目的 比较发散式体外冲击波疗法(RESWT)与神经肌肉电刺激(NMES)对产后腹直肌分离(DRA)的疗效。方法 本研究为随机对照试验,选取2024年1-12月于解放军总医院第七医学中心康复医学科就诊的产后DRA患者72例,随机分为观察组和对照组,每组36例。对照组接受NMES治疗,1次/隔日,3次/周;观察组采用RESWT进行治疗,1次/周;两组均在康复师指导下进行核心稳定性训练,1次/d,每周训练5 d。治疗5周后,比较治疗前后两组腹围、腹直肌间距(IRD),评估腰背痛评分和生活质量评分(WHOQOL-BREF)。结果 72例在研究过程中无脱落,全部进入结果分析。治疗5周后,两组腹围、IRD均缩小,腰背部疼痛(VAS)评分均降低,WHOQOL-BREF升高,差异均有统计学意义(P<0.05);观察组与对照组比较,腹围和IRD差异无统计学意义(P＞0.05),腰背部疼痛症状和生活质量改善差异有统计学意义(P＜0.05)。结论 RESWT与NMES均能有效促进产后DRA恢复,减轻腰背疼痛,提高生活质量,RESWT在疼痛管理方面效果更优。
Abstract
Objective To compare the efficacy of radial extracorporeal shock wave therapy(RESWT) and neuromuscular electrical stimulation(NMES) in the treatment of postpartum diastasis recti abdominis(DRA). Methods This study was a randomized, double-blind trial. A total of 72 patients with postpartum DRA who visited the Rehabilitation Medicine Department of the 7th Medical Center of PLA General Hospital from January 2024 to December 2024 were selected and randomly divided into an observation group(n=36) and a control group(n=36). In the control group, NMES was performed, once every other day, 3 times a week, while RESWT was applied in the observation group, once a week. Both groups received core stability training under the guidance of a rehabilitation therapist, once a day, 5 days a week. After 5 weeks of treatment, the abdominal circumference and inter recti distance(IRD) were measured, the visual analogue scale(VAS) and life quality score(World Health Organization Quality of Life-BREF,WHOQOL-BREF) were compared before and after treatment. Results There was no dropout during the study, and all patients entered the result analysis. After 5 weeks of treatment, the abdominal circumference and IRD were reduced, the VAS of lumbar decreased, the life quality score increased in both groups, and the differences were statistically significant (P<0.05). Compared with the control group, the abdominal circumference and IRD in observation group showed no significant difference (P＞0.05),but there was statistically significant difference in the improvement of low back pain symptoms and quality of life (P＜0.05). Conclusions Both RESWT and NMES can effectively promote the recovery of postpartum DRA, reduce low back pain, and improve life quality. The former is more effective in pain management.
关键词
腹直肌分离 /
核心肌群 /
体外冲击波 /
神经肌肉电刺激 /
产后康复
Key words
diastasis recti abdominis /
core muscle group /
extracorporeal shock wave /
neuromuscular electrical stimulation /
postpartum rehabilitation
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Benjamin D R,Frawley H J,Nora S,et al.Relationship between diastasis of the rectus abdominis muscle(DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review[J].Physiotherapy, 2019,105(1):24-34.
[2] Mota P,Pascoal A G,Carita A I,et al.Normal width of the inter-recti distance in pregnant and postpartum primipa rous women[J].Musculoskelet Sci Pract,2018,35(2):34-37.
[3] Kamel D M,Yousif A M.Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles[J].Ann Rehabil Med,2017,4(3):465-474.
[4] 王允芳,刘亚琴,刘晓东,等.低频神经肌肉电刺激联合WAFF运动对产后腹直肌分离的下效果[J].中国医刊,2025,60(1):66-70.
[5] 张丽明,李秀珍,谢宇娟.低频神经肌肉电刺激联合手法按摩对产后腹直肌分离的疗效[J].现代电生理学杂志,2021,28(2):98-101.
[6] 卢嘉茵,谢 谨,黎婉仪,等.核心肌群训练手法联合电刺激对产后腹直肌分离的疗效分析[J].中国计划生育和妇产科,2024,16(7):80-84.
[7] 中国研究型医院学会冲击波医学专业委员会.中国骨肌疾病体外冲击波疗法指南(2023年版)[J].中国医学前沿杂志(电子版),2023,15(9):1-20.
