慢性腰痛患者静止站立时躯干肌的激活特征及足底压力分布

doi:10.3969/j.issn.1006-9771.2025.04.012

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (4): 466-475.doi: 10.3969/j.issn.1006-9771.2025.04.012

慢性腰痛患者静止站立时躯干肌的激活特征及足底压力分布

徐钊强¹, 李岩², 彭嘉慧¹, 谢浩宇¹, 陈宇³, 王楚怀¹()

1.中山大学附属第一医院康复医学科，广东广州市 510062
2.温州医科大学药学院，浙江温州市 325035
3.广州天使儿童医院康复科，广东广州市 510160

收稿日期:2024-11-14 修回日期:2025-02-28 出版日期:2025-04-25 发布日期:2025-04-25
通讯作者: 王楚怀(1966-)，男，汉族，广东潮州市人，硕士，教授，主要研究方向：脊柱疾病的康复治疗。E-mail: wangchuh@mail.sysu.edu.cn
作者简介:徐钊强(1997-)，男，汉族，宁夏吴忠市人，康复治疗师，主要研究方向：下肢生物力学、矫形器及矫形鞋垫治疗。
基金资助:
1.粤港科技创新联合资助项目(2023A0505010014);2.国家重点研发计划项目(2022YFC2009700);3.国家自然科学基金项目(82172532)

Characteristics of trunk muscle activation and plantar pressure distribution in patients with chronic low back pain in static standing

XU Zhaoqiang¹, LI Yan², PENG Jiahui¹, XIE Haoyu¹, CHEN Yu³, WANG Chuhuai¹()

1. Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510062, China
2. School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
3. Department of Rehabilitation, Guangzhou Angel Children's Hospital, Guangzhou, Guangdong 510160, China

Received:2024-11-14 Revised:2025-02-28 Published:2025-04-25 Online:2025-04-25
Contact: WANG Chuhuai, E-mail: wangchuh@mail.sysu.edu.cn
Supported by:
Guangdong-Hong Kong Technology Innovation Joint Funding(2023A0505010014);National Key Research and Development Program(2022YFC2009700);National Natural Science Foundation of China(82172532)

摘要/Abstract

摘要：

目的比较慢性腰痛(cLBP)患者与健康受试者在静止站立时躯干肌肉激活、肌肉共同收缩水平与足底压力分布的差异。
方法 2021年7月至2022年7月，于中山大学附属第一医院康复医学科招募17例健康受试者(健康对照组)和18例cLBP患者(cLBP组)，采集两组人口信息和cLBP组的疼痛程度、功能障碍程度及静止站立时身体质心位移参数。采用足底压力平板记录两组受试者执行静止站立任务时的足底压力分布情况，并同步使用无线表面肌电图记录腹横肌(TrA)、竖脊肌(ES)和腰椎多裂肌(LM)的活动，分析各肌肉的激活水平以及各肌肉对之间的共收缩指数(CCI)。
结果与健康对照组比较，cLBP组双侧LM激活水平升高(∣t∣ > 2.479, P < 0.05)，腰腹部肌肉对左LM-左TrA (t = 2.212, P = 0.042)、左LM-右TrA (t = 2.868, P = 0.008)、右LM-右TrA (U = 75.000，P = 0.009) CCI升高。cLBP组右拇趾区域压力下降(t = 2.825, P = 0.009)，右内和左外足跟区域压力升高(U < 77.000, P < 0.05)。
结论在静止站立期间，cLBP患者需要更高水平的躯干肌肉激活和肌肉共收缩，足底压力分布后移，可能因为采取了不同的姿势补偿策略来维持静态姿势的稳定性。

关键词: 慢性腰痛, 表面肌电, 共收缩指数, 足底压力, 静止站立任务

Abstract:

