北京生物医学工程

FM筋膜手法联合筋膜刀疗法对老年下背疼痛的生物力学机制探讨

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

作者：罗军肖立娟刘四文

单位：广东省工伤康复医院康复科（广州 510440） 通信作者：罗军。E-mail：yxzzs10001@163.com

关键词：下背痛；FM筋膜手法；筋膜刀疗法；疼痛；胸腰椎生物力学

分类号：R318.04

出版年·卷·期（页码）：2021·40·5（530-535）

摘要：

目的探讨FM筋膜手法联合筋膜刀疗法对老年下背疼痛的生物力学机制。方法选取2018年2月至2019年11月我院收治的40例老年下背痛患者，随机分为对照组（FM筋膜手法治疗）及实验组（FM筋膜手法结合筋膜刀疗法），进行为期3周的随机对照实验。两组的治疗时间均为3周。于疗程结束后1个月、3个月随访评价中、远期疗效；治疗前、治疗3周后，评估并比较两组疼痛程度；各时点，评估并比较两组的腰椎间凸度和骶骨倾斜角；各时点，测量比较两组的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/E）等腰背肌生物力学情况。结果实验组随访1个月、随访3个月的治疗总有效率均高于对照组，差异有统计学意义（P＜0.05）。治疗前，两组的PRI、VAS、ODI分值对比，差异无统计学意义（P＞0.05）；治疗3周后，两组的PRI、VAS、ODI分值均较治疗前降低，且实验组低于对照组，差异有统计学意义（P＜0.05）。治疗前，两组的腰椎间凸度和骶骨倾斜角对比，差异无统计学意义（P＞0.05）；治疗后，两组的腰椎间凸度较治疗前升高，骶骨倾斜角较治疗前降低，且实验组的腰椎间凸度高于对照组，骶骨倾斜角低于对照组，差异有统计学意义（P＜0.05）；治疗后，两组的AP、PT均较治疗前升高，F/E较治疗前降低，且实验组AP、PT高于对照组，F/E低于对照组，差异有统计学意义（P＜0.05）。结论 FM筋膜手法联合筋膜刀疗法治疗老年下背痛，较单用FM筋膜手法的治疗效果更好，更利于减轻患者疼痛程度，患者治疗后的胸腰椎生物力学性能明显改善，临床应用价值较高。

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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