产后腹直肌分离康复治疗研究进展

doi:10.3969/j.issn.1006-9771.2022.09.009

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (9): 1065-1073.doi: 10.3969/j.issn.1006-9771.2022.09.009

产后腹直肌分离康复治疗研究进展

封盼盼¹,孙武东²,曲艺²,宋鹏飞²,马明²()

1.南京体育学院研究生部,江苏南京市 210014
2.东南大学附属中大医院康复医学科,江苏南京市 210009

收稿日期:2022-03-16 修回日期:2022-04-15 出版日期:2022-09-25 发布日期:2022-10-08
通讯作者: 马明 E-mail:nj9868@163.com
作者简介:封盼盼(1997-),女,汉族,江苏连云港市人,硕士研究生,主要研究方向：产后康复。|马明(1980-),男,回族,副主任治疗师,主要研究方向：运动损伤康复。
基金资助:
南京市卫生科技发展专项资金项目计划(YKK19163)

Advance in rehabilitation therapy with diastasis recti abdominis in postpartum women (review)

FENG Panpan¹,SUN Wudong²,QU Yi²,SONG Pengfei²,MA Ming²()

1. Graduate Faculty, Nanjing Sport Institute, Nanjing, Jiangsu 210014, China
2. Department of Rehabilitation Medicine, the Affiliated Zhongda Hospital of Southeast University, Nanjing, Jiangsu 210009, China

Received:2022-03-16 Revised:2022-04-15 Published:2022-09-25 Online:2022-10-08
Contact: MA Ming E-mail:nj9868@163.com
Supported by:
Nanjing Health Science and Technology Development Special Fund Project Plan(YKK19163)

摘要/Abstract

摘要：

腹直肌分离是产后女性常见疾病,会严重影响患者的生理和心理健康。康复治疗是腹直肌分离的主要干预方式。神经肌肉电刺激和运动疗法均能有效治疗产后腹直肌分离,但最佳治疗方案尚未明确。后续还需开展多中心、大样本研究,对治疗参数进行比较。

关键词: 腹直肌分离, 产后, 康复, 综述

Abstract:

Diastasis recti abdominis (DRA) is common in postpartum women. DRA seriously affects the physiological and psychological health of patients. Rehabilitation is the main intervention for DRA. It is necessary to clarify the effectiveness of different rehabilitation intervention. Neuromuscular electrical stimulation and exercise therapy can effectively optimize DRA in postpartum period, but the best intervention is not clear. Multi-center researches with large sample should be conducted to compare the treatment parameters in the future.

Key words: diastasis recti abdominis, postpartum, rehabilitation, review

中图分类号:

R714.69

封盼盼,孙武东,曲艺,宋鹏飞,马明. 产后腹直肌分离康复治疗研究进展[J]. 《中国康复理论与实践》, 2022, 28(9): 1065-1073.

FENG Panpan,SUN Wudong,QU Yi,SONG Pengfei,MA Ming. Advance in rehabilitation therapy with diastasis recti abdominis in postpartum women (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(9): 1065-1073.

图/表 6

表1

NMES治疗产后DRA"

作者	n	分组	干预参数	评估指标	研究结论
Kamel等^[35](2017)	60	NMES组(n = 30)：4片电极置于双侧腹直肌上下,频率、脉宽、通断比分别为80 Hz/0.1~0.5 ms/5 s:10 s/30 min NMES+运动组(n = 30)：NMES同上,运动包括卷腹、俄罗斯转体、俯卧抬腿、仰卧抬腿训练	介入时间：产后8周治疗时间：每次30 min,每周3次,共8周	IRD BMI 腰臀比腹肌力量	两组所有指标均显著改善,NMES+运动组除了BMI外,其他指标改善程度均优于NMES组
牛蕾蕾等^[44](2020)	117	电刺激组(n = 60)：4片电极置于双侧腹直肌上下,设定频率,脉宽、通断比为20 Hz/300 μs /5 s:10 s,30 min,再将电极移至双侧的腹内、外斜肌处,以同样参数治疗30 min 对照组(n = 57)：空白对照	介入时间：产后第1天治疗时间：每天60 min,共5 d	IRD POP-Q 阴道动态压力	两组POP-Q评分、阴道动态压力在产后6~8周均无显著差异;NMES组IRD明显减小
华永萍等^[45](2022)	84	运动组(n = 21)：站姿和跪姿收腹、仰卧抬腿、仰卧蹬腿、平板支撑运动+电刺激组(n = 21)：将电极片置于双侧腹直肌、腹横肌和腹斜肌,持续时间为75 Hz/400 μs/7 s,30 Hz/200 μs/8 s,4 Hz/300 μs/11 s,3 Hz/150 μs/5 s,20 min;运动同上运动+肌贴组(n = 21)：一字贴垂直于腹直肌,拉力为0,X贴布垂直于腹直肌,拉力80%;运动同上运动+电刺激+肌贴组(n = 21)：同上	介入时间：产后6~24周治疗时间：每天20 min,共2周	IRD VAS 腰围	四组所有指标均得到改善,其中NMES联合肌贴治疗效果最佳
邹燕齐等^[46](2020)	90	NMES组(n = 30)：8片电极分别置于双侧腹直肌、腹横肌和腹内、外斜肌上,采用75 Hz/400 μs/7 s, 30 Hz/200 μs/8 s, 4 Hz/300 μs/11 s, 3 Hz/150 μs/5 s进行电刺激悬吊组(n = 30)：进行中立位控制训练 NMES+悬吊组(n = 30)：同上	介入时间：产后6~24周治疗时间：每次30 min,共10 d	IRD	三组IRD均显著降低,NMES组和悬吊组无显著差异,联合组疗效显著优于其他两组

