腰背肌功能锻炼治疗退行性腰椎滑脱的临床观察

发布时间：2018-03-13 08:24

本文选题：腰背肌　切入点：功能锻炼　出处：《黑龙江中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：退行性腰椎滑脱(degenerative lumbar spondyloli-sthesis,DLS)也称“假性滑脱”,是由于腰椎间盘和腰椎关节退变,使椎体间连接发生异常,引起的上位椎体与下位椎体表面部分或全部的滑移。退行性腰椎滑脱是一种临床常见腰椎病变,目前临床治疗手段可分为非手术治疗(保守治疗)和手术治疗两大类,但是如果治疗方法选择不恰当,就会造成致残率的增加,进而对患者正常工作生活产生严重影响。对于轻度的腰椎滑脱,大多数患者希望采取非手术治疗,缓解症状。在医生指导下进行腰背肌功能锻炼,增强全身和局部机能,促进气血运行,增进机体修复能力,防止关节的僵硬、软组织的粘连和肌肉萎缩,使机体恢复到正常状态。加强腰部周围的肌肉、韧带的力量来维持腰椎的稳定性,其疗效被越来越多的临床医师认可。本临床观察选取退行性腰椎滑脱的患者,从腰椎的解剖结构、影像学、患者体征等角度去认识退行性腰椎滑脱,并查阅本病相关的文献参考,着重阐述了腰背肌功能锻炼的方法。并选取确诊病例,采取随机分组模式,分为对照组(卧床、腰椎制动等保守治疗方式)和治疗组(在对照组治疗的基础上配合腰背肌功能锻炼),比较两组治疗的疗效,客观评价了腰背肌功能锻炼对退行性腰椎滑脱治疗的临床疗效。目的：证明腰背肌功能锻炼在治疗退行性腰椎滑脱中的效能,为保守治疗退行性腰椎滑脱提供依据,为制定腰背肌功能锻炼治疗退行性腰椎滑脱标准提供科学依据。研究方法：将符合观察期间(2014年3月到2015年1月)及符合纳入标准的60例的退行性腰椎滑脱的住院患者(均来自黑龙江中医药大学附属第一医院的骨伤二科病房),采取随机抽签的方式,随机划分为治疗组和对照组,每组收纳30例患者,对照组采用卧床、腰椎制动等保守治疗方式；治疗组采用在对照组治疗的基础上配合腰背肌功能锻炼,主要观察指标为患者治疗前后JOA评分,时限以1个月为1个疗程。结果：全部受试者经1个疗程的治疗后,观察结果为,治疗组总有效率90%,对照组总有效率为63%。且治疗组患者各项评定指标均优于对照组,经统计学分析,数据差异有统计学意义,可见主动的腰背肌功能锻炼在治疗退行性腰椎滑脱的疗效优于单纯的传统的保守方式。结论：1、腰背肌功能锻炼对治疗退行性腰椎滑脱具有明显疗效。2、腰背肌功能锻炼对维持腰椎稳定起一定作用。3、腰背肌功能锻炼能有效地延缓滑脱的进行性发展且优于常规的非手术治疗方法。4、腰背肌功能锻炼方法简单、系统,安全有效。
[Abstract]:Degenerative lumbar spondyloli-s spondyloli-s spondylolisthesis (DLSs), also known as "pseudo-spondylolisthesis," is due to degeneration of the lumbar intervertebral disc and lumbar joint, resulting in abnormal connections between the vertebrae. Degenerative lumbar spondylolisthesis is a common clinical disease of lumbar vertebrae. At present, the clinical treatment can be divided into two categories: non-operative treatment (conservative treatment) and surgical treatment. However, if the treatment is not properly chosen, it will lead to an increase in the rate of disability, which in turn has a serious impact on the normal working life of patients. For mild lumbar spondylolisthesis, most patients wish to take non-surgical treatment. Relief symptoms. Under the guidance of doctors, the psoas and dorsalis muscle function exercise, enhance the whole body and local function, promote the movement of qi and blood, improve the body repair ability, prevent joint stiffness, soft tissue adhesion and muscle atrophy, To restore the body to a normal state. To strengthen the muscles and ligaments around the waist to maintain the stability of the lumbar vertebrae, its efficacy has been recognized by more and more clinicians. This clinical observation selects patients with degenerative lumbar spondylolisthesis. To recognize degenerative lumbar spondylolisthesis from the angle of anatomical structure, imaging, patient's sign and so on, and to refer to the literature about this disease, the method of lumbar dorsalis muscle function exercise was expounded emphatically, and the confirmed cases were selected, and the random grouping model was adopted to study the degenerative lumbar spondylolisthesis. They were divided into two groups: the control group (bed rest, lumbar spine immobilization and other conservative treatment methods) and the treatment group (on the basis of the treatment of the control group combined with the psoas dorsalis function exercise), and the curative effects of the two groups were compared. Objective: to evaluate the efficacy of lumbar dorsalis muscle exercise in the treatment of degenerative lumbar spondylolisthesis, and to provide evidence for conservative treatment of degenerative lumbar spondylolisthesis. To provide scientific basis for the establishment of standard for the treatment of degenerative lumbar spondylolisthesis by lumbar dorsalis muscle functional exercise. Methods: 60 cases of degenerative lumbar spondylolisthesis in accordance with the observation period (March 2014 to January 2015) and 60 cases of degenerative lumbar spondylolisthesis were included. The patients (all from the first affiliated Hospital of Heilongjiang University of traditional Chinese Medicine in the second Department of Bone injury) were randomly drawn by lots. They were randomly divided into treatment group and control group, each group received 30 patients, the control group was treated with bed rest, lumbar spine immobilization and other conservative treatment methods, and the treatment group was treated with lumbar dorsum muscle function exercise on the basis of the control group. The main outcome measure was JOA score before and after treatment, and the time limit was 1 month as a course of treatment. Results: after one course of treatment, the results of observation were as follows:. The total effective rate of the treatment group was 90 and the total effective rate of the control group was 63. All the evaluation indexes of the patients in the treatment group were superior to those in the control group. It can be seen that active lumbar dorsalis muscle exercise is more effective than traditional conservative method in the treatment of degenerative lumbar spondylolisthesis. Conclusion: 1, psoas dorsal muscle function exercise has obvious curative effect in treating degenerative lumbar spondylolisthesis. Exercise plays a certain role in maintaining lumbar stability. The functional exercise of the lumbar dorsal muscle can effectively delay the progressive development of spondylolisthesis and is superior to the conventional non-surgical treatment of .4.The method of functional exercise of the lumbar dorsalis muscle is simple. System, safe and effective.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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