Objective To compare trunk muscle activation, muscle co-contraction levels and plantar pressure distribution between patients with chronic low back pain (cLBP) and healthy subjects during static standing.
Methods From July, 2021 to July, 2022, 17 healthy subjects (healthy control group) and 18 cLBP patients (cLBP group) were recruited from the Department of Rehabilitation Medicine, the First Affiliated Hospital of Sun Yat-sen University. Demographic information was collected for both groups, as well as the pain intensity, functional disability, and center of pressure displacement parameters of the cLBP group in static standing. A plantar pressure plate was used to record plantar pressure distribution in static standing task. Simultaneously, a wireless surface electromyography (sEMG) system was used to record the activity of the transverse abdominis (TrA), erector spinae (ES) and lumbar multifidus (LM). The activation levels of each muscle and the co-contraction index (CCI) between trunk muscle pairs were analyzed.
Results Compared with the healthy control group, the cLBP group showed higher activation levels of the bilateral LM (∣t∣ > 2.479, P < 0.05) and higher lumbar-abdominal muscle CCI of left LM-left TrA (t = 2.212, P = 0.042), left LM-right TrA (t = 2.868, P = 0.008) and right LM-right TrA (U = 75.000, P = 0.009). In the cLBP group, pressure decreased in the right big toe region (t = 2.825, P = 0.009), and increased in the right medial and left lateral heel regions (U < 77.000, P < 0.05).
Conclusions During static standing, patients with cLBP require higher level of trunk muscle activation and co-contraction， with a posterior shift in plantar pressure distribution, which might be due to the adoption of different postural compensation strategies to maintain postural stability.

Key words: chronic low back pain, surface electromyography, co-contraction index, plantar pressure, static standing task

中图分类号:

R681.5

徐钊强, 李岩, 彭嘉慧, 谢浩宇, 陈宇, 王楚怀. 慢性腰痛患者静止站立时躯干肌的激活特征及足底压力分布[J]. 《中国康复理论与实践》, 2025, 31(4): 466-475.

XU Zhaoqiang, LI Yan, PENG Jiahui, XIE Haoyu, CHEN Yu, WANG Chuhuai. Characteristics of trunk muscle activation and plantar pressure distribution in patients with chronic low back pain in static standing[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(4): 466-475.

图/表 5

表1

表2

两组腰腹部肌肉的RMS比较"

靶肌肉	组别	n	$x - ± s$	t值	P值
左侧TrA	健康对照组	17	0.18±0.05	-1.254	0.218
	cLBP组	18	0.20±0.05
右侧TrA	健康对照组	17	0.18±0.06	-0.529	0.600
	cLBP组	18	0.19±0.04
左侧ES	健康对照组	17	0.15±0.06	-1.360	0.183
	cLBP组	18	0.17±0.04
右侧ES	健康对照组	17	0.15±0.04	-1.075	0.290
	cLBP组	18	0.17±0.03
左侧LM	健康对照组	17	0.18±0.09	-2.479	0.020
	cLBP组	18	0.21±0.05
右侧LM	健康对照组	17	0.16±0.06	-3.159	0.003
	cLBP组	18	0.22±0.05

表2

表3

两组肌肉对CCI比较"

肌肉对	组别	n	( $x - ± s$ )/M(Q_L,Q_U)	t/U值	P值
左ES-左TrA	健康对照组	17	10.21 $± 3.89$	0.796	0.432
	cLBP组	18	11.20 $± 3.52$
左ES-右TrA	健康对照组	17	9.18 $± 4.12$	1.617	0.115
	cLBP组	18	11.22 $± 3.33$
右ES-左TrA	健康对照组	17	10.92(8.31,12.91)	156.000	0.935
	cLBP组	18	10.88(9.52,12.58)
右ES-右TrA	健康对照组	17	10.30(6.44,13.11)	126.000	0.386
	cLBP组	18	11.15(9.66,12.50)
左LM-左TrA	健康对照组	17	9.50 $± 5.37$	2.212	0.042
	cLBP组	18	12.97 $± 4.28$
左LM-右TrA	健康对照组	17	8.31 $± 5.18$	2.868	0.008
	cLBP组	18	12.59 $± 3.42$
右LM-左TrA	健康对照组	17	10.53 $± 4.14$	1.961	0.058
	cLBP组	18	13.14 $± 3.72$
右LM-右TrA	健康对照组	17	10.87(6.69,12.62)	75.000	0.009
	cLBP组	18	12.69(11.15,16.13)

