本体感觉反射疗法治疗颈型颈椎病表面肌电活动研究

发布时间：2018-05-09 21:35

本文选题：颈型颈椎病 + 澳式手法　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:本研究采用本体感觉反射疗法与澳式手法治疗颈型颈椎病,通过比较分析治疗前后表面肌电信号,观察颈部肌肉疲劳与表面肌电信号特征的相关性,探讨表面肌电图检测是否可以作为检测手法有效性的一种客观的、可量化的有效的观察指标。方法:本实验采用随机对照研究,利用计算机随机数字表法产生随机数字,从2016年3月至2016年12月在广东省中医院康复科门诊接受诊治的患者中,选取符合本研究纳入标准的60例颈型颈椎病患者,随机分组对照组和观察组,两组各30例,总共收集病例63例,其中脱落3例例,其它患者均顺利完成实验,收集到有效病例60例。对照组接受澳式手法治疗,观察组接受本体感觉反射疗法治疗,每组均接受3次治疗,每次治疗前后均进行简化McGill疼痛询问量表(MPQ)评估、痛域测定、表面肌电图检测。两组患者在治疗结束2周后接受1次随访。数据采集完成后,对数据先进行基线分析,计数数据组与组之间比较时采用卡方检验,符合正态分布以及方差齐性的特点的计量数据组与组之间比较时,采用t检验。不符合正态分布或者方差齐性的特点时,采用秩和检验进行分析;实验结果采用重复测量的方差分析。结果:本研究纳入的60例患者,对照组男12例,女18例,平均年龄(岁)28.80±6.07,平均病程(天)28.00±24.82;观察组男10例,女20例,平均年龄(岁)27.13±4.53,平均病程(天)33.23±37.00;两组患者的基本情况包括年龄、性别、病程、治疗前MPQ评分、治疗前痛域、治疗前胸锁乳突肌肌电值、颈竖脊肌屈曲放松比组间进行比较,差异无统计学意义(P0.05),具有可比性。治疗后,整体分析显示各项指标在时间点主效应上均有统计学意义,而在处理主效应上仅在痛域测定中左、右侧耐痛域和胸锁乳突肌左旋左侧RMS、右旋右侧RMS指标有统计学差异外,其余各项均无统计学意义;另外,疼痛问卷量表中S和Total处理效应与时间的交互作用均有统计学意义,胸锁乳突肌左右前屈AEMG和RMS处理效应与时间效应也存在交互作用。进一步对时间点进行分析,组间比较:两组简化McGill疼痛询问量表(MPQ)仅在第1次治疗后疼痛强度(PPI)方面比较有显著性差异(P0.05);痛域测定方面,两组第1次治疗后左侧耐痛域和第2次治疗后左、右耐痛域比较差异有显著性意义(P0.05);竖脊肌屈曲放松比:第1次治疗后,颈竖脊肌两组左侧屈曲放松比比较差异有显著性意义(P0.05)。胸锁乳突肌肌电值:第1次治疗后,胸锁乳突肌两组右旋右侧时RMS比较差异有显著性意义(P0.05),第2次治疗后,胸锁乳突肌两组左旋左侧、右旋右侧时RMS比较差异均有显著性意义(P0.05),第3次治疗后,两组右旋时右侧胸锁乳突肌RMS比较有显著性差异(P0.05)。结论:对照组与观察组均能有效改善颈型颈椎病患者主观感觉、肩中俞痛域,在肌电活动方面,两种手法对颈部屈曲放松比、颈前屈时胸锁乳突肌的肌电活动影响是没有明显差异的,但对照组手法对旋转时胸锁乳突肌的肌电活动影响较观察组好。
[Abstract]:Objective: This study used proprioceptive reflex therapy and Australian manipulation to treat cervical spondylosis. By comparing and analyzing the surface electromyography (EMG) before and after treatment, the correlation between cervical muscle fatigue and surface myoelectric signal characteristics was observed. It was discussed whether the surface electromyography detection could be an objective and quantifiable method to detect the effectiveness of the manipulation. Methods: the randomized controlled study was used in this experiment. Random numbers were used to produce random numbers. From March 2016 to December 2016, 60 patients with cervical spondylosis were selected in the patients who were treated in the clinic of Rehabilitation Department of Guangdong Province Traditional Chinese Medical Hospital, which were randomly divided into control group and observation group, two In the group of 30 cases, a total of 63 cases were collected, of which 3 cases were exfoliated. All the other patients completed the experiment successfully and collected 60 cases of effective cases. The control group received Australian manipulation treatment, the observation group received proprioceptive reflex therapy, each group received 3 treatment, and each treatment was evaluated by simplified McGill pain questionnaire (MPQ) before and after each treatment, and the pain domain was evaluated before and after each treatment. Two groups of patients were followed up for 1 times after 2 weeks of treatment. After the data collection was completed, the data were first baseline analyzed, the count data group and the group were compared with the chi square test. The t test was adopted when the measurement number of the normal distribution and the homogeneity of variance was compared between the group and the group. In the characteristics of state distribution or homogeneity of variance, the rank sum test was used to analyze the results, and the experimental results were analyzed by repeated measurements. Results: 60 patients were included in this study, 12 in the control group and 18 in women, with the average age of 28.80 + 6.07 and the average course (day) 28 + 24.82; the average age was 27.13 + 27.13 + 4.53, the average age was 27.13 + 4.53, and the average age was 27.13 +. The course of the disease (day) was 33.23 + 37. The basic conditions of the two groups were age, sex, course of disease, pre treatment MPQ score, pre treatment pain domain, treatment of the electromyography of the sternocleidomastoid muscle and the flexion relaxation of the cervical spine muscle. There was no statistical difference (P0.05). The overall analysis showed that the indexes were in the time point. There were statistical significance in the effect, but in the treatment of the main effect only in the pain domain, the right pain domain and the left left RMS of the sternocleidomastoid muscle and the right right-hand right RMS index had statistical difference, and the other items were not statistically significant. In addition, the interaction of S and Total treatment effect and time in the pain questionnaire was statistically significant. There was also interaction between the AEMG and RMS treatment effects of the left and right papillomastoid myomomastoid flexion and the time effect of the sternocleidomastoid muscle. Further analysis of the time point was carried out. The two groups of simplified McGill pain questionnaire (MPQ) had significant difference (P0.05) in the pain intensity (PPI) only after first times of treatment (P0.05); the pain domain was measured, and the two groups were treated left after the treatment. There was significant difference in the left and right pain tolerance regions of the lateral pain domain and the second treatment (P0.05); the flexion and relaxation ratio of the erection muscle was significant (P0.05) after the treatment of the first times. The electromyography of the sternocleidomastoid muscle: after the first treatment, the RMS difference was compared between the two groups of the right side of the sternocleidomastoid muscle and the right side of the sternocleidomastoid muscle. There was significant significance (P0.05). After the second treatment, there were significant differences in the RMS difference between the left side left side of the sternocleidomastoid muscle group and the right side on the right side (P0.05). After the third treatment, the RMS of the right sternocleidomastoid muscle in the two groups was significantly different (P0.05). Conclusion: the control group and the observation group can effectively improve the subjective of cervical spondylosis patients. It is felt that there is no significant difference between the two manipulations on the flexion and relaxation ratio of the neck and the electromyoelectric activity of the sternocleidomastoid muscle during the cervical flexion, but the control group has a better effect on the electromyography of the sternocleidomastoid muscle than the observation group.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.55

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