中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (32): 5091-5096.doi: 10.12307/2023.815

• 肌肉肌腱韧带组织构建 tissue construction of the muscle, tendon and ligament • 上一篇    下一篇

高频超声观察不同训练动作对产后腹直肌分离间距的即时影响

岑婉仪1，2，3，龚宇萱3，黄镇东3，胡芯雨4，林  君3，阙可欣3，李太良3，王润妹3，宋成宪3   

  1. 1南方医科大学南方医院康复医学科，广东省广州市  510000；2杭州医学院康复学院，浙江省杭州市  311399；3广州医科大学附属第三医院康复医学科，广东省广州市  510000；4广州医科大学，广东省广州市  510000
  • 收稿日期:2022-08-03 接受日期:2022-10-12 出版日期:2023-11-18 发布日期:2023-03-22
  • 通讯作者: 宋成宪，博士，副主任医师，广州医科大学附属第三医院康复医学科，广东省广州市 510000
  • 作者简介:岑婉仪，女，1999年生，广东省肇庆市人，汉族，杭州医学院毕业，康复治疗师，主要从事孕产康复相关的临床与研究工作。
  • 基金资助:
    广州市卫生健康科技项目(20181A011086)，项目负责人：宋成宪；广州医科大学附属第三医院青年科研项目(2019Q10)，项目负责人：李太良

Immediate effects of different training movements on inter-rectus distance in postpartum women: a high-frequency ultrasound observation

Cen Wanyi1, 2, 3, Gong Yuxuan3, Huang Zhendong3, Hu Xinyu4, Lin Jun3, Que Kexin3, Li Tailiang3, Wang Runmei3, Song Chengxian3   

  1. 1Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510000, Guangdong Province, China; 2Rehabilitation College of Hangzhou Medical College, Hangzhou 311399, Zhejiang Province, China; 3Department of Rehabilitation Medicine, the Third Affiliated Hospital, Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China; 4Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
  • Received:2022-08-03 Accepted:2022-10-12 Online:2023-11-18 Published:2023-03-22
  • Contact: Song Chengxian, MD, Associate chief physician, Department of Rehabilitation Medicine, the Third Affiliated Hospital, Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
  • About author:Cen Wanyi, Rehabilitation therapist, Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510000, Guangdong Province, China; Rehabilitation College of Hangzhou Medical College, Hangzhou 311399, Zhejiang Province, China
  • Supported by:
    Guangzhou Health Science and Technology Project, No. 20181A011086 (to SCX); Youth Scientific Research Project of the Third Affiliated Hospital of Guangzhou Medical University, No. 2019Q10 (to LTL)

