背景:在怀孕和产后,生物力学的变化会导致肌筋膜系统功能障碍,如腹直肌舒张,各种类型的疼痛,和盆底功能障碍。这些常见的产后问题严重威胁着妇女的健康。肌筋膜治疗,作为提高生物力学的有效手段,对产后功能障碍的治疗效果没有统一的认识。本研究旨在系统评价肌筋膜治疗对产后腹直肌舒张的康复效果。腰腿痛,通过对已发表的随机对照试验的荟萃分析,以及盆底功能障碍。
方法:对中文和英文数据库进行了系统的文献检索,直到2023年5月。治疗方法采用肌筋膜疗法治疗腹直肌分离的随机对照研究,腰腿痛,和盆底功能障碍。主要结局指标为腹围,腹直肌分离距离,视觉模拟疼痛评分,盆底肌电位,生活在日常活动中的能力,事件的数量,和治疗效果。
结果:共有22项研究,包括2235名患者。结果表明,与对照组相比,肌筋膜治疗可降低腹围和腹直肌分离指数,显著改善腰椎功能,减少尿失禁和盆腔器官脱垂。在肌筋膜治疗组中,盆底肌力明显增强,盆底肌前/后静息电位明显下降,盆底肌电位增强。与对照组相比,在肌筋膜治疗后,各种类型的疼痛患者数量和疼痛评分均显著减少.当肌筋膜治疗持续<4周时,疼痛缓解更大。在肌筋膜治疗组中,进行日常活动的能力显著提高。对治疗效果的分析表明,在肌筋膜治疗后,患者的症状明显改善。所有结果之间的异质性也很低。
结论:结果表明,肌筋膜治疗可有效减少腹直肌分离,缓解盆底肌肉功能障碍,增强腰椎功能,缓解疼痛,提高日常生活活动能力。所有数据表明,肌筋膜疗法对产后功能障碍具有良好的治疗效果。
BACKGROUND: During pregnancy and postpartum, changes in biomechanics can cause dysfunctions in the myofascial system, such as rectus abdominis diastasis, various types of pain, and pelvic floor dysfunction. These common postpartum problems seriously threaten women\'s health. Myofascial therapy, as an effective means of improving biomechanics, has no unified understanding of its therapeutic effects on postpartum functional disorders. This study aims to systematically evaluate the rehabilitative effects of myofascial therapy on postpartum rectus abdominis diastasis, low back and leg pain, and pelvic floor dysfunction through a meta-analysis of published randomized controlled trials.
METHODS: A systematic literature search of databases in Chinese and English was performed through May 2023. The treatment methods were randomized controlled studies using myofascial therapy in the treatment of rectus abdominis separation, lumbo-leg pain, and pelvic floor dysfunction. The main outcome indicators were abdominal circumference, rectus abdominis separation distance, visual analogue pain score, pelvic floor muscle potential, ability to live daily activities, number of events, and treatment effectiveness.
RESULTS: There were 22 studies, including 2235 patients. The result showed that compared with control group, myofascial therapy demonstrated to reduce abdominal circumference and rectus abdominis separation index, improve lumbar function significantly, and decrease urinary incontinence and pelvic organ prolapse. In the myofascial therapy group, pelvic floor muscle strength was significantly enhanced, anterior/posterior resting potential of pelvic floor muscle was significantly decreased, and pelvic floor muscle potential was enhanced. Compared with the control group, the number of patients with various types of pain and pain scores were significantly reduced after myofascial therapy. When myofascial therapy lasted <4 weeks, pain relief was greater. In the myofascial therapy group, the ability to perform daily activities was significantly improved. An analysis of the effectiveness of the treatment showed that after myofascial therapy, the patient\'s symptoms improved significantly. There also saw low heterogeneity among all outcomes.
CONCLUSIONS: The results suggested that myofascial therapy could effectively reduce rectus abdominis separation, relieve pelvic floor muscle dysfunction, enhance lumbar function, relieve pain, and improve the ability of daily living activities. All the data demonstrated that myofascial therapy had a good therapeutic effect on postpartum dysfunction.