张珊珊,张振发,黄诗敏,等.慢性腰痛患者深层多裂肌非线性肌电信号的特征分析[J].中华物理医学与康复杂志,2023,45(9):815-819
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| 慢性腰痛患者深层多裂肌非线性肌电信号的特征分析 |
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| DOI：10.3760/cma.j.issn.0254-1424.2023.09.010 |
| 中文关键词: 腰痛 深层多裂肌 非线性肌电特征 LZ复杂度 |
| 英文关键词: Low back pain Lumbar multifidus Electromyography Lempel-Ziv complexity |
| 基金项目:国家自然科学基金（82172532、82102677）、广东省基础与应用基础研究基金（2019A1515110628） |
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| 中文摘要: |
| 目的 采用非线性动力学方法提取慢性腰痛（cLBP）患者与健康对照者深度多裂肌不同状态下肌电图(EMG)信号中所蕴含的非线性动力学信息，比较二者的非线性指标Lempel-Ziv（LZ）复杂度的变化特点。 方法 选取符合标准的cLBP患者25例设为cLBP组，另选取性别、年龄、教育程度等相匹配的正常受试者28例设为正常组。采用sEMG结合丝电极记录2组受试者腰部L4深层多裂肌EMG信号，分析静息状态、最大肌力、耐力收缩、持续收缩后放松等4种不同状态下多裂肌电非线性特征LZ复杂度的差异，并比较cLBP组腰部痛侧与非痛侧多裂肌LZ复杂度的差异性。采用Pearson相关分析cLBP组的疼痛持续时间、疼痛强度和功能障碍指数与LZ复杂度的相关性。 结果 cLBP组患者的VAS评分平均为（4.00±1.04）分，持续疼痛时间平均为（5.96±4.69）年，ODI指数平均为（17.12±10.49）。cLBP组患者肌电信号采集各时间点（进针时、退针后、肌肉收缩时和动作终止时）的VAS评分均显著高于正常组，差异均有统计学意义（P＜0.01）。cLBP组在肌力测试、耐力测试和持续收缩后放松的深层多裂肌LZ复杂度与正常组比较，差异均有统计学意义（P＜0.01）。2组受试者肌力测试、耐力测试和持续收缩后放松的深层多裂肌LZ复杂度与组内静息状态比较，差异均有统计学意义（P＜0.01）；2组受试者持续收缩后放松的深层多裂肌LZ复杂度与组内肌力测试和耐力测试时比较，差异均有统计学意义（P＜0.01）。cLBP组疼痛持续时间与其深层多裂肌最大等长收缩（肌力测试时和耐力测试时）的LZ复杂度呈显著负相关（P＜0.01）。 结论 持续的疼痛刺激会影响大脑对深层多裂肌的协调控制，进而导致中枢对核心稳定肌肉的控制能力下降，提示中枢参与核心稳定肌调控障碍可能是cLBP病因机制的关键因素。 |
| 英文摘要: |
| Objective To explore any changes in the electromyographic (EMG) signals from the deep lumbar multifidus (DM) of patients with chronic low back pain (cLBP). Methods Twenty-five cLBP patients formed the cLBP group, while twenty-eight healthy counterparts similar in sex, age and education background were chosen as the control group. EMG signals were recorded during maximum isometric voluntary contraction of the DM. Two-way repeated measures analysis of variance was applied to compare the two groups′ signals′ Lempel-Ziv (LZ) complexity values at rest and during the maximum strength, strength endurance and relaxation stages of contraction. Pearson correlation coefficients were computed relating the LZ complexity to pain duration and intensity, as well as to Oswestry disability index (ODI) values in the cLBP group. Results The cLBP patients reported a mean symptom duration of 5.96±4.69 years, with an average VAS score of 4.00±1.04 and ODI of 17.12±10.49. They reported greater pain intensity during needle insertions, needle removal, muscle contraction and relaxation than the healthy controls. There were significant differences in LZ complexity among the four stages of contraction with all of the subjects. The LZ complexity was significantly lower in the maximum strength and strength endurance states, but higher in the relaxation after contraction states in the cLBP group. Pain duration was negatively correlated with the nonlinear index of DM during contraction. Conclusion Continuous pain stimulation will affect the coordinated control of the deep multifidus muscle, leading to decreased control of core muscles via the central nervous system. That provides insight into the mechanisms underlying activation and coordinated control during chronic pain. |
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