應力性尿失禁婦女腹橫肌與腰部多裂肌肌肉休息厚度及其收縮變化

Abstract

背景與目的：近來研究發現尿失禁婦女在執行動作時其骨盆底肌及淺層軀幹肌群的動作策略改變，類似的肌肉收縮型態也出現在脊椎不穩定造成之下背痛患者身上，下背痛患者同時有深層軀幹肌肉：腹橫肌與腰部多裂肌收縮障礙的情形；然而應力性尿失禁婦女之腹橫肌與多裂肌卻未被進一步探討。近年來，即時影像超音波被廣泛應用於量測深層軀幹肌肉形態變化的研究，本研究的目的為利用超音波評估應力性尿失禁與正常婦女其腹橫肌與腰部多裂肌之肌肉形態變化，進一步比較不同嚴重度患者之變異。法：本橫斷型研究，15位應力性尿失禁症狀之婦女納為實驗組(年齡48.3±6.7歲)，另10位年齡相符之無症狀婦女納為對照組(年齡46.5±6.8歲)。所有的參與者需接受影像超音波量測腹橫肌、腰部多裂肌肌肉厚度及收縮形態變化；每條肌肉兩邊各測三次，肌肉與左右順序採隨機控制，超音波資料以自製Matlab軟體度量線性肌肉厚度。統計分析採用SPSS 11.0版本，以T- test及Mann-Whitney U test比較尿失禁組與對照組、輕重度尿失禁婦女組間的肌肉休息厚度及其收縮變化。果：尿失禁組與對照組婦女之腹橫肌及腰部多裂肌的休息厚度無顯著的差異，然而尿失禁組婦女腹橫肌及腰部多裂肌之收縮厚度變化則明顯小於對照組 (腹橫肌：尿失禁組0.14±0.06cm，對照組0.22±0.06cm，p=0.001；腰部多裂肌：尿失禁組0.29±0.17cm，對照組0.51±0.20cm，p=0.006；中間層多裂肌：尿失禁組0.11±0.07cm，對照組0.40±0.19cm，p<0.005)。而輕度與重度尿失禁婦女組間的休息厚度及其收縮變化皆無顯著的差異。論：應力性尿失禁婦女腹橫肌及腰部多裂肌收縮能力較差，建議未來臨床上對於應力性尿失禁婦女之治療，除了骨盆底肌運動外，可增加對腹橫肌及腰部多裂肌之訓練。

Background and Purpose: Altered motor control strategies of pelvic floor muscles (PFM) and superficial trunk muscles in women with stress urinary incontinence (SUI) were found recently. The similar contraction pattern of trunk muscles was also demonstrated in subjects with spinal instability due to low back pain (LBP). Transversus abdominis (TrA) and lumbar multifidus (MF) which are classified to deep trunk muscles and primarily provide spinal stability are also dysfunctioned in patients with low back pain. However, muscle activities of TrA and lumbar MF are not evaluated in women with SUI. Real-time ultrasonography is the most common tool for assessing deep trunk muscles activities in recent years. The aims of the study are to assess the difference in resting thickness and change on contraction of TrA and lumbar MF in women with or without SUI through real-time ultrasonography. Further, to compare the differences among the women with different severities of SUI. ethods: This is a cross-sectional study. Fifteen women who suffered SUI episode at least once during previous month were recruited as SUI group, and 10 age-matched asymptomatic women were recruited as control group. The morphometric change of TrA and lumbar MF were recorded by ultrasound. Each muscle in both sides was assessed for 3 times. Order of evaluation of muscles and sides was randomized. Data were exported for linear measurements analysis using a custom- written Matlab program. Statistical analysis was performed using SPSS 11.0. T- test and Mann-Whitney U test were used to compare the muscles thickness at rest and change of muscle thickness on contraction between women with SUI and asymptomatic controls, and women with different severities. esults: There were no significant differences in resting muscle thickness of TrA and lumbar multifidus between women with and without SUI. However, change in muscle thickness of TrA and lumbar MF in women with SUI was significantly less than asymptomatic controls. (TrA: SUI 0.14±0.06cm vs. asymptomatic 0.22±0.06cm, p=0.001; lumbar MF: SUI 0.29±0.17cm vs. asymptomatic 0.51±0.20cm, p=0.006; intermediate MF: SUI 0.11±0.07cm vs. asymptomatic 0.40±0.19cm, p<0.0005). Further, measured variables were not different between women with different severities of SUI. onclusion: The morphometric change on contraction of TrA and lumbar MF is smaller in women with SUI comparing to those without SUI recorded by ultrasound. Integrating TrA and lumbar MF with PFM training is suggested in treatment for women with SUI.