表1

表2

表3

深层核心稳定性训练对产后DRA的影响"

作者	n	分组与干预	干预参数	评估指标	研究结论
Tuttle等^[37] (2018)	30	核心锻炼组(n = 10)：腹式呼吸、侧平板、死虫训练、坐姿收腹,每个动作重复10次肌贴组(n = 8)：连续佩戴4~7 d,两次治疗间休息2~4 d 联合组(n = 5)：同上空白对照组(n = 7)	介入时间：产后6~12周治疗时间：每次30 min,每周4~5次,共12周	IRD RDQ PFDI-20	核心锻炼组和联合组IRD显著降低
邹燕齐等^[46] (2020)	90	悬吊组(n = 30)：进行仰卧位、俯卧位、侧卧位、中立位控制训练电刺激组(n = 30)：8个电极片,分别置于双侧腹内、外斜肌、腹横肌和腹直肌上联合组(n = 30)：同上	介入时间：产后6~24周治疗时间：每次30 min,每周5次,共4周	IRD	三组IRD均显著降低,电刺激组和悬吊组疗效相似,联合组疗效最好
Awad等^[52] (2021)	50	平板运动组(n = 25)：俯卧中立位平板支撑,单侧平板支撑,巴氏球上平板支撑(3组,每组20次,每次1 min,组间休息2 min) 对照组(n = 25)：束腹带固定	介入时间：产后12~24周治疗时间：每次30 min,每周3~4次,共8周	IRD	两组IRD均显著降低,但接受渐进式俯卧平板运动的患者IRD改善更明显
Laframboise等^[53](2021)	8	核心锻炼组(n = 7)：以腹式呼吸为主,重点进行腹部等长收缩训练(臀桥、死虫训练) 对照组(n = 1)：空白对照	介入时间：妊娠24周治疗时间：每次30 min,每周3次,共12周	IRD 体质量 UHBE	核心锻炼组体质量和UHBE评分无显著改善,但休息和活动时的IRD均显著减小
Keshwani等^[55](2021)	32	核心锻炼组(n = 8)：毛巾支撑腹壁,进行收腹、死虫训练,坐姿收腹,渐进式侧平板运动束腹带组(n = 8)：除洗澡和睡觉外全天佩戴联合组(n = 8)：同上空白对照组(n = 8)	介入时间：产后3周治疗时间：每次30 min,每周4~6次,共12周	IRD 腹肌力量和耐力 VAS PFDI ODI 身体满意度	核心锻炼组IRD无改善,但腹部力量得到增强;联合组腹部力量改善最明显
Kazmi等^[56] (2021)	40	核心锻炼组(n = 20)：收腹、坐姿收腹、收腹下蹲、俯卧撑空白对照组(n = 20)	治疗时间：每次30 min,每周5次,共8周	IRD 腹肌力量	核心锻炼能缩小IRD,且能增强腹部肌肉力量

表3

表4

腹壁强化训练对产后DRA的影响"