表3

表4

两组8个足底区域的时间积分平均压力值比较"

足底区域	组别	n	( $x - ± s$ )/(M(Q_L,Q_U))	t/U值	P值
左侧T₁	健康对照组	17	12.85±6.37	0.580	0.566
	cLBP组	18	11.61±6.32
右侧T₁	健康对照组	17	13.88±5.90	2.825	0.009
	cLBP组	18	9.23±3.45
左侧T_2-5	健康对照组	17	5.60(4.89,7.62)	185.000	0.303
	cLBP组	18	5.47(3.80,6.13)
右侧T_2-5	健康对照组	17	6.67±2.94	0.785	0.438
	cLBP组	18	5.93±2.59
左侧M₁	健康对照组	17	22.47±6.79	1.066	0.294
	cLBP组	18	19.81±7.86
右侧M₁	健康对照组	17	22.28±8.75	2.013	0.052
	cLBP组	18	17.06±6.49
左侧M_2-4	健康对照组	17	38.5(32.9,39.8)	191.000	0.219
	cLBP组	18	35.47(31.22,38.40)
右侧M_2-4	健康对照组	17	34.81±7.69	1.105	0.277
	cLBP组	18	32.31±5.59
左侧M₅	健康对照组	17	20.84±5.32	1.771	0.086
	cLBP组	18	17.37±6.20
右侧M₅	健康对照组	17	21.36±5.14	1.744	0.091
	cLBP组	18	17.60±7.34
左侧MF	健康对照组	17	13.59±3.76	0.144	0.886
	cLBP组	18	13.36±5.54
右侧MF	健康对照组	17	14.03(12.25,15.84)	176.500	0.443
	cLBP组	18	10.06(9.34,18.45)
左侧MH	健康对照组	17	40.93(39.33,42.23)	102.000	0.096
	cLBP组	18	41.84(40.15,42.94)
右侧MH	健康对照组	17	39.17(36.6,41.47)	77.000	0.011
	cLBP组	18	41.99(40.48,42.65)
左侧LH	健康对照组	17	40.70(40.12,42.2)	60.500	0.002
	cLBP组	18	43.13(42.13,44.44)
右侧LH	健康对照组	17	39.90(37.15,43.72)	103.500	0.103
	cLBP组	18	42.80(40.88,44.54)

表4

表5

两组身体质心位移参数的比较"

项目	组别	n	$x - ± s$	t值	P值
前-后位移速度/(mm⋅s^-1)	健康对照组	17	6.00±2.00	0.681	0.525
前-后位移速度/(mm⋅s^-1)	cLBP组	18	5.50±1.25	0.681	0.525
左-右位移速度/(mm⋅s^-1)	健康对照组	17	4.00±2.00	-1.188	0.258
左-右位移速度/(mm⋅s^-1)	cLBP组	18	4.50±3.25	-1.188	0.258
位移长度/mm	健康对照组	17	244.00±64.50	1.047	0.152
位移长度/mm	cLBP组	18	254.00±100.50	1.047	0.152
位移面积/mm²	健康对照组	17	200.00±138.00	0.140	0.890
位移面积/mm²	cLBP组	18	206.50±185.75	0.140	0.890

表5

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组别	n	性别(男/女)/n	年龄/岁	身高/m	体质量/kg	BMI/(kg⋅m^-2)	足姿指数
健康对照组	17	6/11	25.71±2.64	1.67±0.08	60.06±8.92	21.33±1.85	0.71±0.69
cLBP组	18	6/12	27.00±3.25	1.66±0.09	59.17±9.26	21.41±2.14	0.67±0.69
χ²/t/Z值		0.015	1.287	-0.491	-0.290	0.104	0.182
P值		0.903	0.207	0.627	0.774	0.918	0.883

慢性腰痛患者静止站立时躯干肌的激活特征及足底压力分布

Characteristics of trunk muscle activation and plantar pressure distribution in patients with chronic low back pain in static standing

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