原發性脊柱側彎患者與正常受試者背部伸肌收縮時肌電訊號之分析比較

Comparison of the back extension muscles electromyography analyses in patients with idiopathic scoliosis and normal subjects

蔡子宜(Zi-Yi Tsai)

指導教授 ： 王淳厚

中山醫學大學/醫學科技學院/物理治療學系/碩士(2020年)

https://doi.org/10.6834/csmu202000173

摘要

背景：如何矯正脊柱側彎的問題仍然是骨科物理治療最困難的議題之一，需要進一步探討背部肌肉用力模式，尋找解決方法。
目的：本研究目的是對原發性脊柱側彎患者與正常年輕人背部伸肌於靜止休息時與上肢執行對稱性、不對稱性動作下兩側背部肌肉收縮情形比較。並利用伊東（Ito）軀幹維持測試比較脊柱側彎患者與正常年輕人背部伸肌收縮時變化、疲勞表現及耐力時間。
材料和方法：本研究包含16名原發性脊柱側彎患者（正S脊柱側彎患者9名與反S脊柱側彎患者7名，共16名）及16名健康年輕人。其中原發性脊柱側彎患者年齡為20～22歲，患有胸腰椎脊柱側彎，主要側彎角度之考伯氏（Cobb’s）角為30°以上。使用NORAXON 2400T G2肌電圖儀於不同用力狀態下背部伸肌收縮及軀幹維持測試期間連續紀錄肌電活動訊號以及耐力時間。使用單因子變異數分析法（one-way ANOVA）比較三組（健康、正S、反S）的差異，事後分析比較則採用薛費法（Scheffe method）。
結果：（1）靜止休息時3組之多裂肌兩側肌電訊號對稱性出現統計上顯著差異（F（2,29） = 6.537, p = .005）。而健康人與反S脊柱側彎組之多裂肌兩側肌電訊號對稱性出現顯著差異（p = .005），反S脊柱側彎組腰椎凸側肌電訊號明顯高於凹側。而豎脊肌則無此現象發生（F
（2,29） = 2.347, p = .114）。（2）雙上肢進行對稱性動作時，豎脊肌與多裂肌的兩側肌電訊號對稱性3組間並無明顯差異（分別為F（2,29） = 1.773, p = .188；F（2,29） = 1.448, p = .251）。（3）健康人抬慣用手與脊柱側彎患者抬胸椎凹側手之不對稱性動作時，豎脊肌與多裂肌的兩側肌電訊號對稱性3組間出現統計上顯著差異（分別為F（2,29） = 4.263, p = .024；F（2,29） = 6.205, p = .006）。健康人與正S脊柱側彎之豎脊肌與多裂肌的兩側肌電訊號有統計上顯著差異（分別為p = .027；p = .006），健康人均為非慣用側肌電訊號高於手抬高之慣用側，而正S脊柱側彎則是胸、腰椎凹側的肌電訊號較低，反S脊柱側彎則兩側均無差異。（4）健康人抬非慣用手與脊柱側彎患者抬胸椎凸側手之不對稱性動作時，多裂肌的兩側肌肉訊號對稱性3組間出現統計上顯著差異（F（2,29） = 8.373, p = .001）。反S脊柱側彎多裂肌的兩側肌電訊號對稱性與正S脊柱側彎和健康人有統計上顯著差異（分別為p = .001；p = .030）。反S脊柱側彎患者抬胸椎凸側手時腰椎凸側的肌電訊號遠高於腰椎凹側，而健康人與正S脊柱側彎兩側多裂肌之肌電訊號則無明顯差異。而豎脊肌則無此現象發生（F（2,29） = 2.311, p = .117），3組之間並無顯著差異。（5）背部伸肌之耐力時間在3組間未達到顯著差異（F（2,29） = 1.167, p = .325），3組的耐力時間平均值分別為167.2 ± 59.5秒（健康人）、170.7 ± 67.8秒（正S脊柱側彎）、128.3 ± 58.4秒（反S脊柱側彎）。（6）自覺用力係數在3組間達到統計上顯著差異（F（2,29） = 4.292, p = .023），3組的自覺用力係數平均值分別為7.5 ± 0.8（健康人）、8.4 ± 0.7（正S脊柱側彎）、7.7 ± 0.8（反S脊柱側彎），正S脊柱側彎大於健康人（p = .025），與反S脊柱側彎無顯著差異，而健康人與反S脊柱側彎也無顯著差異。（7）豎脊肌的耐力斜率分析在3組間均無顯著差異，而多裂肌的耐力斜率分析在3組間達統計上顯著差異（左右側分別為F（2,29） = 17.898, p < .001；F（2,29） = 37.035, p < .001），健康人的耐力斜率與正S、反S脊柱側彎比較均有顯著差異（分別為 p < .001；p < .001），而正S與反S脊柱側彎之間並無顯著差異。
結論：從以上結果可以看出的趨勢為正S組在A1不對稱性動作下的豎脊肌、多裂肌活動與健康人不同，其餘靜止值和其他動作下的豎脊肌、多裂肌活動皆呈現類似的肌肉收縮模式；反S組所出現的不對稱活動皆發生於多裂肌，並與健康人達到顯著差異。在自覺用力係數顯現的結果為正S組比健康人來的疲憊，反S組則與健康人差不多。脊柱側彎患者兩側豎脊肌MF及MPF耐力斜率皆與健康人無達到顯著差異，雖然三組耐力時間表現差不多，但脊柱側彎組（正S與反S組）在兩側多裂肌MF及MPF耐力斜率皆較健康人來的低並達顯著差異。

