本文選題：腰背肌　切入點：功能鍛煉　出處：《黑龍江中醫(yī)藥大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：退行性腰椎滑脫(degenerative lumbar spondyloli-sthesis,DLS)也稱“假性滑脫”,是由于腰椎間盤和腰椎關(guān)節(jié)退變,使椎體間連接發(fā)生異常,引起的上位椎體與下位椎體表面部分或全部的滑移。退行性腰椎滑脫是一種臨床常見腰椎病變,目前臨床治療手段可分為非手術(shù)治療(保守治療)和手術(shù)治療兩大類,但是如果治療方法選擇不恰當,就會造成致殘率的增加,進而對患者正常工作生活產(chǎn)生嚴重影響。對于輕度的腰椎滑脫,大多數(shù)患者希望采取非手術(shù)治療,緩解癥狀。在醫(yī)生指導(dǎo)下進行腰背肌功能鍛煉,增強全身和局部機能,促進氣血運行,增進機體修復(fù)能力,防止關(guān)節(jié)的僵硬、軟組織的粘連和肌肉萎縮,使機體恢復(fù)到正常狀態(tài)。加強腰部周圍的肌肉、韌帶的力量來維持腰椎的穩(wěn)定性,其療效被越來越多的臨床醫(yī)師認可。本臨床觀察選取退行性腰椎滑脫的患者,從腰椎的解剖結(jié)構(gòu)、影像學(xué)、患者體征等角度去認識退行性腰椎滑脫,并查閱本病相關(guān)的文獻參考,著重闡述了腰背肌功能鍛煉的方法。并選取確診病例,采取隨機分組模式,分為對照組(臥床、腰椎制動等保守治療方式)和治療組(在對照組治療的基礎(chǔ)上配合腰背肌功能鍛煉),比較兩組治療的療效,客觀評價了腰背肌功能鍛煉對退行性腰椎滑脫治療的臨床療效。目的：證明腰背肌功能鍛煉在治療退行性腰椎滑脫中的效能,為保守治療退行性腰椎滑脫提供依據(jù),為制定腰背肌功能鍛煉治療退行性腰椎滑脫標準提供科學(xué)依據(jù)。研究方法：將符合觀察期間(2014年3月到2015年1月)及符合納入標準的60例的退行性腰椎滑脫的住院患者(均來自黑龍江中醫(yī)藥大學(xué)附屬第一醫(yī)院的骨傷二科病房),采取隨機抽簽的方式,隨機劃分為治療組和對照組,每組收納30例患者,對照組采用臥床、腰椎制動等保守治療方式；治療組采用在對照組治療的基礎(chǔ)上配合腰背肌功能鍛煉,主要觀察指標為患者治療前后JOA評分,時限以1個月為1個療程。結(jié)果：全部受試者經(jīng)1個療程的治療后,觀察結(jié)果為,治療組總有效率90%,對照組總有效率為63%。且治療組患者各項評定指標均優(yōu)于對照組,經(jīng)統(tǒng)計學(xué)分析,數(shù)據(jù)差異有統(tǒng)計學(xué)意義,可見主動的腰背肌功能鍛煉在治療退行性腰椎滑脫的療效優(yōu)于單純的傳統(tǒng)的保守方式。結(jié)論：1、腰背肌功能鍛煉對治療退行性腰椎滑脫具有明顯療效。2、腰背肌功能鍛煉對維持腰椎穩(wěn)定起一定作用。3、腰背肌功能鍛煉能有效地延緩滑脫的進行性發(fā)展且優(yōu)于常規(guī)的非手術(shù)治療方法。4、腰背肌功能鍛煉方法簡單、系統(tǒng),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.
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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