全身式振動訓練對於腰椎內視鏡手術患者核心肌群的影響

EFFECTS OF WHOLE BODY VIBRATION TRAINING IN CORE MUSCLES FOR PATIENTS WITH LUMBAR ENDOSCOPIC SURGERY

林禮立(Li-Li Lin)

指導教授 ： 林槐庭

高雄醫學大學/醫學院/運動醫學系碩士在職專班/碩士(2018年)

摘要

中文摘要
背景:
椎間盤突出為椎間盤受到連續性壓力，而使椎間核向後外側方向凸出壓迫神經，引起酸、麻、脹、痛與無力萎縮等症狀，嚴重時肢體會出現感覺異常與肌肉萎縮的症狀，這時只能靠外科手術來治療。術後病患腰部肌肉與穩定訓練是很重要的，腰部核心肌肉有力不只減少椎間盤壓力，也能預防神經壓迫的復發，並且改善術後的肢體遲鈍與無力的狀況，傳統腰椎內視鏡手術後患者會接受電療、熱療與居家運動的復健物理治療。而全身振動訓練的介入藉由特定的頻率振動刺激肌肉纖維感受器，無須特別的動作即可達到增加運動員的運動表現或促進年長者的身體平衡與反應能力，用在脊椎術後的患者，或許也可以增進腹部核心的功能。

目的:
本研究主要是探討在傳統復健中再加上6週全身振動訓練，是否會增加患者其核心肌群能力、主觀自我症狀恢復程度、軀幹核心動態穩定以及核心肌群的穩定能力與最大力量。

方法:
本研究於活力得中山脊椎外科醫院招募30位接受腰椎內視鏡手術的椎間盤突出患者，隨機分類為兩組:常規治療組為接受每週2次熱敷、電療等常規保守物理治療，持續6周；振動訓練組接受常規物裡治療之外，同時額外持續每週2次，每次兩組，3分鐘屈膝站姿垂直振動訓練，振動頻率設為26 Hz。持續6週兩組人會同時教導相同的核心誘發等長收縮運動訓練，並在接受訓練前後做下列評估:核心壓力穩定與最大壓力測試、自覺臉譜量表、Y字平衡測試、腹橫肌超音波厚度檢測。

統計:
二因子混合設計變異數分析 (Two-way mixed designed ANOVA)檢測組內結果的差異，再使用單因子共變數分析(ANCOVA)檢測組與組之間結果的差異。重複測量之數據如Y字平衡測試、腹橫肌超音波厚度量測採用組內貝氏統計(Intraclass correlation coefficient , ICC)來檢測其進步的可靠性。

結果:
核心肌群/力訓練裝置檢測的核心穩定與最大肌力前後測中，顯示兩組都有顯著進步(組內)，而最大肌力只有振動訓練組達顯著增進，兩組之間(組間)比較，振動訓練組核心穩定與最大肌力進步優於常規治療組。主觀感覺疼痛量表與Y字平衡測試方面，兩組都達統計上顯著增進，但兩組進步幅度在統計上卻無明顯差異。超音波影像學腹橫肌顯影檢測中，肌肉收縮幅度兩組在後測皆比前測顯著增加，而振動訓練組效果優於常規治療組。組內可信度分析顯示Y字平衡與超音波量測腹橫肌厚度之數值達0.7以上，顯示這兩種量測具良好可靠性。

結論:
6週的全身振動訓練結合常規的術後物理治療在增進核心力量與穩定能力的表現比單純接受常規物理治療的效果較好，建議以後術後病人在做物理治療時，可以搭配振動訓練，以達到更好的效果。

關鍵字:
椎間盤突出、下背痛、核心運動、全身振動訓練、脊椎術後運動

關鍵字

椎間盤突出 ； 下背痛 ； 核心運動 ； 全身振動訓練 ； 脊椎術後運動

並列摘要

ABSTRACT
Background: The herniation of intervertebral disc (HIVD) is the condition when the protruded nucleus pulposus compresses the nerve root. Lumbar HIVD is a common disease that not only makes patients feel pain or numb in the lower back, buttocks, thighs or legs, but can also make the patient’s lower limb muscles weak or suffer from muscle atrophy. Severe symptoms of lumbar HIVD, such as paresthesia and muscle atrophy in the lower limbs have to treat by spinal surgery. It is very important for patient to have sufficient core muscle strength and stability after surgery. It could reduce the lumbar disc pressure and prevent the recurrence of symptoms after spinal surgery. Traditionally, these patients would have physical therapy and doing exercise at home for recovery. The whole-body vibration training (WBVT) is a new method for training neuromuscular system in athletes, aged people or even patients. However, few studies investigated the effect of WBVT in the patient’s recovery after spinal surgery.
Purpose: The purpose of this study was to investigate whether the WBVT could help patients to train core muscles, improve the symptom recovery, core stability and maximum force of the core muscles as a complementary therapy after surgery.
Methods: This experiment was conducted at a local hospital in Southern Taiwan for 30 patients with HIVD and had undergone lumbar endoscopic surgery. Thirty subjects were divided randomly into two groups, namely a WBVT group and a control group. The Subjects in both groups received general physical therapy 2 times a week during 6 weeks training and subjects in the WBVT group received additional WBVT. All subjects had functional evaluations before and after 6 weeks of therapy (training). The evaluation consisted of maximum force of the core muscles, core stability, the Wong-Baker Face Pain Rating Scale, Y-Balance Test, and the thickness of the transversus abdominis.
Statistics: The two way mixed designed ANOVA was used to analyze differences between the pre-test and post-test within a group, while the ANCOVA was used to compare the WBVT group with the control group. Reliability between repeated measurements of Y-Balance Test, and the thickness of the transversus abdominis was evaluated with the intraclass correlation coefficient ( ICC ).
Results: After 6-weeks intervention, the core stability significantly increased in both groups. The progress rate of maximum force of the core muscles and core stability in the WBVT group were significant better than control group. The Wong-Baker Face Pain Rating Scale and Y- Balance Test scores were significantly increase after training in both groups, however there was no significant difference in progress rate between the two groups. The muscle activity and the thickness of the transversus abdominis was significant increase in both groups, and the effects of the WBVT as a complementary therapy were better than the subjects only treat traditional physical therapy. The ICC value of Y-Balance Test and the thickness of the transversus abdominis greater than 0.7 indicated good reliability.
Conclusion: In addition to conventional therapy, using the Whole-body vibration training as a complementary therapy could further improve core muscles function in post-operative patients.

Key words:
Lower back pain; Core muscle exercise; Lumbar endoscopic; Physical therapy; Whole-body vibration training; Herniated intervertebral disc

並列關鍵字

Lower back pain ； Core muscle exercise ； Lumbar endoscopic ； Physical therapy ； Whole-body vibration training ； Herniated intervertebral disc

參考文獻

參考文獻

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