[8] 盛 炜,张 丽,李美蓉,等. 体外冲击波疗法促进组织修复及再生的机制综述[J].解放军医学院学报,2020,41(6):638-642.
[9] 安 东,刘 阳,杨通江,等. 体外冲击波疗法在烧伤创面修复和烧伤后瘢痕治疗中的应用[J].中国组织工程研究,2022,26(20):3265-3272.
[10] 张立俭,黄振俊,祁昌杰,等.两种治疗方法对军事训练伤致非钙化性冈上肌腱炎的疗效[J].海军医学杂志,2021,42(4):387-390.
[11] 张立俭,黄静宜,祁昌杰,等.温针灸“肩三针”结合体外冲击波治疗劳损性冈上肌腱炎[J].中医学报,2020,35(9):2024-2027.
[12] 黄静宜,张立俭,王慧珍,等.放射式体外冲击波治疗肱二头肌长头肌腱炎的远期疗效观察[J].解放军医学院学报,2017,38(9):850-852.
[13] 封盼盼,孙武东,曲 艺,等.产后腹直肌分离康复治疗研究进展[J].中国康复理论与实践,2022,28(9):1065-1072.
[14] Laframboise F C,Schlaff R A,Baruth M.Postpartum exercise intervention targeting diastasis recti abdominis[J].Int J Exerc Sci,2021,14(3):400-409.
[15] 武广艳,张 冉,王 璐,等.核心肌群运动控制训练对产后腹直肌分离的效果[J].中国康复理论与实践,2023,29(8):948-953.
[16] Mota P,Pascoal A G,Sancho F,et al.Test-retest and intrarater reliability of 2-dimensional ultrasound measurements of distance between rectus abdominis in women[J].J Orthop Sports Phys Ther,2012,42(11): 940-946.
[17] 丘小娟,邢贞通,颜 励,等.产后腹直肌分离诊治进展[J].解放军医学院学报,2020,41(10):1042-1045.
[18] Lee D,Hodges P W.Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study[J].J Orthop Sports Phys Ther,2016, 46(7):580-589.
[19] Tuttle L J,Fasching J,Keller A,et al.Noninvasive treatment of postpartum diastasis recti abdominis: a pilot study[J].J Women Health Phys Ther,2018,42(2):1-10.
[20] 李 莉,邓燕梅,丘 青,等.高频超声在产前和产后腹直肌检查中的应用研究[J].中国中西医结合影像学杂志,2021,19(6):576-579.
[21] 南 娜,王 莉,王 璐,等.产褥期不同部位腹直肌间距及分离的超声评价与相关风险因素分析[J].空军军医大学学报,2024,45(8):925-929,934.
[22] 乔彩娜,吕 振,黄秋晨,等.肌肉能量技术联合核心稳定性训练对产后女性骶髂关节功能障碍的影响[J].中国康复, 2023,38(3): 178-183.
[23] 季 华,胡晓梅,吴吉林,等.神经肌肉电刺激辅以Flexi-bar 运动训练治疗产后腹直肌分离的疗效观察[J].实用临床医药杂志,2024,28(4):131-135.
[24] 史海燕,王兆蒙,张 超,等.神经肌肉电刺激联合凯格尔运动治疗产后腹直肌分离及便秘的疗效观察[J].中国妇幼保健,2021,36(21):4924-4927.
[25] Gregory C,Bickel C.Recruitment patterns in human skeletal muscle during electrical stimulation[J].Phys Ther, 2005,85(4):358-364.
[26] Tinazzi M,Zarattini S,Valeriani M,et al.Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation(TENS) of forearm muscles: evidence of reciprocal inhibition and facilitation[J].Exp Brain Res,2005,161(4):457-464.
[27] Agostino M C,Craig K,Tibalt E,et al.Shock wave as biological therapeutic tool: from mechanical stimulation to recovery and healing, through mechanotransduction[J].Int J Surg,2015,24(Pt B):147-153.
[28] Jaalouk D E,Lammerding J.Mechanotransduction gone awry[J].Nat Rev Mol Cell Biol,2009,10(1):63-73.
[29] Moralli M R,Caldwell N J,Patil P V,et al.An in vivo model of for investigations of mechanical signal transduction in trabecular bone[J].J Bone Miner Res,2000,15(7):1346-1353.
PDF(994 KB)
