Adolescent idiopathic scoliosis (AIS) is a progressive three-dimensional skeletal deformity that affects spinal mobility and trunk symmetry. It was previously believed that AIS was not accompanied with pain, but recent studies have shown that approximately 31.5% of the patients complain of low back pain, which may due to factors such as paravertebral muscle imbalance and fatigue.

To observe morphological changes of paravertebral multifidus muscles at the top of the main curvature after high energy laser therapy (HILT) combined with physiotherapy scoliosis specific exercise (PSSE) in AIS patients with low back pain by using musculoskeletal ultrasound. and evaluate the clinical effect of treatment on the correction of paravertebral muscle imbalance.

A total of 30 patients with AIS RigoE1 admitted to the Scoliosis Correction Center of the Fifth Hospital of Harbin from December 2020 to December 2021 were selected for a randomized single-blind controlled trial and divided into the experimental group (n=15) and control group (n=15) , the experimental group was treated with HILT combined with PSSE, and the control group was only treated with HILT. Musculoskeletal ultrasound, visual analogue scale (VAS) scores, range of motion of the patient's lumbar joints and Roland-Morris lumbar spine dysfunction questionnaire (RDQ) were performed before and 4 weeks after treatment in both groups. Pearson correlation analysis was used to investigate whether there was a correlation between the changes in the multifidus muscles after treatment and the treatment effect.

The cross-sectional area of the convex side of multifidus muscles, anterior flexion, left lateral flexion, left rotation and right rotation of the experimental group were higher than those of the control group after treatment (P<0.05) , the cross-sectional area and thickness of multifidus muscles on the concave side, the cross-sectional area and thickness ratios of multifidus muscles on the concave and convex sides, extension after treatment were higher than those before treatment in the experimental group (P<0.05) . VAS scores and RDQ scores after treatment were lower than those before treatment, and anterior flexion, left lateral flexion, right lateral flexion, left rotation and right rotation were higher than those before treatment (P<0.05) in both two groups. The extension after treatment was lower than that before treatment in the control group (P<0.05) . Pearson correlation analysis showed that the cross-sectional area ratio of multifidus muscles on the concave and convex sides was negatively related with right rotation of the lumbar spine after treatment in the experimental group (r=-0.660, P<0.01) , the thickness ratio of the concave and convex sides of multifidus muscles was negatively related with right flexion of the lumbar spine (r=-0.614, P<0.05) .

HILT combined with PSSE can change the morphology of the multifidus muscles on the concave side of the parietal vertebrae of scoliosis, reduce low back pain, increase lumbar spine mobility, reduce lumbar spine dysfunction and improve activities of daily living; the use of HILT alone can effectively relieve low back pain caused by scoliosis, although it has no significant effect on the morphological changes of the multifidus muscles. Balancing the morphology of the multifidus muscles on both sides of the spine has a positive effect on improving the lateral flexion and rotation of the lumbar spine.

青少年特发性脊柱侧凸（AIS）是影响脊柱活动及躯干对称性的进展性三维骨骼畸形，有研究认为AIS不伴有疼痛，但最近的研究显示约有31.5%的患者伴有腰背疼痛。腰背痛产生的原因可能是由于椎旁肌失衡及疲劳等因素所致。

应用肌骨超声观察AIS伴腰部疼痛患者在高能量激光疗法（HILT）联合脊柱侧凸特定运动疗法（PSSE）治疗后主弯顶椎旁多裂肌形态变化，评价联合治疗对椎旁肌失衡纠正的临床效果。

选取2020年12月—2021年12月哈尔滨市第五医院脊柱侧弯矫治中心收治的AIS Rigo E1型患者30例进行随机单盲对照试验，将患者随机分为试验组（n=15）和对照组（n=15）；试验组采用HILT联合PSSE，对照组仅采用HILT。两组分别于治疗前与治疗4周后进行肌骨超声检查、视觉模拟量表评分（VAS）、患者腰椎关节活动范围检查、Roland-Morris腰椎功能障碍问卷（RDQ）评分。采用Pearson相关性分析探究治疗后多裂肌的变化与治疗效果是否存在相关性。

治疗后试验组多裂肌凹侧横截面积、前屈度、左侧屈度、左旋转度、右旋转度高于对照组（P<0.05），试验组治疗后多裂肌凹侧横截面积、凹侧厚度、凹凸侧横截面积比、凹凸侧厚度比、伸展度高于治疗前（P<0.05）。两组治疗后VAS评分、RDQ评分均低于治疗前，前屈度、左侧屈度、右侧屈度、左旋转度、右旋转度高于治疗前（P<0.05）；对照组治疗后伸展度低于治疗前（P<0.05）。Pearson相关性分析显示，治疗后凹凸侧多裂肌横截面积比与治疗后腰椎右旋转度呈负相关（r=-0.660，P<0.01），治疗后凹凸侧多裂肌厚度比与治疗后腰椎右侧屈度呈负相关（r=-0.614，P<0.05）。

HILT联合PSSE可使脊柱侧凸顶椎凹侧多裂肌形态改变，减轻腰部疼痛，增加腰椎活动度及降低腰椎功能障碍，提高日常生活能力；单独使用HILT虽对多裂肌形态变化影响不明显，但可有效缓解脊柱侧凸引起的下腰痛。脊柱双侧多裂肌形态趋于平衡对改善腰椎侧屈与旋转功能具有积极作用。