(jí),F=25.012,P=0.000]。④足下垂康復(fù)率。所有患者均獲得隨訪,隨訪時(shí)間18～30個(gè)月。術(shù)后2 d、術(shù)后6個(gè)月及末次隨訪時(shí),3組患者的足下垂康復(fù)率比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.067,P=1.000; χ2=1.457,P=0.483; χ2=1.094,P=0.579); 術(shù)后6周3組患者足下垂康復(fù)率的差異有統(tǒng)計(jì)學(xué)意義(χ2=6.338,P=0.045),進(jìn)一步兩兩比較(α’=0.017),組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(χ2=4.666,P=0.035; χ2=4.855,P=0.048; χ2=0.014,P=1.000)。結(jié)論:對(duì)于接受腰椎減壓手術(shù)治療的腰椎退行性疾病合并足下垂患者,術(shù)后進(jìn)行生物電刺激治療不能明顯提高脛骨前肌肌力和足下垂康復(fù)率,但能在早期緩解下肢疼痛、改善患者生活質(zhì)量; 經(jīng)皮電刺激治療和針刺電刺激治療的效果沒(méi)有明顯差異。
Abstract:
Objective:To explore the applied values of bio-electric stimulation(BES)therapy in postoperative rehabilitation of patients undergoing lumbar decompression surgery for treatment of lumbar degenerative diseases and foot drop.Methods:One hundred and two patients with lumbar degenerative diseases and foot drop were enrolled in the study and were randomly divided into 3 groups.All patients in the 3 groups were treated with lumbar decompression surgery,followed by conventional functional exercises.Thirty-four patients were merely treated with conventional functional exercises(conventional exercise group),moreover,36 patients were further treated with transcutaneous electrical stimulation(TES)therapy(TES therapy group),and 32 patients with acupuncture electrical stimulation(AES)therapy(AES therapy group)for consecutive 6 weeks.The curative effects were evaluated by measuring lower limb pain visual analogue scale(VAS)scores,Oswestry disability index(ODI),tibialis anterior(TA)muscle strength and recovery rate of foot drop.Results:There was interaction between time factor and group factor in lower limb pain VAS scores(F=3.558,P=0.002).There was no statistical difference in lower limb pain VAS scores between the 3 groups in general,in other words,there was no group effect(F=1.082,P=0.340).There was statistical difference in lower limb pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=275.441,P=0.000).The lower limb pain VAS scores presented a time-dependent decreasing trend in the 3 groups(5.59±1.84,3.50±1.52,2.38±1.02,1.76±0.99 points,F=49.742,P=0.000; 6.64±2.05,3.72±1.23,1.86±0.87,1.06±0.86 points,F=123.021,P=0.000; 6.19±1.77,3.44±0.98,1.84±0.81,0.97±0.86 points,F=122.715,P=0.000).There was no statistical difference in lower limb pain VAS scores between the 3 groups before the surgery and at 2 days after the surgery(F=2.699,P=0.072; F=0.481,P=0.620); while the differences between the 3 groups at 6 weeks and 6 months after the surgery were statistically significant(F=3.907,P=0.023; F=7.872,P=0.001).The lower limb pain VAS scores were lower in TES therapy group and AES therapy group compared to conventional exercise group(P=0.018,P=0.017; P=0.001,P=0.001),and there was no statistical difference between TES therapy group and AES therapy group(P=0.937; P=0.694).There was interaction between time factor and group factor in ODI(F=2.707,P=0.031).There was statistical difference in ODI between the 3 groups in general,in other words,there was group effect(F=14.775,P=0.000).There was statistical difference in ODI between different timepoints before and after the surgery,in other words,there was time effect(F=189.455,P=0.000)...

參考文獻(xiàn)/References:

[1] WANG Y,NATARAJ A.Foot drop resulting from degenerative lumbar spinal diseases:clinical characteristics and prognosis[J].Clin Neurol Neurosurg,2014,117:33-39.
[2] 宋揚(yáng)揚(yáng),徐文韜,倪光夏.針灸對(duì)軸突生長(zhǎng)導(dǎo)向分子影響的研究進(jìn)展[J].針刺研究,2020,45(11):941-944.
[3] 王東巖,何雷,宋晶,等.經(jīng)皮穴位電刺激改善腦卒中后偏癱患者踝背屈障礙的療效觀察[J].針灸臨床雜志,2018,34(5):38-41.
[4] 胥少汀,葛寶豐,徐印坎.實(shí)用骨科學(xué)[M].4版.北京:人民軍醫(yī)出版社,2012.
