腰椎后路单节段融合术后早期功能康复的临床意义

Clinical significance of early functional rehabilitation after posterior single-segment lumbar interbody fusion procedures

中文关键词:  腰椎融合术  早期康复  加速康复  并发症

英文关键词:Lumbar fusion  Early rehabilitation  Enhanced recovery after surgery  Complication

中文摘要:

  【摘要】 目的：探讨腰椎后路单节段融合术后早期功能康复对患者功能恢复及并发症的影响。方法：回顾性研究2016年10月～2017年12月因腰椎退行性疾病行腰椎后路单节段融合手术（posterior lumbar interbody fusion，PLIF）病例，将患者分为早期康复组和对照组。早期康复组患者术后第1天在腰围保护下离床活动，同时拔除尿管，更改引流为常压引流袋，在康复师指导下行早期功能锻炼；对照组患者术后卧床休息，维持负压引流，拔除引流管后进行自行功能锻炼。主要观察指标包括腰椎Oswestry功能障碍指数（Oswestry disability index，ODI）及疼痛视觉模拟评分（visual analogue scale，VAS），围手术期并发症、引流量及引流时间，以及住院时间。结果：本研究共纳入113例单节段PLIF病例，其中2017年6月前手术患者均行传统康复措施，纳入对照组，之后手术患者均进行早期康复锻炼并纳入早期康复组。早期康复组52例，女性占61.5%（32例），患者平均年龄52.4±15.9岁（23～78岁）。对照组61例，患者平均年龄55.0±11.2岁（21～76岁），女性患者占54.1%（33例）。两组患者手术时间（118.79min vs 117.77min，P>0.05）、术中出血量（306.56ml vs 307.73ml，P>0.05）无显著统计学差异。术后两组拔管时间（3.00d vs 3.15d）及总引流量（390.77ml vs 374.75ml）均无明显统计学差异（P>0.05），两组患者术后1个月、3个月、6个月和1年随访ODI和VAS评分无明显统计学差异（P>0.05）。早期康复组出现1例再手术，1例术后腹胀便秘，对照组出现2例下肢静脉血栓形成，2例泌尿系感染，4例腹胀便秘，两组围手术期相关并发症发生率（3.8% vs 13.1%，P<0.05）及平均住院时间（8.7±3.2d vs 10.2±2.7d，P<0.01）比较，差异具有统计学意义。结论：腰椎单节段融合术后早期在康复师指导下进行离床活动及主动功能锻炼可降低围手术期卧床相关并发症风险，减少住院时间，但对总引流量、拔管时间、临床疗效及疼痛改善无明显影响。

英文摘要:

  【Abstract】 Objectives: To explore the effect of early functional rehabilitation after single-segment posterior lumbar interbody fusion(PLIF) on functional recovery and complications of patients. Methods: Patients with lumbar degenerative disease undergoing single-segment PLIF were divided into two groups. Patients in the early rehabilitation group were discharged from the bed under the protection of the lumbar spine on the first day postoperatively, and the catheter was removed. The drainage was changed to the normal pressure fromnegative pressure drainage bag, and the early functional exercise was guided by the rehabilitation therapist. The control group took rest in bed postoperatively, maintained negative pressure drainage, and the autonomous function exercise was performed after the urinary tube was removed. The operation time, intraoperative blood loss, postoperative extubation time and total drainage volume, lumbar Oswestry disability index(ODI) score, pain visual analogue scale(VAS) score and perioperative complications preoperative, and 1 month, 3 months, 6 months and 1 year perioperatively were recorded. Results: A total of 113 single-segment PLIF cases were included in the study. All patients underwent conventional rehabilitation measures before June 2017, and were included in the control group. All patients underwent early rehabilitation and were included in the early rehabilitation group. In the early rehabilitation group, there were 52 patients with female accounted for 61.5%(32 patients), the average age was 52.4±15.9 years(range: 23-78 years). In the control group, 61 patients had an average age of 55.0±11.2 years(range, 21-76 years), and female patients accounted for 54.1%(33 cases). There were no statistically significant differences in operation time between the two groups(118.79min vs 117.77min, P<0.05) and intraoperative blood loss(306.56ml vs 307.73ml, P<0.05). There were no significant differences in extubation time(3.00d vs 3.15d) and total drainage volume(390.77ml vs 374.75ml) between the two groups(P>0.05). There was no significant difference in the ODI and VAS scores between the 1 month, 3 months and 6 months, and 1-year follow-up(P>0.05). In the early rehabilitation group, there were 1 case with reoperation, 1 postoperative abdominal distension constipation, there were 2 cases had lower extremity venous thrombosis, 2 cases had urinary tract infection, and 4 cases had abdominal distension constipation in the control group. The difference in the bedridden related complication rate between the two groups was statistically significant(3.8% vs 13.1%, P<0.05). The average length of hospital stay was(8.7±3.2d vs 10.2±2.7d, P<0.01), and the difference was statistically significant.　Conclusions: Functional exercise under the guidance of a rehabilitation therapist in the early stage after single level PLIF procedure can reduce the risk of perioperative complications, and has no significant effect on total drainage, extubation time, functional rehabilitation and pain improvement.