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摘要：

文题释义：
高频超声：高频超声是相对于低频超声来讲的，一般采用高频线阵探头进行检查，对肌肉肌腱等软组织具有较高的分辨率，可实时动态观察，并且具有无创、便捷、可重复等优点，是目前评估腹直肌分离间距最为准确客观的方法。
产后腹直肌分离：是产后妇女常见的并发症之一，指两侧的腹直肌在腹白线位置发生分离，一般认为两腹直肌内侧边缘的间距大于20 mm即可确诊。如产后腹直肌分离得不到及时有效修复，一方面对脊柱骨盆的稳定性以及核心力量的产生和传递造成不良影响；另一方面易导致腹部膨隆，影响产妇的形体美观。
背景：产后腹直肌分离具有较高的发病率，对产妇的身心健康造成了一定的不良影响。运动疗法是其主要的治疗方法之一，但何种运动方式能更有效地促进其修复，目前尚缺乏共识。
目的：通过高频超声检查，观察卷腹运动、腹部中空运动、盆底肌收缩和联合运动4个训练动作对产后腹直肌分离间距的即时影响。
方法：招募39例符合条件的腹直肌分离产妇，产后时间2-6个月。在静息状态、卷腹运动、腹式呼吸、盆底收缩、联合运动5个动作模式下，利用高频超声分别在受试者脐上4.5 cm、脐水平和脐下4.5 cm处对腹直肌分离间距进行测量。
结果与结论：①脐上4.5 cm处，4个训练动作与静息状态相比，对腹直肌分离间距的影响差异均无显著性意义(均P > 0.05)；脐水平处，卷腹运动与静息状态相比腹直肌分离间距显著减少(P < 0.01)，而联合运动与静息状态相比腹直肌分离间距增加(P < 0.05)；脐下4.5 cm处，卷腹运动与静息状态相比腹直肌分离间距减少(P < 0.05)，其他3个动作与静息状态相比，腹直肌分离间距虽有增加的趋势，但差异无显著性意义(均P > 0.05)；②顺产组和剖腹产组相比，静息状态下3个测量位置的腹直肌分离间距差异均无显著性意义(均P > 0.05)；在脐水平处，经产组腹直肌分离间距较初产组增宽，差异有显著性意义(P < 0.05)；③脐下4.5 cm处，体质量指数与腹直肌分离间距呈正相关(r=0.359，P=0.025)；④在即时效果上，卷腹运动可缩小腹直肌分离的间距，而腹部中空运动、盆底收缩运动和两者的联合运动则具有相反的效果；多次生产和体质量指数高的产妇可能更容易出现腹直肌分离；研究结果可为产后腹直肌分离的康复治疗提供一定的理论依据。
https://orcid.org/0000-0001-7920-6543(岑婉仪)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程


关键词: 产后, 腹直肌, 腹直肌分离, 高频超声, 运动训练, 卷腹运动, 腹部中空运动, 盆底收缩运动

Abstract: BACKGROUND: Postpartum diastasis rectus abdominis have a high incidence, which has a certain adverse effect on the physical and mental health of parturients. Exercise therapy is one of the main treatment methods, but there is still a lack of consensus on which exercise can promote its repair more effectively.
OBJECTIVE: To observe the immediate effects of curl-up movement, abdominal breathing, pelvic floor muscle contraction and combined exercise on inter-rectus distance using high-frequency ultrasound.
METHODS: Thirty-nine eligible subjects with postpartum diastasis rectus abdominis were recruited 2-6 months after delivery. Inter-rectus distance was measured using high-frequency ultrasound at 4.5 cm above the umbilicus, at the level of the umbilicus and at 4.5 cm below the umbilicus in five movement patterns: resting state, curl-up movement, abdominal breathing, pelvic floor contraction and combined movement.
RESULTS AND CONCLUSION: There was no significant difference in the inter-rectus distance between the resting state and the other four movement patterns at 4.5 cm above the umbilicus (P > 0.05). At the level of the umbilicus, the inter-rectus distance was significantly decreased in the curl-up movement compared with the resting state (P < 0.01), while the inter-rectus distance significantly increased in the combined exercise compared with the resting state (P < 0.05). At the 4.5 cm below the umbilicus, the inter-rectus distance decreased in the curl-up movement compared with the resting state (P < 0.05), while the inter-rectus distance tended to increase in the other three movements compared with the resting state, but there was no statistical difference (P > 0.05). There was no significant difference in the inter-rectus distance between spontaneous delivery group and cesarean section group at the resting state (all P > 0.05). However, at the umbilical level, the inter-rectus distance in the multiparity group was significantly wider than that in the primiparity group (P < 0.05). At 4.5 cm below the umbilicus, the body mass index was positively correlated with the inter-rectus distance (r=0.359, P=0.025). In terms of immediate effects, curl-up movement can reduce the inter-rectus distance, while abdominal breathing, pelvic floor contraction and combined exercise have the opposite effects. Parturients with multiple births and a high body mass index may be more likely to develop postpartum diastasis rectus abdominis. Results from this study will provide a theoretical basis for the rehabilitation treatment of postpartum diastasis rectus abdominis.

Key words: postpartum, rectus abdominis, diastasis rectus abdominis, high-frequency ultrasound, exercise training, curl-up movement, abdominal breathing, pelvic floor contraction

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