摘要
目的基于超声影像技术评价慢性下背痛患者的膈肌收缩特征。方法选取2019年11月至2020年4月在中山大学附属第三医院康复科门诊募集的慢性下背痛患者29例以及健康人员26例,分为下背痛组和健康对照组。采用便携式彩超设备评估分别在不同的体位下测量受试者深呼吸时的膈肌厚度(Tdi)。要求受试者分别在仰卧位与站立位下进行用力最大吸气(TLC)后缓慢呼气(FRC),分别记录最大吸气末膈肌厚度(TdiTLC)和平静呼气末膈肌厚度(TdiFRC),并计算出膈肌增厚分数(DTF)。分析下背痛受试者一般资料及Oswestry功能障碍指数评分(ODI)与膈肌功能的相关性;比较健康对照组与下背痛组的膈肌功能;分析Tdi及DTF诊断下背痛的受试者工作特征(ROC)曲线。结果ODI提物功能得分与站立位TdiTLC呈负相关(r=-0.50,P<0.01)。在组内比较中,健康对照组受试者站立位状态下,TdiTLC值与TdiFRC值均较仰卧状态增加(t=6.115、7.314,均P<0.001);下背痛组受试者站立位状态下,TdiTCL值与TdiFRC值均较仰卧状态增加(t=2.834、4.673,均P<0.01)。在组间比较中,仰卧位下与站立位下背痛患者TdiTLC值较健康对照组显著下降(t=2.597、3.338,均P<0.05);站立位下背痛患者TdiFRC值较健康对照组显著下降(t=2.098,P=0.041);站立位下背痛患者DTF值较健康对照组显著下降(t=2.902,P=0.006)。以仰卧位下TdiTCL≤3.3 mm预测下背痛,其诊断灵敏度、特异度分别为78.6%、53.8%,曲线下面积为0.661;以站立位下TdiTCL≤4.5 mm预测下背痛,其诊断灵敏度、特异度分别为95.7%、46.2%,曲线下面积为0.759;以站立位下DTF≤81.3%预测下背痛,其诊断灵敏度、特异度分别为52.2%、84.6%,曲线下面积为0.698。结论下背痛患者膈肌收缩功能较正常受试者降低,且在站立位下差异显著。建议在患者站立位下进行右侧超声图像采集有助测量结果准确、客观。同时,可采用站立位TdiTCL≤4.5 mm或DTF≤81.3%作
Objective Using ultrasound imaging technology to evaluate the contraction characteristics of diaphragm in patients with chronic low back pain.Methods Twenty nine patients with chronic low back pain and 26 healthy persons recruited from the rehabilitation department of the Third Affiliated Hospital of Sun Yat-sen University from November 2019 to April 2020 were selected and divided into the low back pain(LBP)group and the healthy control group.The thickness of the diaphragm(Tdi)of the subjects during deep breathing was evaluated by portable color Doppler ultrasound equipment under different body positions.The subjects were required to perform maximum inspiration for total lung capacity(TLC)and expiration for functional residual capacity(FRC)in the supine and standing position,respectively.The end-inspiratory diaphragm thickness(TdiTLC)and end-expiratory diaphragm thickness(TdiFRC)were recorded,and the diaphragmatic thickening fraction(DTF)was calculated.The general data of subjects with lower back pain and the correlation between Oswestry Dysfunction Index(ODI)and diaphragm function were analyzed;The diaphragm function of healthy control group and LBP group were compared;The receiver operating characteristic(ROC)curve of Tdi and DTF in the diagnosis of lower back pain were analyzed.Results ODI lifting score was negatively correlated with standing TdiTLC(r=-0.50,P<0.01).In intra-group comparison,the TdiTLC and TdiFRC values of healthy subjects in standing position were increased compared with those in supine position(t=6.115,7.314,all P<0.001);In standing position,TdiTCL and TdiFRC values in LBP group were increased compared with those in supine position(t=2.834,4.673,all P<0.01).In comparison between groups,TdiTLC values in supine and standing position of LBP group were significantly lower than those in healthy control group(t=2.597,3.338,all P<0.05);In standing position,TdiFRC of patients in LBP group was significantly lower than that of healthy control group(t=2.098,P=0.041)and DTF value of patients in LBP group
作者
汤伟健
王庄富
关韩月
麦艺颖
贺涓涓
解东风
岳博宇
姜丽
Tang Weijian;Wang Zhuangfu;Guan Hanyue;Mai Yiying;He Juanjuan;Xie Dongfeng;Yue Boyu;Jiang Li(Department of Rehabilitation,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Pediatrics,Zhujiang Hospital of Southern Medical University,Guangzhou 510282,China;Department of Rehabilitation,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 610655,China)
出处
《中国医师杂志》
CAS
2022年第6期838-843,共6页
Journal of Chinese Physician
基金
国家自然科学基金(81201508)。
关键词
超声检查
下背痛
膈
Ultrasonography
Low back pain
Diaphragm