關鍵字

原發性脊柱側彎 ； 豎脊肌 ； 肌肉疲勞 ； 肌肉耐力 ； 肌電活動

並列摘要

ABSTRACT
Background: How to correct scoliosis is still one of the most difficult issues in orthopaedic physiotherapy, and the activity patterns of back muscle need to further explored to find solution.
Objective: The purpose of this study was to compare the contraction of the back muscles on both sides of the patients with idiopathic scoliosis and normal young healthy, to assess the impact of symmetric and asymmetric exercises on the electromyographically activity of the paraspinal muscles with the symmetric ratios. The Ito test was used to compare the change of back muscle contractions, muscle’s fatigue performance and endurance time in patients with scoliosis and young healthy.
Materials and Methods: This study included 16 patients with idiopathic scoliosis （9 with right lumbar left thoracic （S curve） scoliosis, 7 with right thoracic left lumbar （reverse S curve） scoliosis）, and 16 healthy young people. The patients with idiopathic scoliosis are 20 to 22 years old. Their Cobb angle of major curve were more than 30°. The NORAXON 2400T G2 electromyography was used to record the electomyographically signals during the tests. One-way ANOVA was used to compare the differences between the three groups （young healthy, S curve scoliosis, and reverse S curve scoliosis）, and the post-hoc analysis was using the Scheffe method.
Results: （1） There was a significant difference in the symmetry of the multifidus muscle activities on both sides at resting position between three groups （F（2,29） = 6.537, p = .005）. The electromyography activity of the convex side was higher than concave side in the reverse S curve group, and compared with young healthy had a statistic significant difference （p = .005）. There had not found a significant difference in the symmetry of the erector spinae muscle activities on both sides at resting position between three groups （F（2,29） = 2.347, p = .114）. （2） There were no significant differences in the symmetry of the erector spinae and multifidus muscle activities on both sides during the symmetry exercise of bilateral upper extremities between three groups （F（2,29） = 1.773, p = .188; F（2,29） = 1.448, p = .251; respectively）. （3） During the asymmetry movement （A1）, there were significant differences in the symmetry of the erector spinae and multifidus muscle activities on both sides between three groups （F（2,29） = 4.263, p = .024; F（2,29） = 6.205, p = .006; respectively）. The symmetry of the erector spinae and multifidus muscle activities on both sides in S curve group compared with young healthy had significant differences （p = .027; p = .006; respectively）. The S curve group had lower muscle activities in concave side, healthy group had lower muscle activities in dominant side, and the reverse S curve group was symmetry in both side. （4） During the asymmetry movement （A2）, there had a significant difference in the symmetry of the multifidus muscle activities on both sides between three groups （F（2,29） = 8.373, p = .001）, the erector spinae did not （F（2,29） = 2.311, p = .117）. The symmetry of multifidus muscle activities on both sides in reverse S curve group compared with young healthy group and S curve group had significant differences （p = .001; p = .030; respectively）. The reverse S curve group had higher multifidus muscle activity in convex side than concave side, the young healthy and S curve groups had not. （5） The endurance time of the back muscle of three groups were 167.2 ± 59.5 seconds （young healthy）, 170.7 ± 67.8 seconds （S curve scoliosis）, 128.3 ± 58.4 seconds （reverse S curve scoliosis）. The endurance time of the back muscles had no significant differences between three groups （F（2,29） = 1.167, p = .325）. （6） The RPE scores of the three groups were 7.5 ± 0.8 （young healthy）, 8.4 ± 0.7 （S curve scoliosis）, 7.7 ± 0.8 （reverse S curve scoliosis）, respectively. There had a significant difference between three groups （F（2,29） = 4.292, p = .023）, the S curve scoliosis group was larger than young healthy （p = .025）, there was no significant difference compared with reverse S curve scoliosis group, and the young healthy group had no significant difference with reverse S curve scoliosis group. （7） The slope of endurance of the erector spinae muscle had no significant differences between three groups, but the multifidus muscle had a significant difference between three groups （F（2,29） = 17.898, p < .001; F（2,29） = 37.035, p < .001; the left and right side respectively）. The slope of endurance of young healthy had a significantly different with S curve scoliosis group, reverse S curve scoliosis group （p <.001; p <.001; respectively）, and there is no significant difference between S curve scoliosis group and reverse S curve scoliosis group.
Conclusion: In S curve scoliosis group, the erector spinae and multifidus muscles activity were different compared with the young health during A1 asymmetric movement, and the others movements had same muscles activity on erector spinae and multifidus muscles. The asymmetric activities in the reverse S curve scoliosis group all occurred in multifidus muscles, and had a significant difference with young healthy group.The endurance time of the back muscles had no significant differences between the three groups, but RPE had. In patients with scoliosis, the slope of the MF and MPF of the erector spinae muscles on both sides were no significant differences with healthy people. Although the endurance times of the three groups were similar, but the slopes of MF and MPF of multifidus muscles on both sides of the scoliosis group are lower than young healthy and that had significant differences.

並列關鍵字

Idiopathic scoliosis ； Erector spinae ； Muscle fatigue ； Muscle endurance ； Electromyographic activity

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