neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2023-25-2-60-67neurosurgery-1373Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTВлияние операции ламинэктомии на боль, функциональную нетрудоспособность, сенсибилизацию и активные триггерные точки у пациентов с грыжей поясничного дискаThe effects of laminectomy surgery on pain, functional disability, sensitization and active trigger points in subjects with lumbar disc herniationЭззатиК.EzzatiK.

Терапевт, PhD, доцент кафедры физиотерапии, Исследовательский центр неврологии, больница Пурсина, медицинский факультет Университета медицинских наук Гиляна.

Решт

PT, PhD, Associate Professor in Physical Therapy, Neuroscience Research Center, Poursina Hospital, Faculty of Medicine, Guilan University of Medical Sciences; Guilan Road Trauma Research Center, Guilan University of Medical Sciences

Rasht

РеханянЗ.RehanianZ.

Исследовательский центр неврологии, больница Пурсина; Исследовательский центр дорожной травмы Гилана, Университет медицинских наук Гиляна.

Решт

Guilan Road Trauma Research Center, Guilan University of Medical Sciences; 

Department of Neurosurgery, Poursina Hospital, School of Medicine Guilan University of Medical Sciences

Rasht

Юсефзаде-ЧабокШ.Yousefzadeh-ChabokSh.

Исследовательский центр дорожной травмы Гилана

Решт

Guilan Road Trauma Research Center

Rasht

ГадарджаниШ.GhadarjaniSh.

Врач, нейрохирург, сертифицированный неврологический хирург, больница Гаема.

Решт

MD, Neurosurgeon, Board Certified Neurological Surgeon

Rasht

Давуди-КиакалайехА.Davoudi-KiakalayehA.

Отделение нейрохирургии, больница Пурсина, медицинский факультет Университета медицинских наук Гилян.

Решт

Department of Neurosurgery, Poursina Hospital, School of Medicine

Rasht

Больница Пурсина, Университета медицинских наук Гилян; Исследовательский центр дорожной травмы Гилана, Университет медицинских наук ГилянаИранPoursina Hospital; Guilan University of Medical SciencesIslamic Republic of IranБольница Пурсина, Университета медицинских наук ГилянИранGuilan University of Medical SciencesIslamic Republic of IranУниверситет медицинских наук ГилянаИранGuilan University of Medical SciencesIslamic Republic of IranБольница ГаемаИранGhaem HospitalIslamic Republic of Iran2023100720232526067Copyright © Эззати К., Реханян З., Юсефзаде-Чабок Ш., Гадарджани Ш., Давуди-Киакалайех А., 20232023Эззати К., Реханян З., Юсефзаде-Чабок Ш., Гадарджани Ш., Давуди-Киакалайех А.Ezzati K., Rehanian Z., Yousefzadeh-Chabok S., Ghadarjani S., Davoudi-Kiakalayeh A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1373Цель

Цель. Оценить влияние ламинэктомии на боль, функциональную нетрудоспособность, сенсибилизацию и активные триггерные точки у пациентов с грыжей поясничного диска.

Методы

Методы. В настоящее проспективное одногрупповое исследование до и после операции вошел 71 пациент (42 мужчины и 29 женщин) в возрасте 20–60 лет (48 ± 13,41). За 48 ч до операции пациентов осмотрел физиотерапевт. Интенсивность боли измеряли по визуальной аналоговой шкале, инвалидность – по индексу Освестри (персидская версия), а уровень чувствительности – с помощью альгометра давления. Через 3 мес после ламинэктомии пациенты были повторно обследованы с помощью указанных тестов.

Результаты

Результаты. У большинства (23 случая, 32,4 %) пациентов до операции выявлены 3 активные триггерные точки в мышцах. У 60 (84,5 %) испытуемых наблюдалось постепенное зарождение боли в ногах без травм в анамнезе. Триггерные точки до ламинэктомии в основном присутствовали в поясничной многораздельной (74,9 %), медиальной икроножной (73,2 %), камбаловидной (70,4 %) и средней ягодичной (62 %) мышцах. С другой стороны, после ламинэктомии триггерные точки в основном были в медиальной икроножной (54,9 %), латеральной икроножной (53,5 %), камбаловидной (50,7 %), многораздельной (39,4 %) и квадратной поясничной (39,4 %) мышцах. Распространенность триггерных точек в длиннейшей мышце грудной клетки (р = 0,04), квадратной поясничной (р = 0,001), большой ягодичной (р = 0,04) и передней большеберцовой (р = 0,02) мышцах значительно уменьшилась после ламинэктомии. Признаки боли, инвалидизации и порог болевого давления выявили значительные различия до и после операции. Обсуждение. Картина распределения активных триггерных точек мышц отличалась до и после операции. Наиболее часто миофасциальный болевой синдром до и после операции присутствовал на многораздельной и икроножной мышцах соответственно.

Заключение

Заключение. Настоящее исследование показало, что боль, инвалидизация, число и распространенность триггерных точек уменьшились после поясничной ламинэктомии. При этом болевой порог давления на триггерные точки после операции повысился. Картина распределения активных триггерных точек мышц была разной до и после операции. Наиболее часто миофасциальный болевой синдром до и после операции присутствовал на многораздельной и икроножной мышцах соответственно. Фактически результаты настоящего исследования показали, что активные триггерные точки следует учитывать в период до и после ламинэктомии.

Objectives

Objectives. To evaluate the effects of laminectomy surgery on pain, functional disability, sensitization and active trigger points in subjects with lumbar disc herniation.

Methods

Methods. This study was a prospective pre‑post single group study. Seventy‑one patients (42 male and 29 female) have been enrolled in the research with an age range of 20–60 (48 ± 13.41). During 48 hours before surgery, patients were examined by a physiotherapist. Pain intensity were measured by visual analogue scale, disability by oswestry index (Persian version) and sensitivity level using pressure algometer. Three month after laminectomy, the patients were re‑examined for mentioned outcomes again.

Results

Results. The majority of the patients (23 cases, 32.4 %) revealed 3 active trigger points of the muscles before surgery. 60 subjects (84.5 %) experienced a gradual onset of leg pain without a trauma history. Lumbar multifidus (74.9 %), medial gastrocnemius (73.2 %), soleus (70.4) gluteus medius (62 %) were the most involved muscles with trigger points before laminectomy. On the other hand, after laminectomy medial gastrocnemius (54.9 %), lateral gastrocnemius (53.5 %), soleus (50.7 %), multifidus (39.4 %) and quadratus lumborum (39.4 %) were the most involved muscles with trigger points. The existence of trigger points in longissimus thoracis (p = 0.04), quadratus lumborum (p = 0.001), gluteus maximus (p = 0.04) and tibialis anterior (p = 0.02) were decreased significantly after laminectomy. Pain, disability and pain pressure threshold revealed significant differences before and after surgery.

Discussion

Discussion. The pattern of active trigger points of muscles was different before and after surgery. Multifidus and gastrocnemius were the most prevalent muscles with myofascial pain syndrome before and after surgery respectively.

Conclusion

Conclusion. The present study revealed that pain, disability, number and prevalence of trigger points decreased after lumbar laminectomy. Nevertheless, pressure pain threshold of trigger points increased after surgery. The pattern of active trigger points of muscles was different before and after surgery. Multifidus and gastrocnemius were the most prevalent muscles with myofascial pain syndrome before and after surgery respectively. In fact, current results showed that active trigger points should be considered before and after laminectomy surgery

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The authors declare that there are no conflicts of interest present.