摘要目的 研究支具疗法、特定运动疗法以及两者相结合方式对青少年特发性脊柱侧凸患者弯弧、生活质量和躯干肌肉力量的影响。方法 选取2018年9月至2021年2月天津医院行支具、运动和两者联合治疗的青少年特发性脊柱侧凸各20例,共60例受试者。其中支具组男4例,女16例;年龄10~15岁,平均(13.46±1.46)岁;运动组男7例,女13例;年龄10.00~14.50岁,平均(12.83±1.77)岁;联合组男6例,女14例;年龄10~15岁,平均(13.02±1.56)岁。三组按照制定的个体化方案治疗。分别记录治疗前和末次随访时的一般资料和影像学资料及SRS22问卷量表(scoliosis research society-22,SRS-22)和顶椎椎旁肌两侧的表面肌电信号。结果 与治疗前相比,三组治疗均可阻止侧凸Cobb角和躯干旋转角(angle of trunk rotation,ATR)进展,联合组的Cobb角、ATR和运动组的ATR较治疗前,差异有统计学意义(P<0.05);生活质量方面,运动组和联合组对于疼痛、心理健康和治疗满意度的改善优于支具组(P<0.05);表面肌电结果显示支具组与运动组顶椎椎旁肌两侧差异有统计学意义(P<0.05),且凸侧高于凹侧。支具组与联合组之间弯弧凸凹两侧的平均均方根值(root mean square,RMS)相比,差异有统计学意义(P<0.05)。结论 支具与特定运动疗法相结合可更有效改善患者Cobb角和ATR,提高患者生活质量和椎旁肌肌肉力量。
Abstract:Objective To study the effects of brace therapy,specific exercise therapy,and a combination of the two on the curve,quality of life and trunk muscle strength of adolescent patients with idiopathic scoliosis.Methods 60 adolescent idiopathic scoliosis patients underwent bracing,exercise and combined treatment of the bracing and exercise in Tianjin Hospital from September 2018 to February 2021 with 20 patients in each group.Among them,there were 4 males and 16 females in the brace group,and the ages ranged from 10 to 15 years with an average age of (13.46±1.46)years.There were 7 males and 13 females in the exercise group,and the ages ranged from 10.00 to 14.50 years with an average age of (12.83±1.77)years.In the combined group,there were 6 males and 14 females,and the age ranged from 10 to 15 years with an average age of (13.02±1.56)years.The three groups were treated in accordance with the established individualized plan.The general data and imaging data before treatment and at the last follow-up were recorded,as well as the SRS-22 questionnaire (scoliosis research society-22) and the surface electromyography(EMG) signals on both sides of the paraspinal muscles.Results Compared with before treatment,the three groups of treatments can prevent the progression of scoliosis Cobb angle and ATR (angle of trunk rotation,ATR).The Cobb angle,ATR in the combined group and ATR of the exercise group had statistically significant differences compared those before treatment (P<0.05).In terms of quality of life,the improvement of pain,mental health and treatment satisfaction in the exercise group and the combined group was better than that of the brace group (P<0.05).The surface EMG results showed the convex side was higher than the concave side near the apical vertebra in the brace group and exercise group,(P<0.05).The root mean square(RMS) between the brace group and the combination group was statistically different (P<0.05).Conclusion The combination of brace and specific exercise therapy can more effectively improve the Cobb angle and ATR of patients,and improve the quality of life and paraspinal muscle strength.
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