施罗斯脊柱侧凸矫正体操联合三维牵引对青少年特发性脊柱侧凸患者脊柱-骨盆重塑的效果

Clinical efficacy of Schroth scoliosis-specific exercises combined with three-dimensional traction therapy in spinal-pelvic remodeling for adolescents with idiopathic scoliosis

中文关键词:  施罗斯脊柱侧凸矫正体操  三维牵引  青少年特发性脊柱侧凸  脊柱-骨盆重塑

英文关键词:Schroth scoliosis-specific exercises  Three-dimensional traction  Adolescent idiopathic scoliosis  Spinal-pelvic remodeling

中文摘要:

  【摘要】 目的：探讨施罗斯脊柱侧凸矫正体操联合三维牵引对青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者脊柱-骨盆重塑的临床效果。方法：收集2021年6月～2024年6月我院接收治疗的80例AIS患者。根据随机数字表法分为对照组（n=40，行单纯施罗斯脊柱侧凸矫正体操治疗）、研究组（n=40，行施罗斯脊柱侧凸矫正体操联合三维牵引治疗）。两组患者一般资料均衡（P>0.05）。比较两组患者临床总有效率，比较治疗前、治疗1个月、治疗3个月脊柱-骨盆重塑指标，包括Cobb角、躯干倾斜角（angle of trunk inclination，ATI）、躯干旋转角度（angle of trunk rotation，ATR）、冠状面平衡指标C7铅垂线-骶骨中垂线距离（C7 plumb line to the center sacral vertical line，C7-CSVL）、顶椎偏距（apical vertebral translation，AVT）、凹凸侧竖直肌表面肌电指标中位频率（median frequency，MF）、平均功率频率（mean power frequency，MPF）、平均肌电值（average electromyography，AEMG）、骨盆倾斜角（pelvic tilt，PT）、骨盆入射角（pelvic incidence，PI）、骶骨倾斜角（sacral slope，SS）；重复测量方差分析两组患者治疗期间脊柱-骨盆重塑指标的主效应检验，Pearson分析Oswestry功能障碍指数（Oswestry disability index，ODI）评分与脊柱-骨盆重塑指标的关系。结果：研究组患者的治疗总有效率高于对照组（97.50% vs 67.50%，P<0.001）。与治疗前相比，治疗后1个月、治疗后3个月，两组患者Cobb角、ATI、ATR降低（P<0.05），与对照组相比，治疗后1个月、治疗后3个月研究组Cobb角、ATI、ATR降低（P<0.05）。治疗后1个月、治疗后3个月，两组患者PI、SS降低，PT升高（P<0.05）。与对照组相比，治疗后1个月、治疗后3个月研究组PI、SS降低，PT升高（P<0.05）。与治疗前相比，治疗后1个月、治疗后3个月，两组患者C7-CSVL、AVT降低（P<0.05），与对照组相比，治疗后1个月、治疗后3个月研究组C7-CSVL、AVT降低（P<0.05）。治疗后1个月、治疗后3个月，两组患者MF、MPF、AEMG升高（P<0.05），与对照组相比，治疗后1个月、治疗后3个月研究组MF、MPF、AEMG升高（P<0.05）。主效应检验分析治疗期间脊柱-骨盆重塑指标时间效应、组间效应、交互效应均具有统计学意义（P<0.05）。治疗前后Cobb角、ATI、ATR、C7-CSVL、AVT、MF、AEMG、MPF、PI、PT、SS与ODI评分均相关（P<0.05）。研究组ODI评分治疗后下降幅度显著优于对照组（β=-6.178，P<0.001）。结论：施罗斯脊柱侧凸矫正体操联合三维牵引对青少年特发性脊柱侧凸患者的脊柱-骨盆重塑具有显著的效果，能够有效改善脊柱侧凸角度和骨盆对称性。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of Schroth scoliosis-specific exercises combined with three-dimensional traction therapy in spinal-pelvic remodeling for adolescents idiopathic scoliosis(AIS). Methods: 80 AIS patients who received treatment at our hospital from June 2021 to June 2024 were enrolled. They were randomly divided into a control group(n=40, received Schroth spinal scoliosis-specific correction exercises alone) and a research group(n=40, underwent a combination of Schroth spinal scoliosis-specific correction exercises and three-dimensional traction therapy) using a random number table method. The general demographic data of the two groups were well-balanced(P>0.05). The clinical overall response rates of the two groups were compared, and spinal-pelvic remodeling indicators, including Cobb angle, angle of trunk inclination(ATI), angle of trunk rotation(ATR), C7 plumb line to the center sacral vertical line(C7-CSVL), apical vertebral translation(AVT), as well as median frequency(MF), mean power frequency(MPF), and average electromyography(AEMG) of the surface electromyography of the erector spinae muscles on the concave and convex sides, pelvic tilt(PT), pelvic incidence(PI), and sacral slope(SS), were assessed before treatment, at 1 month and 3 months after treatment. Repeated measures analysis of variance was conducted to test the main effects of spinal-pelvic remodeling indicators during the treatment period for both groups. Pearson correlation analysis was performed to examine the relationship between the Oswestry disability index(ODI) score and spinal-pelvic remodeling indicators. Results: The total effective treatment rate was significantly higher in the research group than in the control group(97.50% vs 67.50%, P<0.001). Compared with the pre-treatment values, the Cobb angle, ATI, and ATR of both groups decreased at 1 month and 3 months post-treatment(P<0.05). Moreover, when compared with the control group, the research group showed a more pronounced decrease in Cobb angle, ATI, and ATR at 1 month and 3 months post-treatment(P<0.05). Both groups exhibited a decrease in PI and SS, along with an increase in PT at 1 month and 3 months post-treatment(P<0.05). In comparison with the control group, the research group demonstrated a more significant decrease in PI and SS, and a more pronounced increase in PT at 1 month and 3 months post-treatment(P<0.05). The C7-CSVL and AVT of both groups decreased at 1 month and 3 months post-treatment(P<0.05), and the research group showed a more significant decrease in C7-CSVL and AVT compared with the control group at 1 month and 3 months post-treatment(P<0.05). Both groups experienced an increase in MF, MPF, and AEMG of the surface electromyography of the erector spinae muscles at 1 month and 3 months post-treatment(P<0.05), with the research group showing a more significant increase compared with the control group at 1 month and 3 months post-treatment(P<0.05). The main effect tests revealed statistically significant time effects, inter-group effects, and interaction effects for the spinal-pelvic remodeling indicators during the treatment period(P<0.05). The Cobb angle, ATI, ATR, C7-CSVL, AVT, MF, AEMG, MPF, PI, PT, and SS were all found to be correlated with the ODI score before and after treatment(P<0.05). The decrease in the ODI score of study group after treatment was significantly better than that of control group(β=-6.178, P<0.001). Conclusions: Schroth scoliosis-specific exercises combined with three-dimensional traction therapy significantly improve spinal-pelvic remodeling in AIS patients, effectively reducing spinal curvature and enhancing pelvic symmetry.