《Chinese Journal of Rehabilitation Theory and Practice》 ›› 2022, Vol. 28 ›› Issue (9): 1065-1073.doi: 10.3969/j.issn.1006-9771.2022.09.009
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FENG Panpan1,SUN Wudong2,QU Yi2,SONG Pengfei2,MA Ming2()
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:
CLC Number:
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.
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作者 | n | 分组 | 干预参数 | 评估指标 | 研究结论 | |
---|---|---|---|---|---|---|
Kamel等[ | 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[ | 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[ | 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[ | 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 |
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作者 | n | 分组 | 测量方式 | 研究结论 |
---|---|---|---|---|
Mota等[ (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[ | 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[ | 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[ | 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[ | 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[ (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 |
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作者 | n | 分组与干预 | 干预参数 | 评估指标 | 研究结论 |
---|---|---|---|---|---|
Tuttle等[ (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[ (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[ (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[ | 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[ | 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[ (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 |
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作者 | n | 分组与干预 | 干预参数 | 评估指标 | 研究结论 |
---|---|---|---|---|---|
Sancho等[ | 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[ (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[ | 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[ (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[ | 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[ | 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[ | 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[ | 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[ (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[ (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 |
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作者 | n | 分组与干预 | 干预参数 | 评估指标 | 研究结论 |
---|---|---|---|---|---|
Mesquita等[ | 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[ | 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[ (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[ | 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 |
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作者 | n | 分组与干预 | 干预参数 | 评估指标 | 研究结论 |
---|---|---|---|---|---|
Keshwani等[ | 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[ | 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[ (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[ | 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[ | 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 |
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