[5] STEVENS F,WEERKAMP N J,CALS J W.Foot drop[J].BMJ,2015,350:1736.
[6] CHIAROTTO A,MAXWELL L J,OSTELO R W,et al.Measurement properties of visual analogue scale,numeric rating scale,and pain severity subscale of the brief pain inventory in patients with low back pain:a systematic review[J].J Pain,2019,20(3):245-263.
[7] FAIRBANK J C,PYNSENT P B.The oswestry disability in-dex[J].Spine(Phila Pa 1976),2000,25(22):2940-2952.
[8] LIU K,ZHU W,SHI J,et al.Foot drop caused by lumbar degenerative disease:clinical features,prognostic factors of surgical outcome and clinical stage[J].PLoS One,2013,8(11):e80375.
[9] YOUNG A,GETTY J,JACKSON A,et al.Variations in the pattern of muscle innervation by the L5 and S1 nerve Roots[J].Spine(Phila Pa 1976),1983,8(6):616-624.
[10] 劉昆,賈連順,史建剛,等.腰椎退變性疾病致足下垂的臨床特點(diǎn)及其預(yù)后影響因素[J].中國(guó)脊柱脊髓雜志,2013,23(4):302-306.
[11] 吳亞?wèn)|,魯玉州,齊曉艷,等.聯(lián)合手術(shù)治療腰椎退行性病足下垂相關(guān)因素分析[J].中國(guó)矯形外科雜志,2020,28(1):20-24.
[12] AONO H,NAGAMOTO Y,TOBIMATSU H,et al.Surgical outcomes for painless drop foot due to degenerative lumbar disorders[J].J Spinal Disord Tech,2014,27(7):E258-E261.
[13] BHARGAVA D,SINHA P,ODAK S,et al.Surgical outcome for foot drop in lumbar degenerative disease[J].Global Spine J,2012,2(3):125-128.
[14] 魯玉州,吳亞?wèn)|,王金國(guó).腰椎退行性病變伴足下垂手術(shù)治療的臨床研究進(jìn)展[J].中國(guó)當(dāng)代醫(yī)藥,2019,26(25):29-31.
[15] BEKLER H,BEYZADEO(ˇoverG)LU T,G?? A.Tibialis posterior tendon transfer for drop foot deformity[J].Acta Orthop Traumatol Turc,2007,41(5):387-392.
[16] GIRARDI F P,CAMMISA F J,HUANG R C,et al.Improvement of preoperative foot drop after lumbar surgery[J].J Spinal Disord Tech,2002,15(6):490-494.
[17] BIELECKI M,ZEBROWSKI P,KURYLISZYN-MOSKAL A.Treatment of foot drop in orthopaedic practice[J].Wiad Lek,2012,65(2):132-137.
[18] SAHYOUNI R,MAHMOODI A,CHEN J W,et al.Inter-facing with the nervous system:a review of current bioelectric technologies[J].Neurosurg Rev,2019,42(2):227-241.
[19] 區(qū)燕云,李冬芬,何煜才,等.經(jīng)皮穴位電刺激配合康復(fù)鍛煉干預(yù)方案對(duì)危重癥多發(fā)性神經(jīng)病患者下肢運(yùn)動(dòng)功能的改善效果[J].中國(guó)醫(yī)藥科學(xué),2019,9(1):180-182.
[20] 李菲,孫琦,邵曉梅,等.電針配合PNF調(diào)節(jié)腦卒中患者下肢本體感覺(jué)及運(yùn)動(dòng)功能:隨機(jī)對(duì)照研究[J].中國(guó)針灸,2019,39(10):1034-1040.
[21] 閆泓池.環(huán)跳穴的深淺不同刺法對(duì)坐骨神經(jīng)損傷大鼠L4-L5神經(jīng)節(jié)中PI3K、AKT、Bcl-2表達(dá)的影響[D].沈陽(yáng):遼寧中醫(yī)藥大學(xué),2016.
[22] ESTEVE V,CARNEIRO J,MORENO F,et al.The effect of neuromuscular electrical stimulation on muscle strength,functional capacity and body composition in haemodialysis patients[J].Nefrologia,2017,37(1):68-77.
[23] 高睿琦,唐成林,黃思琴,等.電針對(duì)失坐骨神經(jīng)大鼠腓腸肌細(xì)胞凋亡及相關(guān)蛋白的影響[J].針刺研究,2017,42(4):302-307.
[24] 陳佳旭,邵開(kāi)超,魯常武.神經(jīng)干刺激療法在腦卒中恢復(fù)期患者下肢功能康復(fù)中的應(yīng)用[J].針刺研究,2020,45(5):412-415.
