Department of Rheumatology and Institute of Physical Medicine, University Hospital Zürich, Zurich, Switzerland.
Eur Spine J. 2012 Aug;21 Suppl 6(Suppl 6):S750-9. doi: 10.1007/s00586-011-1707-8. Epub 2011 Mar 31.
Spine stabilisation exercises, in which patients are taught to preferentially activate the transversus abdominus (TrA) during "abdominal hollowing" (AH), are a popular treatment for chronic low back pain (cLBP). The present study investigated whether performance during AH differed between cLBP patients and controls to an extent that would render it useful diagnostic tool. 50 patients with cLBP (46.3 ± 12.5 years) and 50 healthy controls (43.6 ± 12.7 years) participated in this case-control study. They performed AH in hook-lying. Using M-mode ultrasound, thicknesses of TrA, and obliquus internus and externus were determined at rest and during 5 s AH (5 measures each body side). The TrA contraction-ratio (TrA-CR) (TrA contracted/rest) and the ability to sustain the contraction [standard deviation (SD) of TrA thickness during the stable phase of the hold] were investigated. There were no significant group differences for the absolute muscle thicknesses at rest or during AH, or for the SD of TrA thickness. There was a small but significant difference between the groups for TrA-CR: cLBP 1.35 ± 0.14, controls 1.44 ± 0.24 (p < 0.05). However, Receiver Operator Characteristics (ROC) analysis revealed a poor and non-significant ability of TrA-CR to discriminate between cLBP patients and controls on an individual basis (ROC area under the curve, 0.60 [95% CI 0.495; 0.695], p = 0.08). In the patient group, TrA-CR showed a low but significant correlation with Roland Morris score (Spearman Rho = 0.328; p = 0.02). In conclusion, the difference in group mean values for TrA-CR was small and of uncertain clinical relevance. Moreover, TrA-CR showed a poor ability to discriminate between control and cLBP subjects on an individual basis. We conclude that the TrA-CR during abdominal hollowing does not distinguish well between patients with chronic low back pain and healthy controls.
脊柱稳定练习，即教导患者在“腹部凹陷”（AH）期间优先激活腹横肌（TrA），是治疗慢性下腰痛（cLBP）的一种流行方法。本研究旨在探讨 cLBP 患者和对照组在 AH 期间的表现是否存在差异，这种差异是否足以成为一种有用的诊断工具。50 名 cLBP 患者（46.3 ± 12.5 岁）和 50 名健康对照组（43.6 ± 12.7 岁）参与了这项病例对照研究。他们在钩卧位进行 AH。使用 M 模式超声，在休息时和进行 5 秒 AH 时（每侧身体 5 次测量），确定 TrA、内斜肌和外斜肌的厚度。研究了 TrA 收缩比（TrA-CR）（收缩的 TrA/休息时的 TrA）和维持收缩的能力[保持阶段 TrA 厚度的标准差]。在休息或 AH 期间，绝对肌肉厚度或 TrA 厚度的标准差，两组间均无显著差异。两组间的 TrA-CR 有一个较小但显著的差异：cLBP 组 1.35 ± 0.14，对照组 1.44 ± 0.24（p < 0.05）。然而，接受者操作特征（ROC）分析显示，TrA-CR 个体区分 cLBP 患者和对照组的能力较差且无统计学意义（ROC 曲线下面积，0.60 [95% CI 0.495；0.695]，p = 0.08）。在患者组中，TrA-CR 与 Roland Morris 评分呈低度但显著相关（Spearman Rho = 0.328；p = 0.02）。总之，组间 TrA-CR 的平均值差异较小，且具有不确定的临床相关性。此外，TrA-CR 个体区分对照组和 cLBP 受试者的能力较差。我们得出结论，腹部凹陷时 TrA-CR 对慢性下腰痛患者和健康对照组的区分效果不佳。
