腹肌锻炼对腰椎间盘突出症患者单侧MIS-TLIF术后的疗效观察

发布时间：2018-03-31 04:16

本文选题：腹肌锻炼　切入点：腰椎间盘突出症　出处：《福建中医药大学》2017年硕士论文

【摘要】：目的:观察腹肌功能锻炼对腰椎间盘突出症单侧MIS-TLIF(minimally invasive transforaminal lumbar interbody fusion)固定术后患者的临床疗效。研究方法:自2015年9月至2016年3月连续收集64例腰椎间盘突出症单侧MIS-TLIF术后患者,根据入院顺序随机分为治疗组和对照组各32例,其中对照组,患者在术后2d(拔管后),由专业康复医师开始指导进行直腿抬高训练,在1周后开始进行常规腰背肌锻炼;治疗组在对照组训练治疗的基础上,由同一名康复医师指导在患者出院前教会患者进行腹肌锻炼计划的所有动作,在术后2d进行呼气收腹训练,术后1周增加仰卧抱膝训练,术后2周开始侧桥结合屏气训练,两组功能锻炼均持续3个月。记录两组患者随访过程中的VAS评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、下腰痛JOA评分、腰椎正侧位片。整理临床收集的数据,使用SPSS20.0软件,对收集数据进行统计、分析。结果:1.VAS评分方面,两组患者术后评分比较无显著差异(P0.05);两组患者在术后1个月随访VAS评分均有显著改善(P0.01)。在后续随访的术后1月、术后3月、术后6月三个时间段,治疗组与对照组相比,治疗组的评分均低于对照组(P0.05)。2.Oswestry功能障碍指数方面,两组患者术后及术后1个月治疗组与对照组相比,治疗组的ODI评分无明显改善(P0.05)。术后3、6、12个月,治疗组与对照组比较,治疗组的ODI评分均低于对照组(P0.01)。3.JOA评分方面,两组患者术后JOA评分比较,治疗组与对照组无明显差异(P0.05);两组患者术后第1、3、6、12个月随访患者JOA评分,治疗组JOA评分均优于对照组,差异均具有统计学意义(P0.05)。4.影像学检查,随访3个月后复查腰椎X线正侧位片,治疗组与对照组患者所有X线片均无钉棒和融合器的松动、移位。结论:腰椎间盘突出症患者单侧MIS-TLIF术后早期行腹肌锻炼结合常规腰背肌功能锻炼可减少术后腰腿疼痛,术后患者生活质量得到改善。随访术后3个月X线片未见患者手术内固定物松动和移位,该阶梯式腹肌功能锻炼方法患者容易接受,临床安全性高。
[Abstract]:Objective: to observe the clinical effect of abdominal muscle function exercise on unilateral MIS-TLIF(minimally invasive transforaminal lumbar interbody fusion of lumbar disc herniation.Methods: from September 2015 to March 2016, 64 consecutive patients with lumbar disc herniation after unilateral MIS-TLIF were randomly divided into treatment group (n = 32) and control group (n = 32).At 2 days after extubation, the patients were trained with straight leg elevation under the guidance of a professional rehabilitation physician, and the regular lumbar dorsal muscle training began after 1 week. The treatment group was treated on the basis of training and treatment in the control group.Under the guidance of the same rehabilitation physician, all the movements of the abdominal muscle training plan were performed before the patient was discharged from the hospital. The abdominal expiratory training was performed on the 2nd day after the operation. The training of supine knee was increased 1 week after operation, and the side bridge training combined with breath holding training began 2 weeks after the operation.Functional exercise lasted 3 months in both groups.Oswestry disability index (Oswestry disability index), low back pain (JOA) score and lumbar anteroposterior radiography were recorded.Collect clinical data, use SPSS20.0 software to collect data statistics, analysis.Results 1. There was no significant difference in postoperative scores between the two groups (P 0.05), and the VAS scores of the two groups were significantly improved at 1 month after operation (P 0.01).The scores in the treatment group were lower than those in the control group at 1 month, 3 months and 6 months after follow-up compared with those in the control group. 2. The score of Oswestry dysfunction index in the treatment group was lower than that in the control group.Compared with the control group, the ODI scores of the two groups were not significantly improved (P 0.05).Compared with the control group, the ODI score of the treatment group was lower than that of the control group at 6 and 12 months postoperatively, and the JOA score of the two groups was lower than that of the control group.There was no significant difference between the treatment group and the control group (P 0.05), the JOA score of the treatment group was better than that of the control group in the first 3 months after operation, and the JOA score of the treatment group was better than that of the control group, and the difference was statistically significant.All X-ray films of the treatment group and the control group had no loosening and displacement of the screw rod and fusion cage.Conclusion: early abdominal muscle exercise combined with routine lumbar dorsum muscle exercise in patients with lumbar disc herniation after unilateral MIS-TLIF can reduce postoperative pain of waist and leg and improve the quality of life of patients after operation.There was no loosening and displacement of the internal fixation in the patients after 3 months follow-up. The patients with the step abdominal muscle function exercise method were easy to accept and the clinical safety was high.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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