比較增生療法與傳統物理治療對腰薦椎轉變椎體所造成慢性下背痛的療效

Comparison of the Effects of Prolotherapy and Traditional Physical Therapy in Low Back Pain Patients with Lumbosacral Transitional Vertebra

張韡瀚(Wei‐Han Chang) ； 周適偉(Shih‐Wei Chou) ； 陳建宏(Chien‐Hung Chen) ； 吳致寬(Chih‐Kuan Wu) ； 吳佩璇(Katie P. Wu) ； 林瀛洲(Yin‐Chou Lin)

《台灣復健醫學雜誌》 43卷3期 (2015/09) Pp. 159-169

https://doi.org/10.6315/2015.43(3)03

摘要

腰薦椎轉變椎體(Lumbosacral transitional vertebra, LSTV)是一種先天性的骨骼結構異常。腰薦椎橫突變大所形成的無名關節(anomalous articulation)，可能會退化造成下背痛；這類族群的髂腰韌帶(iliolumbarligament)明顯比較細及脆弱，這些因素都有可能是腰薦椎轉變椎體引起下背痛的原因。本研究將探討腰薦椎轉變椎體的下背痛病患，在髂腰韌帶接受增生療法或接受傳統下背痛復健是否會對疼痛、柔軟度及平衡功能產生影響。本研究為病例對照研究(case control study)，共收錄2014年4月至2014年12月間在桃園長庚醫院復健科門診有下背痛症狀的腰薦椎轉變椎體患者22名(排除其它主要造成下背痛原因)。將其分成兩組，實驗組共14人，對照組共8人。實驗組接受增生療法，對照組接受傳統下背痛物理治療。患者在治療前、治療後第四週接受平衡測試、關節柔軟度測試及視覺疼痛量表等檢測。結果顯示在疼痛指數方面，實驗組(增生療法注射髂腰韌帶)在治療4週後，疼痛指數改善明顯比對照組(傳統物理治療)好，但實驗組及對照組治療前後的疼痛指數都有顯著的改善。至於平衡及柔軟度測試治療前後的結果，則沒有統計學上的差異。增生療法對治療與腰薦椎轉變椎體相關的下背痛是可能有效的，而且可能比傳統物理治療在效果及時間效益上有明顯的優勢。

關鍵字

腰薦椎轉變椎體 ； 髂腰韌帶 ； 增生療法 ； 物理治療 ； 下背痛

並列摘要

A lumbosacral transitional vertebra (LSTV) is a congenital musculoskeletal abnormality with a higher incidence in patients with low back pain as to the normal population. Such finding implicates that an altered mechanics caused by a transitional vertebra may contribute to pain generation. In cadavers with an LSTV, the iliolumbar ligament at the level immediately above the transitional vertebra was thinner and weaker than it was for cadavers without an LSTV. This ligament of LSTV is vulnerable to sprains in terms of structural and biomechanical alterations and may be the target of treatment. Twenty-two patients with chronic low back pain in the presence of an LSTV participated in this study. Intervention effects of prolotherapy and traditional physical therapy on pain control, balance performance and flexibility of the low back in patients with an LSTV were investigated. The experimental group, consisting of 14 participants, over the iliolumbar ligament and anomalous articulation of the LSTV was treated with prolotherapy (local injection with 25% glucose). The control group consisted of 8 weight-, height-, and age-matched participants that underwent traditional physical therapy. Both groups were evaluated in terms of balance performance, flexibility of the low back, and the visual analogue scale at Weeks 0, and 4. The results showed that both groups had significant pain reduction after 4 weeks of treatment, but the experimental group showed superior pain reduction than the physical therapy group. Balance and flexibility were not significantly improved after 4 weeks of treatment for both groups. In conclusion, prolotherapy showed a more promising pain reduction effect than traditional physical therapy in 4 weeks, future researches are needed to examine its chronic effect.

並列關鍵字

lumbosacral transitional vertebra (LSTV) ； iliolumbar ligament ； prolotherapy ； physical therapy ； low back pain

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