背景技术腰椎间盘突出症(LDH)引起的腰骶神经根病(LSR)是由神经根的机械压迫引起的病症。由于LDH,已提出了各种物理治疗干预措施来保守管理LSR。然而,缺乏多模式形式的物理治疗干预措施的研究。此外,物理治疗对受压迫神经根扩散张量成像(DTI)参数的影响尚未研究。本研究旨在探讨多模式物理治疗(MPT)对疼痛的影响,残疾,比目鱼H反射,LDH导致的慢性单侧LSR患者压迫神经根的DTI参数。方法采用便利样本进行前瞻性初步临床前-后试验。共招募了14例因L4-L5或L5-S1LDH引起的慢性单侧LSR患者进行研究。参与者总共接受了18个为期六周的MPT计划,其中包括电物理试剂,手动治疗干预,和核心稳定性练习。电物理试剂涉及干扰电流和热包。手动治疗干预包括肌筋膜释放,侧姿势位置分散,被动脊柱旋转动员,和高速低振幅操纵。视觉模拟量表(VAS),罗兰-莫里斯残疾问卷(RMDQ),比目鱼H反射振幅,左右振幅(H/H)比,分数各向异性(FA),在基线和干预后测量受压神经根的表观扩散系数(ADC)。结果VAS有明显改善,RMDQ,H/H比,FA,和受压神经根的ADC。此外,与对侧相比,患侧的H反射幅度显着改善。结论该初步试验的观察结果表明,MPT是由于LDH导致的慢性单侧LSR患者的成功干预措施。关于受压神经根的DTI参数,FA升高,ADC降低。未来的研究与对照组,大样本量,需要更长的随访时间。
Background Lumbosacral radiculopathy (LSR) due to lumbar disc herniation (LDH) is a condition caused by mechanical compression of nerve roots. Various physical therapy interventions have been proposed for the conservative management of LSR due to LDH. However, the study of physical therapy interventions in a multimodal form is lacking. Additionally, the effect of physical therapy on diffusion tensor imaging (DTI) parameters of the compressed nerve root has not been studied. This study aimed to investigate the effects of multimodal physical therapy (MPT) on pain, disability, soleus H-reflex, and DTI parameters of the compressed nerve root in patients with chronic unilateral LSR due to LDH. Methods A prospective preliminary pre-post clinical trial with a convenience sample was conducted. A total of 14 patients with chronic unilateral LSR due to paracentral L4-L5 or L5-S1 LDH were recruited for the study. Participants received a total of 18 sessions of a six-week MPT program that consisted of electrophysical agents, manual therapy interventions, and core stability exercises. Electrophysical agents involved interferential current and hot pack. Manual therapy interventions included myofascial release, side posture positional distraction, passive spinal rotation mobilization, and high-velocity low-amplitude manipulation. Visual analog scale (VAS), Roland-Morris Disability Questionnaire (RMDQ), soleus H-reflex amplitude, side-to-side amplitude (H/H) ratio, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of the compressed nerve root were measured at baseline and post-intervention. Results There were significant improvements in VAS, RMDQ, H/H ratio, FA, and ADC of the compressed nerve root. Furthermore, significant improvement was found in the affected side compared with the contralateral side in H-reflex amplitude. Conclusions The observations of this preliminary trial suggest that MPT is a successful intervention in patients with chronic unilateral LSR due to LDH. Regarding DTI parameters of the compressed nerve root, FA increased and ADC decreased. Future studies with a control group, large sample sizes, and longer follow-up periods are needed.