神经肌肉电刺激联合手法推拿在产后腹直肌分离患者中的应用价值

Application value of neuromuscular electrical stimulation combined with manual therapy for postpartum diastasis recti abdominis

摘要

目的 基于盆腹动力学及腹直肌超声参数变化探究神经肌肉电刺激联合手法推拿在产后腹直肌分离患者中的应用价值。方法 选取2024年8月至2025年8月安徽中医药大学第一附属医院收治的60例产后腹直肌分离患者,采用随机信封法将其分为对照组和研究组各30例,其中对照组接受常规康复训练和神经肌肉电刺激,研究组在对照组的基础上联用手法推拿。干预4周后评估两组患者腹直肌超声参数、盆底肌肌力、盆底功能、腰痛程度、生活质量以及不良反应发生情况。结果 干预后,两组患者脐上3 cm、脐水平以及脐下3 cm 的腹围、腹直肌分离距离均降低,且研究组均低于对照组(t介于2.418到3.325之间,P<0.05);干预后,两组患者盆底Ⅰ类肌纤维平均值、盆底Ⅱ类肌纤维肌力最大值均升高,且研究组均高于对照组(t=3.323、2.921,P<0.05);干预后,两组患者的盆底功能障碍量表(PFDI-20)、Oswestry功能障碍指数(ODI)评分均降低,且研究组均低于对照组,世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分均升高,且研究组高于对照组(t=4.933、5.344、3.305,P<0.05),两组不良反应发生情况比较差异无统计学意义(P>0.05)。结论 神经肌肉电刺激联合手法推拿用于产后腹直肌分离患者中,可有效改善患者腹直肌分离情况及盆腹功能,同时还能缓解腰痛,提高生活质量,具备安全性,值得在临床中推广应用。

Abstract

Objective To explore the application value of neuromuscular electrical stimulation combined with manual therapy in patients with postpartum diastasis recti abdominis based on abdominopelvic dynamics and rectus abdominis ultrasound parameter changes. Methods 60 patients with postpartum diastasis recti abdominis admitted to the hospital from August 2024 to August 2025 were selected and divided into control group and study group by random envelope method,with 30 cases in each group.The control group received routine rehabilitation training and neuromuscular electrical stimulation,while the study group received manual therapy on the basis of the control group.After 4 weeks of intervention,the rectus abdominis ultrasound parameters (inter-rectus distance,rectus abdominis separation distance),pelvic floor muscle strength (average muscle strength of typeⅠ muscle fibers,maximum muscle strength of typeⅡ muscle fibers),pelvic floor function [pelvic floor dysfunction inventory (PFDI-20) score], low back pain degree [Oswestry disability index (ODI)],quality of life [World Health Organization Quality of Life-BREF (WHOQOL-BREF) score]and adverse reactions were evaluated in the two groups. Results After intervention,inter-rectus distances and rectus abdominis separation distances of 3 cm above the umbilicus,the umbilicus level and 3 cm below the umbilicus were decreased in both groups,and the indexes in study group were lower than those in control group (t=2.418-3.325,P <0.05).After intervention,the average muscle strength of typeⅠ muscle fibers and maximum muscle strength of typeⅡ muscle fibers were increased in both groups,and the values in study group were higher than those in reference group ( t=3.323,2.921,P<0.05). After intervention,the PFDI-20 score and ODI score in the two groups were decreased,and the scores in study group were lower than those in reference group,and the WHOQOL-BREF score was increased,and the score in study group was higher than that in reference group ( t=4.933,5.344,3.305,P <0.05).There was no statistical difference in the occurrence of adverse reactions between the two groups (P>0.05). Conclusion Neuromuscular electrical stimulation combined with manual therapy can effectively improve diastasis recti abdominis and abdominopelvic function in patients with postpartum diastasis recti abdominis,relieve low back pain,and improve quality of life,with good safety.

关键词

腹直肌分离 / 神经肌肉电刺激 / 推拿 / 盆腹动力学 / 超声

Key words

diastasis recti abdominis / neuromuscular electrical stimulation / manual therapy / pelvic abdominal dynamics / ultrasound

参考文献

[1] Hu J, Gu J, Yu Z, et al. Efficacy of standardized rehabilitation in the treatment of diastasis rectus abdominis in postpartum women[J]. Int J Gen Med, 2021, 14(1): 10373-10383.

[2] Hagovská M, Dudicˇ R, Švihra J, et al. Relationships of diastasis recti abdominis with stress urinary incontinence and pelvic floor muscle dysfunction in postpartum women[J]. Eur J Obstet Gynecol Reprod Biol, 2024, 301: 222-226.

