早期规律康复训练对腰椎融合术后患者腰椎功能和矢状面参数的影响：一项前瞻性随机对照研究

Effects of early regular rehabilitation on lumbar function and sagittal plane parameters in patients after lumbar fusion: a prospective randomized controlled study

中文关键词:  腰椎融合术  功能锻炼  腰椎矢状面参数  临床疗效

英文关键词:Lumbar fusion  Functional exercise  Sagittal plane parameter of lumbar spine  Clinical efficacy

中文摘要:

  【摘要】 目的：探讨早期规律康复训练对腰椎后路单节段融合术后患者腰椎功能及矢状面参数的影响。方法：采用前瞻性、同期、平行、对照的研究设计，将124例因退行性腰椎疾病行单节段传统腰椎后路融合术（posterior lumbar interbody fusion，PLIF）治疗的患者随机分为康复组与对照组，每组62例。康复组，男性30例，女性32例，年龄54.0±4.8岁；对照组，男性29例，女性33例，年龄55.0±5.2岁。康复组在康复师指导下规律康复训练，对照组自行功能锻炼。记录术前、术后1、3、6个月Oswestry功能障碍指数（Oswestry disability index，ODI）、日本骨科协会（Japanese Orthopaedic Association，JOA）评分，Barthel量表评分；记录引流量与住院天数；测量并比较术前、术后3、6个月腰椎前凸角（lumbar lordosis，LL）与腰椎弓形面积（lumbar arch area，LAA）；记录围手术期并发症，最后进行统计分析，比较两组康复效果的差异性。结果：术后1、3个月康复组的ODI、JOA评分、Barthel量表评分均优于对照组，差异有统计学意义（P＜0.05）。术后6个月康复组的ODI、JOA评分、Barthel量表评分与对照组比较差异无统计学意义（P＞0.05）。两组患者的引流量比较，无统计学差异（P＞0.05）。康复组住院天数小于对照组（7.6±0.7d vs 9.7±0.6d），差异有统计学意义（P＜0.05）。术后6个月，康复组患者的LL与LLA（51.3°±2.3°，26.6±1.6mm2）均大于对照组患者（46.8°±4.2°，21.5±3.1mm2），差异有统计学意义（P＜0.05）。术后早期并发症方面，康复组出现1例术后腹胀便秘，1例术区血肿；对照组出现6例腹胀，2例深静脉血栓，1例肺部感染，1例尿道感染。两组并发症比较，差异有统计学意义（P＜0.05）。结论：在腰椎单节段融合术后，早期规律性的康复训练，可缩短住院天数、降低围手术期并发症，改善腰椎矢状面参数，对患者的功能恢复及改善生活能力方面具有积极的作用。

英文摘要:

  【Abstract】 Objectives: To explore the effects of early regular rehabilitation exercise on lumbar function and saggital plane parameters of patients after single-segment posterior lumbar interbody fusion surgery(PLIF). Methods: Using a prospective, contemporaneous, parallel, controlled study design, 124 patients who underwent single-segment PLIF for degenerative lumbar spine disease were randomly divided into a rehabilitation group and a control group, with 62 patients in each group. The rehabilitation group consisted of 30 males and 32 females, with a mean age of 54.0±4.8 years old; The control group included 29 males and 33 females, with a mean age of 55.0±5.2 years old. Patients in the rehabilitation group were instructed in regular functional training under the guidance of rehabilitation instructor, while patients in the control group performed functional exercise on their own. The preoperative, postoperative 1, 3, and 6 months′ Oswestry disability index(ODI), Japanese Orthopaedic Association(JOA) score, and Barthel scale score were recorded. Drainage and hospitalization days were recorded, and lumbar lordosis(LL) angle and lumbar arch area(LAA) before operation and at postoperative 3 and 6 months were measured and compared between groups, perioperative complications were recorded, and finally a statistical analysis was performed to compare the differences in treatment effects between the two groups. Results: The ODI, JOA score and Barthel scale score of the rehabilitation group were better than those of the control group at 1 and 3 months after surgery, with statistical significance(P＜0.05). There were no significant differences in ODI, JOA score and Barthel score between the two groups at 6 months after operation(P>0.05). There was no statistical difference in the amount of drainage between the two groups(P＞0.05). The number of hospitalization days in the rehabilitation group was less than that in the control group (7.6±0.7d vs 9.7±0.6d, P<0.05). At 6 months postoperatively, the LL and LLA of patients in the rehabilitation group(51.3°±2.3° and 26.6±1.6mm2) were greater than those of patients in the control group(46.8°±4.2° and 21.5±3.1mm2), and the differences were statistically significant(P<0.05). As for early postoperative complications, one case of abdominal distension and constipation and one case of hematoma in the operation area were observed in the rehabilitation group; Six cases of abdominal distension, two cases of deep vein thrombosis, one case of lung infection and one case of urinary tract infection were observed in the control group. There was no statistical difference in complications between the two groups(P>0.05). Conclusions: After single-segment PLIF, early and regular rehabilitation training can shorten the length of hospital stays, reduce perioperative complications, and have a positive effect on the functional recovery and improvement of living ability of patients.