核心肌群稳定训练对腰椎术后综合征患者康复的疗效观察

发布时间：2018-06-23 02:04

本文选题：核心肌群稳定训练 + 腰椎术后综合征　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:通过对比腰椎术后综合征患者坚持核心肌群稳定训练时间长度的不同对患者功能康复的影响,明确核心肌群稳定训练法获得明显临床疗效的时间,探讨长期坚持核心肌群稳定训练的必要性,为腰椎术后综合征患者康复计划的制定提供参考。方法:来源于2015年6月-2015年12月期间来我院骨科门诊患者,曾因诊断为"腰椎间盘突出症",并明确为行腰椎减压融合内固定术治疗出院后出现腰椎术后综合征病例60例,随机分成三组:3个月组(始坚持规范的核心肌群稳定训练3个月)20例;6个月组(坚持规范的核心肌群稳定训练6个月)20例;1年组(坚持规范的核心肌群稳定训练1年)20例。以参加训练前及末次随访两个时间段进行腰椎不稳调查问卷及腰椎MRI检查,及使用PACS软件测量病变节段多裂肌的横截面积,记录患者多裂肌面积变化率。以训练前、训练后3个月、6个月及1年四个时间段进行VAS评分、ODI评分收集并拍摄腰椎过伸过屈X片。结果:全部符合纳入标准并完成1年随访时间的患者训练前的病程、年龄、体重等基本资料无差异。三组患者训练前VAS评分、腰椎不稳前期症状问卷调查、ODI评分不存在明显统计学差异(P0.05),末次随访时所有患者进行VAS评分、腰椎不稳前期症状问卷调查、ODI评分存在明显统计学差异(P0.05)。训练后与训练前比较VAS评分、ODI评分都有明显下降。3个月组停止核心肌群稳定训练后VAS评分、ODI评分未见明显改善,与另外两组比较都有明显差异(P0.05);训练6个月组较训练3个月组停止核心肌群稳定训练后VAS评分、ODI评分具有下降趋势;1年与组与训练6个月组在1年的时间段VAS评分、ODI评分比较有差异(P0.05)。三组患者在训练前3个月、6个月、1年四个时间段均无影像学上的腰椎不稳情况。三组患者多裂肌面积变化率不同,其中3个月组多裂肌面积增加最少,6个月组次之,1年组增加最多。三组患者的腰椎不稳前期症状调查结果明显地具有统计学差异(P0.05),3个月组诉有腰椎不稳前期症状的患者人数最多。结论:1.腰椎术后综合征患者坚持3个月规范的核心肌群稳定训练可有效缓解病情;2.腰椎术后综合征患者坚持1年的核心肌群稳定训练对于临床症状的改善具有持续效果;3.腰椎术后综合征患者长期坚持规律的核心肌群稳定训练是必要的,对于远期腰椎不稳定的预防具有一定意义。
[Abstract]:Objective: to compare the effects of different duration of core muscle stabilization training on functional rehabilitation in patients with lumbar postoperative syndrome, and to determine the time of clinical effect of core muscle stabilization training. To explore the necessity of long-term stable training of core muscle group and to provide reference for the establishment of rehabilitation plan for patients with lumbar postoperative syndrome. Methods: from June 2015 to December 2015, 60 cases of lumbar postoperative syndrome were treated with lumbar decompression and fusion internal fixation because of the diagnosis of lumbar disc herniation. They were randomly divided into three groups: 3-month group (3-month group), 6-month group (6-month group) and 1-year group (1-year group). The lumbar spine instability questionnaire and lumbar MRI examination were performed before and at the last follow-up period, and the cross sectional area of the diseased segmental polyfissure muscle was measured by PACS software to record the change rate of the area of the patient's polyfissure muscle. VAS score and ODI score were collected before, 3 months, 6 months and 1 year after training. Results: there was no significant difference in course, age and body weight of all patients who met the inclusion criteria and completed 1 year follow-up. There was no significant difference in VAS score before training and ODI score in pre-unstable lumbar spine symptom questionnaire (P0.05), but VAS score in all patients at the last follow-up, and ODI score in pre-unstable lumbar spine symptom questionnaire (P0.05). VAS scores and ODI scores were significantly decreased after training compared with those before training, but VAS scores and ODI scores did not improve significantly after 3 months of steady training of core muscle groups, and no significant improvement was found in the scores of VAS scores and ODI scores after training. Compared with the other two groups, the VAS scores and ODI scores in the 6-month group decreased compared with those in the 3-month group, and the VAS scores in the 1-year and 6-month groups were evaluated in one year. The score of ODI was different (P0.05). Three groups of patients had no imaging instability in 3 months, 6 months, 1 year and 4 periods before training. The change rate of polyfissure muscle area in the three groups was different. The polyfissure area increased the least in 3 months group, the second in 6 months group, and the most in 1 year group. The results of investigation on the pre-instability symptoms of lumbar vertebrae in the three groups were significantly different (P0.05). The most patients in the 3-month group complained of pre-instability symptoms of lumbar vertebrae. Conclusion 1. Patients with lumbar postoperative syndrome can be effectively relieved by 3 months standard core muscle stability training. One year of core muscle stability training in patients with lumbar postoperative syndrome has a lasting effect on the improvement of clinical symptoms. It is necessary for the patients with lumbar postoperative syndrome to persist in regular training of core muscle group, which is of significance for the prevention of long term lumbar vertebrae instability.
【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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