作者	n	分组与干预	干预参数	评估指标	研究结论
Sancho等^[49](2015)	38	收腹运动卷腹运动	介入时间：产后10~12周	IRD	卷腹运动期间脐上IRD显著缩小
Mota等^[18] (2015)	84	妊娠35~41周：收腹,卷腹产后6~8周：收腹,卷腹产后12~14周：收腹,卷腹产后24~26周：收腹,卷腹	-	IRD	四组IRD均减小,收腹运动使脐下IRD增加
Pascoal等^[62](2014)	20	卷腹	介入时间：产后24周之内	IRD	患者进行卷腹运动时IRD降低
Lee等^[36] (2016)	43	产后组(n = 26)：卷腹,收腹联合卷腹(先收腹再卷腹) 非产后组(n = 17)：同上	-	IRD	卷腹前进行腹横肌预激活(收腹)使产后DRA患者的IRD增加,但腹外斜肌畸形指数显著减小
Gluppe等^[48](2020)	38	抬头运动卷腹运动盆底肌收缩盆底肌收缩+卷腹：盆底肌收缩,卷腹盆底肌收缩+收腹：盆底肌收缩,收腹骨盆的钟摆运动俄罗斯转体	介入时间：产后6周及以上	IRD	抬头和躯干扭转运动使患者的IRD降低,卷腹运动使患者脐上IRD降低。盆底肌收缩、收腹、盆底肌收缩联合收腹运动均使患者脐下IRD增加
Acharry等^[61](2015)	30	运动：收腹,卷腹,俄罗斯转体,骨盆钟摆运动,每个动作重复5~7次	介入时间：产后4周治疗时间：每天2次天,共2周	IRD	运动显著降低IRD
Carrera等^[50](2021)	98	收腹运动卷腹运动降压运动	-		腹横肌预激活(收腹)增加IRD,卷腹和降压运动对IRD没有影响
El-Mekawy等^[60](2013)	30	腹部锻炼组：收腹、骨盆后倾、仰卧起坐、俄罗斯转体,每个动作保持5 s,休息10 s,重复20次束腹带组：除洗澡睡觉外全天佩戴	介入时间：产后2周治疗时间：每次30 min,每周3次,共6周	IRD 腹部力量腰臀比	两组腰围无变化,但腹部锻炼降低了腰臀比,与束腹带治疗相比,IRD显著减小,腹部力量显著增加
Thabet等^[51] (2019)	40	核心锻炼+腹部锻炼组(n = 20)：佩戴束腹带,进腹式呼吸、收腹、盆底肌收缩、骨盆后倾、俯卧蹬腿、俄罗斯转体等腹部锻炼组(n = 20)：佩戴束腹带,骨盆后倾、俯卧蹬腿、俄罗斯转体等	治疗时间：每次30 min,每周3次,共8周	IRD PF10	核心锻炼联合腹部锻炼使IRD降低,生活质量提高
Kamel等^[35] (2017)	60	运动组(n = 30)：卷腹、俄罗斯转体、俯卧蹬腿、死虫训练,每个动作20次,每周增加4次运动+电刺激组(n = 30)：运动同上,电刺激的四个电极分别置于双侧腹直肌上下进行电刺激,30 min	介入时间：产后8周治疗时间:每次30 min,每周3次,共8周	BMI 腰臀比IRD 腹肌力量	两组所有指标均显著改善;联合组除了BMI外,其他指标均优于单独运动组

表4

表5

表6

束腹带和肌内效贴对产后DRA的影响"

作者	n	分组与干预	干预参数	评估指标	研究结论
Keshwani等^[55](2021)	32	束腹带组(n = 8) 运动组(n = 8):毛巾固定腹部下进行收腹、卷腹、侧平板和死虫运动等运动,每周4~6次,每次30 min以上运动+束腹带组(n = 8):同上对照组(n = 8)：不干预	介入时间：产后3周治疗时间：12周	国际体育活动问卷; IRD ODI 躯干肌的强度和耐力	运动组和束腹带组IRD没有得到改善,运动使IRD有所增加,但显著增强腹部力量;联合组腹部力量的增加可持续到24周
El-Mekawy等^[60](2013)	30	束腹带组(n = 15) 腹部锻炼组(n = 15):收腹、骨盆后倾、仰卧起坐、俄罗斯转体,每个动作保持5 s,休息10 s,重复20次,30 min	介入时间：产后第2天治疗时间：6周	BMI IRD 腹肌力量腰臀比	两组腰臀比显著降低,腹部锻炼组IRD和腹直肌的力量改善程度优于束腹带组
Tuttle等^[37] (2018)	33	腹部锻炼组(n = 10):四个动作各重复10次,每周4~5次肌内效贴组(n = 8) 运动+肌内效贴组(n = 5):同上对照组(n = 10)：不干预	介入时间: 产后6~12周治疗时间：12周	IRD RDQ PFDI-20	肌内效贴组IRD有所降低。联合腹部锻炼组IRD显著降低
Ptaszkowska等^[73](2021)	24	肌内效贴组(n = 13):宽2.5 cm的“一”字型贴布,以75%~100%的拉力,垂直于腹直肌的方向进行贴扎假肌贴组(n = 11):假贴布,方法同上	介入时间: 产后6~48周治疗时间：48 h	IRD 腹直肌力量	肌内效贴组IRD明显减小,假肌内效贴组无明显变化
Depledge等^[74](2021)	32	运动组(n = 16):收腹,卷腹,死虫训练,侧平板肌内效贴组(n = 16):2条宽为10 cm的“一”字形贴布以40%的拉力垂直于腹直肌的方向贴于肚脐上下	介入时间：产后3周治疗时间：14周	IRD	运动与肌贴均可减少IRD,但在运动期间,使用肌内效贴不会对IRD产生影响