[25] 端木程琳,王曉宇,張曉寧,等.不同強(qiáng)度電針和經(jīng)皮穴位電刺激對(duì)肌肉炎性痛大鼠的鎮(zhèn)痛效應(yīng)[J].針刺研究,2020,45(11):902-907.
[26] YOSHIDA Y,IKUNO K,SHOMOTO K.Comparison of the effect of sensory-level and conventional motor-level neuromuscular electrical stimulations on quadriceps strength after total knee arthroplasty:a prospective randomized single-blind trial[J].Arch Phys Med Rehabil,2017,98(12):2364-2370.

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[7]秦杰,李振宇.三法十式手法配合中藥腰痹湯治療腰椎間盤(pán)突出癥[J].中醫(yī)正骨,2011,23(02):71.
[8]顏 峰.椎間融合術(shù)配合中藥外敷治療退行性腰椎滑脫癥[J].中醫(yī)正骨,2016,28(01):38.
[9]喻秋萍,唐萌芽,王崢?lè)?等.身痛逐瘀湯治療腰椎間盤(pán)突出癥的系統(tǒng)評(píng)價(jià)[J].中醫(yī)正骨,2016,28(06):24.
　YU Qiuping,TANG Mengya,WANG Zhengfeng,et al.Efficacy of Shentong Zhuyu Tang(身痛逐瘀湯)for treatment of lumbar disc herniation:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(05):24.
[10]董永強(qiáng),何鑫東,張偉偉,等.經(jīng)皮椎間孔鏡髓核摘除術(shù)聯(lián)合McKenzie療法治療腰椎間盤(pán)突出癥的臨床研究[J].中醫(yī)正骨,2016,28(07):38.
　DONG Yongqiang,HE Xindong,ZHANG Weiwei,et al.Observation on the curative effect of fire-needle therapy for treatment of supraspinal and interspinal ligament injuries[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(05):38.
[11]劉彥璐,林耐球,李紹旦,等.正骨手法結(jié)合中藥外敷治療腰椎間盤(pán)突出癥[J].中醫(yī)正骨,2015,27(02):26.
[12]邵禮暉,潘浩.Coflex棘突間動(dòng)態(tài)穩(wěn)定系統(tǒng)治療腰椎退變性疾病40例[J].中醫(yī)正骨,2015,27(02):37.
[13]郭新軍,朱卉敏,王衡,等.一次性纖維環(huán)縫合器在腰椎間盤(pán)突出癥髓核摘除術(shù)中的應(yīng)用[J].中醫(yī)正骨,2015,27(03):59.
[14]林斌,黎秋生,何勇,等.椎弓根螺釘單側(cè)固定與雙側(cè)固定治療腰椎間盤(pán)突出癥 對(duì)鄰近節(jié)段退變的影響[J].中醫(yī)正骨,2015,27(01):16.
　LIN Bin,LI Qiusheng,HE Yong,et al.Effect of unilateral versus bilateral fixation with pedicle screws on adjacent segment degeneration in patients with lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(05):16.
[15]賈龍,張華.“治未病”思想指導(dǎo)下腰椎間盤(pán)突出癥的辨證防治[J].中醫(yī)正骨,2017,29(01):36.
[16]聶富祥,賀海懌,朱文輝,等.一次性可擴(kuò)張通道下微創(chuàng)經(jīng)椎間孔入路腰椎間融合術(shù)治療單節(jié)段腰椎退行性疾病[J].中醫(yī)正骨,2017,29(05):34.
[17]宋仁謙,周英杰,趙剛.經(jīng)皮可灌注骨水泥椎弓根螺釘固定治療合并嚴(yán)重骨質(zhì)疏松癥的腰椎退行性疾病[J].中醫(yī)正骨,2017,29(05):37.
[18]張史飛,任紹東,屠永剛,等.椎弓根螺釘雙皮質(zhì)固定治療合并骨質(zhì)疏松的腰椎不穩(wěn)癥[J].中醫(yī)正骨,2017,29(09):73.
[19]鄧羅義,孫紅,寧旭.神經(jīng)根沉降征及其在腰椎退行性疾病診斷中的應(yīng)用價(jià)值[J].中醫(yī)正骨,2018,30(08):50.
[20]李智斐,李嘉瑯,張翼升,等.醫(yī)用臭氧治療腰椎間盤(pán)突出癥的作用機(jī)制及應(yīng)用進(jìn)展[J].中醫(yī)正骨,2018,30(10):59.

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更新日期/Last Update: 1900-01-01