北京生物醫(yī)學(xué)工程

FM筋膜手法聯(lián)合筋膜刀療法對(duì)老年下背疼痛的生物力學(xué)機(jī)制探討

Investigation on biomechanical mechanism of FM fascia manipulation combined with fascia knife therapy on lower back pain in the elderly

作者：羅軍肖立娟劉四文

單位：廣東省工傷康復(fù)醫(yī)院康復(fù)科（廣州 510440） 通信作者：羅軍。E-mail：[email protected]

關(guān)鍵詞：下背痛；FM筋膜手法；筋膜刀療法；疼痛；胸腰椎生物力學(xué)

分類(lèi)號(hào)：R318.04

出版年·卷·期（頁(yè)碼）：2021·40·5（530-535）

摘要：

目的探討FM筋膜手法聯(lián)合筋膜刀療法對(duì)老年下背疼痛的生物力學(xué)機(jī)制。方法選取2018年2月至2019年11月我院收治的40例老年下背痛患者，隨機(jī)分為對(duì)照組（FM筋膜手法治療）及實(shí)驗(yàn)組（FM筋膜手法結(jié)合筋膜刀療法），進(jìn)行為期3周的隨機(jī)對(duì)照實(shí)驗(yàn)。兩組的治療時(shí)間均為3周。于療程結(jié)束后1個(gè)月、3個(gè)月隨訪評(píng)價(jià)中、遠(yuǎn)期療效；治療前、治療3周后，評(píng)估并比較兩組疼痛程度；各時(shí)點(diǎn)，評(píng)估并比較兩組的腰椎間凸度和骶骨傾斜角；各時(shí)點(diǎn)，測(cè)量比較兩組的60°/s角速的平均功率（average power ，AP）、峰力矩（peak torque ，PT）及腰背屈/伸比值（flexion/extension ，F(xiàn)/E）等腰背肌生物力學(xué)情況。結(jié)果實(shí)驗(yàn)組隨訪1個(gè)月、隨訪3個(gè)月的治療總有效率均高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。治療前，兩組的PRI、VAS、ODI分值對(duì)比，差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）；治療3周后，兩組的PRI、VAS、ODI分值均較治療前降低，且實(shí)驗(yàn)組低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。治療前，兩組的腰椎間凸度和骶骨傾斜角對(duì)比，差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）；治療后，兩組的腰椎間凸度較治療前升高，骶骨傾斜角較治療前降低，且實(shí)驗(yàn)組的腰椎間凸度高于對(duì)照組，骶骨傾斜角低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；治療后，兩組的AP、PT均較治療前升高，F(xiàn)/E較治療前降低，且實(shí)驗(yàn)組AP、PT高于對(duì)照組，F(xiàn)/E低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。結(jié)論 FM筋膜手法聯(lián)合筋膜刀療法治療老年下背痛，較單用FM筋膜手法的治療效果更好，更利于減輕患者疼痛程度，患者治療后的胸腰椎生物力學(xué)性能明顯改善，臨床應(yīng)用價(jià)值較高。

Objective To explore the biomechanical mechanism of FM fascia manipulation combined with fascia knife therapy on lower back pain in the elderly. Methods 42 elderly patients with low back pain who were received by our hospital from February 2018 to November 2019 were randomly divided into a control group (FM fascia manipulation) and an experimental group (FM fascia manipulation combined with fascia knife therapy). A 3-week randomized controlled trial was conducted. The treatment time for both groups was 3 weeks. 1 month and 3 months after the end of the course of treatment, evaluated the mid-term and long-term effects; before treatment and after 3 weeks of treatment, evaluated and compared the pain levels of the two groups, at each time point, the lumbar intervertebral convexity and sacral inclination angle were evaluated and compared between the two groups; at each time point, the biomechanics of lumbar dorsal muscle such as average power (AP), peak torque (PT) and low back flexion/extension ratio (F/E) at 60 °/s angular velocity were measured and compared between the two groups. Results The total effective rate of treatment in the experimental group followed up for 1 month and 3 months was higher than that in the control group, the difference was statistically significant (P<0.05); before treatment, the scores of PRI, VAS, ODI of the two groups were compared, there was no statistical significant difference (P>0.05); after 3 weeks of treatment, the PRI, VAS, and ODI scores of both groups were lower than those before treatment, and the experimental group was lower than the control group, the difference was statistically significant (P<0.05); Before treatment, there was no statistical significant difference in lumbar intervertebral convexity and sacral tilt angle between the two groups (P>0.05); after treatment, the lumbar intervertebral convexity was increased and the sacral tilt angle was decreased in both groups than those before treatment, and the lumbar intervertebral convexity was higher, the sacral tilt angle was lower of the experimental group than those of the control group, the differences were statistically significant (P<0.05); after treatment, the AP and PT were increased, the F/E was decreased in both groups than those before treatment, and AP and PT were higher, F/E was lower in the experimental group than those in the control group, the differences were statistically significant (P<0.05). Conclusions FM fascia manipulation combined with fascia knife therapy for lower back pain in the elderly is better than FM fascia manipulation alone, and it is more conducive to reducing the pain of patients. The biomechanical property of the thoracolumbar spine after treatment is significantly improved, and the clinical value is relatively high.

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