Feng Yu, Gao Yan, Feng Tian-You
Research Center of Osteopathy, Air Force General Hospital of PLA, Beijing 100142, China.
Zhongguo Gu Shang. 2012 Jan;25(1):28-31.
To observe the efficacy and mechanism of orthopedic footwear in treating lumbar intervertebral disc herniation with spinal manipulation.
From September 2009 to September 2010, 44 patients with the lumbar intervertebral disc herniation with posture change were selected in the study. There were 28 males (aged from 24 to 58 years) and 16 females (aged from 21 to 60 years). Firstly, the average EMG (AEMG) and spectrum area (SPA) of bilateral lumbar erector spinae of the patients were tested by surface electromyogram (sEMG), and then absolute value of the difference between AEMG and SPA (larAEMG and larSPA) were compared. After that, they were randomly divided into two groups (experiment group and control group), each group had 22 cases. The patients of experiment group received the spinal manipulation treatment assisted with orthopedic footwear and the other group received the spinal manipulation treatment only. Orthopedic footwear was put on by leg with lower iliac crest line, sole thickness of which depended on the degree of pelvic tilt. According to mitigation degree of symptom and sign, sole thickness was modified till removal of orthopedic footwear. Manipulative therapeutic method which was manipulative by doctors set spinal process to normal anatomical position. Manipulative treatment was 2 - 3 times every week. The clinical healing time were observed in the two groups.
The larSPA was 0.12 +/- 0.73, 0.65 +/- 0.61 and the larAEMG was 3.43 +/- 25.56, 21.74 +/- 20.34 in standing 1 minute of two positions of patients with orthopedic footwear and without orthopedic footwear, respectively; the larSPA was 0.15 +/- 0.36, 0.57 +/- 0.24 and the larAEMG was 4.65 +/- 12.87, 25.18 +/- 16.58 in walking 1 minute of two positions of patients with orthopedic footwear and without orthopedic footwear. There were significant difference between the two groups (P < 0.01). The time of healing well in experiment group and control group were respectively (20.36 +/- 4.92) d and (28.14 +/- 7.13) d, experiment group was shorter than that of control group (P < 0.01).
Orthopedic footwear can obviously improve the unsymmetrical shrink of bilateral lumbar erector spinae and balance lumbar muscle. Therefore,orthopedic footwear can create favourable conditions for the spinal manipulation in treatment of lumbar intervertebral disc herniation, which can shorten the healing well.
观察矫形鞋配合脊柱手法治疗腰椎间盘突出症的疗效及机制。
选取2009年9月至2010年9月因姿势改变导致腰椎间盘突出症的患者44例，其中男性28例（年龄24～58岁），女性16例（年龄21～60岁）。首先采用表面肌电图（sEMG）检测患者双侧腰竖脊肌的平均肌电图（AEMG）和频谱面积（SPA），比较AEMG和SPA差值的绝对值（larAEMG和larSPA）。之后将其随机分为两组（实验组和对照组），每组22例。实验组患者接受矫形鞋辅助的脊柱手法治疗，另一组仅接受脊柱手法治疗。矫形鞋穿于髂嵴线较低一侧的下肢，鞋底厚度根据骨盆倾斜程度而定。根据症状和体征的缓解程度调整鞋底厚度，直至去除矫形鞋。手法治疗方法为医生将脊柱棘突手法复位至正常解剖位置。手法治疗每周2～3次。观察两组的临床愈合时间。
穿矫形鞋和未穿矫形鞋患者在两个姿势站立1分钟时，larSPA分别为0.12±0.73、0.65±0.61，larAEMG分别为3.43±25.56、21.74±20.34；在两个姿势行走1分钟时，larSPA分别为0.15±0.36、0.57±0.24，larAEMG分别为4.65±12.87、25.18±16.58。两组间差异有统计学意义（P<0.01）。实验组和对照组的愈合时间分别为（20.36±4.92）天和（28.14±7.13）天，实验组短于对照组（P<0.01）。
矫形鞋能明显改善双侧腰竖脊肌不对称性收缩，平衡腰部肌肉。因此，矫形鞋可为脊柱手法治疗腰椎间盘突出症创造有利条件，缩短愈合时间。
