| 基于动态肌电图的腰椎间盘突出症诊治和相关因素研究 |
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Received:December 19, 2021
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| 期刊信息：《中国骨伤》2022年35卷，第10期，第984-989页 |
| DOI：10.12200/j.issn.1003-0034.2022.10.015 |
| 基金项目:上海市卫生和计划生育委员会中医药科研课题(编号:2020LP034);上海市卫生和计划生育委员会科研课题面上项目(编号:202140130) |
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目的:分析腰椎间盘突出症(lumbar disc herniation,LDH)患者腰背部肌肉活动的动态肌电特征及相关因素,阐明动态肌电在腰椎间盘突出症患者诊治过程中的临床意义。
方法:自2014年9月至2021年3月,采用表面肌电图遥测仪检测40例腰椎间盘突出症患者,男14例,女26例;年龄20~61(40.68±10.56)岁;病程1~120(17.75±27.56)个月。另外招募12例正常人作为对照组,男2例,女10例;年龄24~53(36.50±10.30)岁。对所有受试者进行静止站立、躯干屈伸过程中的近胸段竖脊肌、腰段竖脊肌、多裂肌的动态肌电测试。比较两组受试者肌电活动数据(肌电振幅、中位频率、原始肌电图形),分析腰椎间盘突出症患者一般资料与肌电活动数据的相关性。
结果:静止站立时,腰椎间盘突出症LDH组受试者右侧及左侧近胸段竖脊肌肌电振幅值较对照组增大(P<0.05)。躯干屈伸时,LDH组受试者右侧及左侧近胸段竖脊肌、腰段竖脊肌、多裂肌肌电振幅均较对照组增大(P<0.05);躯干屈伸时,LDH组受试者右侧及左侧近胸段竖脊肌、腰段竖脊肌、多裂肌中位频率均较对照组增大(P<0.05);躯干屈伸时,LDH组受试者的原始肌电图形与对照组相比明显不同,LDH组受试者的躯干最大限度屈曲维持过程中所测腰背肌肉的肌电活动存在高水平,原始信号中应该规律出现的肌电静止信号不能分辨;躯干屈伸时,LDH组受试者的性别、年龄、体重、身高分别与双侧近胸段、腰段竖脊肌和双侧多裂肌的肌电振幅、中位频率无相关性(P>0.05)。
结论:腰椎间盘突出症患者腰背部肌肉存在不同于正常人的特征性表面肌电改变,这些特征更能客观地反映患者的肌肉情况,可以成为腰椎间盘突出症患者诊断和治疗效果评价的有效指标。由此可见,表面肌电图不单是一种检测手段,其可被考虑在LDH的常规诊疗计划之内来指导临床工作。 |
| [关键词]:动态肌电|椎间盘移位|腰椎|诊断|治疗|相关因素 |
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| Study on diagnosis and treatment of lumbar disc herniation and related factors based on dynamic electromyography |
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Abstract:
Objective: To analyze dynamic electromyography characteristics and related factors of lumbar back muscle activity in patients with lumbar disc herniation,and to clarify the clinical significance of dynamic electromyography in the diagnosis and treatment of patients with lumbar disc herniation(LDH).
Methods: From September 2014 to March 2021,40 patients with lumbar disc herniation(LDH group) were detected by surface electromyography telemeter. There were 14 males and 26 females,aged from 20 to 61 years old,with an average of(40.68±10.56) years old,the course of illness was from 1 to 120 months,with an average of (17.75±27.56) months. In addition,12 normal people were recruited as the control group. There were 2 males and 10 females. The age ranged from 24 to 53 years old,with an average of(36.50±10.30) years old. All subjects were subjected to dynamic electromyographic tests of the subthoracic erector spinae,lumbar erector spinae,and multifidus muscles during static standing and trunk flexion and extension. Compare the EMG activity data (average EMG amplitude,median frequency,original EMG graph) of the tested muscles between patients with lumbar disc herniation and normal people,and analyze the correlation between the general data of patients with lumbar disc herniation and the tested muscle EMG data.
Results: When standing still,the average electromyographic amplitude of the erector spinal muscle of the right and left thoracic segments of the subjects in the LDH group increased compared with the control group,and the difference was significant(P<0.05). In the trunk flexion and extension,the average electromyographic amplitude of the right and left proximal thoracic erector spinae,the right left lumbar erector spinae,and the right left multifidus muscle of the subjects in the LDH group are all larger than the control group,and the difference was significant(P<0.05). In the trunk flexion and extension,the median frequencies of the right left proximal thoracic erector spinae、the right left lumbar erector spinae,and the right left multifidus muscle of the subjects in the LDH group were all larger than the normal control group,and the difference was significant (P<0.05). During trunk flexion and extension,the original electromyographic patterns of subjects in the LDH group were significantly different from those in the control group. During the maintenance of the maximum trunk flexion of the subjects in the LDH group,there was a high level of electromyographic activity of the lower back muscles,and the electromyographic static signals that should appear regularly in the original signal could not be distinguished. When the trunk was flexed and extended,had gender,age,weight and height of subjects in the LDH group were not significantly correlated with the average EMG amplitude and median frequency of bilateral proximal thoracic,lumbar erector spinae and bilateral multifidus muscles respectively(P>0.05).
Conclusion: Patients with lumbar disc herniation have characteristic surface EMG changes in the back muscles that are different from those of normal people. These features can more objectively reflect the patient's muscle condition and can be an effective indicator for the diagnosis and treatment effect evaluation of patients with lumbar disc herniation. It can be seen that surface electromyography is not only a detection method,it can be considered in the routine diagnosis and treatment plan of LDH to guide clinical work. |
| KEYWORDS:Dynamic electromyography|Intervertebral disk displacement|Lumbar vertebrae|Diagnosis|Treatment|Related factors |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 黄萍,卢玄,郭蕾,徐醒,沈峥嵘,陈博.基于动态肌电图的腰椎间盘突出症诊治和相关因素研究[J].中国骨伤,2022,35(10):984~989 |
| 英文格式: | HUANG Ping,LU Xuan,GUO Lei,XU Xing,SHEN Zheng-rong,CHEN Bo.Study on diagnosis and treatment of lumbar disc herniation and related factors based on dynamic electromyography[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(10):984~989 |
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