[3] Tadmare S, Bhatnagar G, Kamble R, et al. Comparison of abdominal exercises and neuromuscular elecrical stimilation on diastasis recti abdominis muscle in postnatal females with caesarean section[J]. Georgian Med News, 2024, 346: 63-67.

[4] 王允芳, 谢永斌. 腹部射频联合手法康复治疗产后腹直肌分离的临床疗效[J]. 中国医刊, 2025, 60(5): 551-554.

[5] Brown O, Heliker B D, Geynisman-Tan J, et al. Vaginal electrical stimulation for postpartum neuromuscular recovery:a randomized clinical trial[J]. Female Pelvic Med Reconstr Surg, 2021, 27(11): 659-666.

[6] 白伟伟, 廖凡, 阚晓纯, 等. 经会阴盆底超声参数联合腹直肌分离度可提高产后压力性尿失禁诊断效能[J]. 分子影像学杂志, 2025, 48(3): 340-346.

[7] 范健, 虞志艳, 李晓辉, 等. 产后腹直肌分离诊疗专家共识[J]. 实用临床医药杂志, 2023, 27(4): 1-14.

[8] Mashayekh-Amiri S, Asghari Jafarabadi M, Rashidi F, et al. Translation and measurement properties of the pelvic floor distress inventory-short form (PFDI-20) in Iranian reproductive age women[J]. BMC Womens Health, 2023, 23(1): 333-335.

[9] Fairbank J C, Pynsent P B. The oswestry disability index[J] Spine(Phila Pa 1976), 2000, 25(22): 2940-2952.

[10] Min S K, Kim K I, Lee C I, et al. Development of the Korean versions of WHO Quality of Life scale and WHOQOL-BREF[J]. Qual Life Res, 2002, 11(6): 593-600.

[11] He X, Liu J, Ji R. Application research of core stability training based on biofeedback in postpartum rectus abdominis muscle separation[J]. Am J Clin Exp Immunol, 2024, 13(5): 226-232.

[12] Chen Y, Sun X Y, Qian C, et al. Therapeutic effect of manual massage on early postpartum rectus abdominis separation and postpartum depression [J]. World J Psychiatry, 2024, 14(5): 678-685.

[13] Wang H, Xie D, Liu Z, et al. Effect of inspiratory plus expiratory neuromuscular electrical stimulation on diastasis recti abdominis in postpartum[J]. Physiother Res Int, 2025, 30(3): e70069.

[14] 郑鹏, 何兴悦, 刘美君, 等. 推拿联合脐灸治疗产后气虚血瘀型腹直肌分离35 例[J]. 中国针灸, 2024, 44(7): 762-764.

[15] 郭祥翠, 李若冰, 王漪琳, 等. 神经肌肉电刺激联合主动功能训练对产后盆底功能障碍及腹直肌分离的干预效果[J]. 中华实用诊断与治疗杂志, 2025, 39(1): 56-60.

[16] Bouguetoch A, Martin A, Grosprêtre S. Insights into the combination of neuromuscular electrical stimulation and motor imagery in a training-based approach[J]. Eur J Appl Physiol, 2021, 121(3): 941-955.

[17] 徐丹丹, 辜锐鑫, 周晶, 等. 盆底康复训练结合太极推拿治疗产后压力性尿失禁的临床观察[J]. 时珍国医国药, 2021, 32(6): 1412-1414.

[18] 史文静, 陈伟, 程芳, 等. 中低周波联合推拿疗法对产后腰痛的治疗效果[J]. 中国医药导报, 2022, 19(3): 127-130.

[19] 罗玉华, 陶颖, 钟红霞. 生物反馈电刺激联合穴位推拿治疗产后盆底功能障碍性疾病的临床研究[J]. 中国计划生育和妇产科, 2024, 16(10): 86-89.

[20] 高晶晶, 姜斌, 程鹤. 运动疗法联合神经肌肉电刺激治疗产后腹直肌分离的疗效观察[J]. 中华物理医学与康复杂志, 2022, 44(6): 536-539.

[21] 程倩, 忻悦, 周燕. 核心肌群训练联合盆底肌电刺激与生物反馈治疗对产后压力性尿失禁患者盆底功能的影响[J]. 中国妇幼健康研究, 2025, 36(7): 91-96.

[22] Liang P, Liang M, Shi S, et al. Rehabilitation programme including EMG-biofeedback-assisted pelvic floor muscle training for rectus diastasis after childbirth:a randomised controlled trial[J]. Physiotherapy, 2022, 117: 16-21.

基金资助

安徽省卫生健康科研项目(AHWJ2023A20327)