表6

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作者	n	分组	测量方式	研究结论
Mota等^[18] (2015)	84	妊娠35~41周：收腹,卷腹产后6~8周：收腹,卷腹产后12~14周：收腹,卷腹产后24~26周：收腹,卷腹	超声检查(脐上2 cm,脐上5 cm,脐下2 cm)	四组患者进行卷腹时IRD均减小;收腹运动则使脐下IRD增加
Theodorsen等^[47](2022)	38	盆底肌收缩盆底肌收缩+收腹	超声检查(脐上2 cm,脐下2 cm)	两种训练均使IRD增加,联合收缩时增幅最明显
Gluppe等^[48](2020)	38	抬头运动卷腹运动收腹运动盆底肌收缩盆底肌收缩+卷腹盆底肌收缩+收腹骨盆的钟摆运动俄罗斯转体	超声检查(脐上2 cm,脐下2 cm)	抬头和躯干扭转运动减少IRD,卷腹运动减少脐上IRD 盆底肌收缩、收腹、盆底肌收缩联合收腹运动均增加脐下IRD
Sancho等^[49](2015)	38	收腹卷腹	超声检查 (脐上2 cm,脐下2 cm)	卷腹运动期间脐上IRD减少,收腹和联合卷腹练习时,脐上IRD没有显著差异
Carrera等^[50](2021)	98	收腹卷腹降压运动	超声检查 (脐中、脐和剑突之间)	腹横肌预激活(收腹)增加IRD,但卷腹和降压运动对IRD没有影响
Lee等^[36] (2016)	43	产后组(n = 26)：卷腹,收腹,联合卷腹(先收腹再卷腹) 非产后组(n = 17)：同上	超声检查 (脐中、脐和剑突之间)	卷腹之前进行预激活(收腹)使产后DRA患者的IRD增加

作者	n	分组与干预	干预参数	评估指标	研究结论
Mesquita等^[65](1999)	50	观察组(n = 25)：从产后6 h开始运动,包括腹式呼吸、扭转卷腹、骨盆后倾、髋关节内收等刺激盆底肌收缩的运动,每个动作重复10~20次对照组(n = 25)：产后8 h开始,运动方式同上	介入时间：产后第1天治疗时间：6周	IRD	两组IRD均降低,产后6 h开始运动使IRD降低12.5%,产后18 h开始运动使IRD降低5.4%
Gluppe等^[66](2018)	175	盆底肌训练组(n = 87)：在5个不同体位进行,每个体位进行3组,8~12次最大收缩,分为6~8 s持续收缩和3~4次快速收缩对照组(n = 88):不干预	介入时间：产后6周治疗时间：每次45 min,每周1次,共16周	IRD	两组在产后6个月和12个月DRA患病率无显著性差异,且运动组产后1年仍有40%的患病率
Theodorsen等^[47] (2022)	38	盆底肌收缩收腹盆底肌收缩+收腹	介入时间：产后24周以内	IRD 尿失禁问卷 ODI骨盆带症状问卷	三种训练均使IRD增加,其中联合收缩时IRD的增幅最明显
Gluppe等^[48](2020)	38	抬头运动卷腹运动收腹运动盆底肌收缩盆底肌收缩+卷腹：保持盆底肌收缩再进行卷腹盆底肌收缩+收腹：保持盆底肌收缩再进行收腹骨盆的钟摆运动俄罗斯转体：仰卧位,肩胛骨和头部抬离床面的同时身体向一侧侧旋	介入时间：产后6周以上	IRD	抬头和躯干扭转运动使患者IRD降低,卷腹运动使患者脐上IRD降低。盆底肌收缩、收腹、盆底肌收缩联合收腹运动均使患者脐下IRD增加

产后腹直肌分离康复治疗研究进展

Advance in rehabilitation therapy with diastasis recti abdominis in postpartum women (review)

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