渐进性功能锻炼预防腰椎融合术后邻近节段退变的临床疗效观察

发布时间：2018-07-09 22:34

本文选题：渐进性功能锻炼 + 腰背肌锻炼　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:通过骨科术后康复指南中腰椎融合术章节所介绍的锻炼方法总结一套由易到难的渐进性功能锻炼方法、同时和我院临床常用腰背肌功能锻炼方法进行对比;观察两组腰椎融合术后患者通过不同功能锻炼后邻近节段退变的情况。方法:选取2015年8月到2016年1月在漳州175医院骨科住院治疗,并行腰椎后路双节段减压内固定+植骨融合术(L4-S1)的女性患者60例,随机分成两组:渐进性功能锻炼组30例(以下简称试验组)和腰背肌功能锻炼组30例(以下简称对照组),两者患者均在住院期间,根据术前宣教和术后分别教授患者渐进性功能锻炼和我院常用腰背肌锻炼方法,定期返院复查并指导并教授或纠正其锻炼动作,同时出院后根据电话及微信等社交通讯工具跟踪其完成情况。术前及术后末次随访时进行腰椎MRI检查,并且拍摄腰椎站立正侧位、过伸过屈位X线片,术前、术后6周、3个月、6个月及1年进行VAS评分、ODI评分,使用ZWCAD+软件测量邻近节段椎间高度、椎间成角、椎体滑移、椎旁肌(腰大肌、竖脊肌、多裂肌)的横截面积、椎管狭窄情况,记录各数据的变化情况,根据Pfirrmann法[19]评估术前、术后邻近节段椎间盘退变情况。结果:所有患者均符合纳入标准并完成1年随访,患者术前年龄、体重、身高、BMI指数等一般资料差异无统计学意义。两组患者术后VAS评分、ODI评分较术前明显下降,但试验组患者在术后6周、术后3个月的VAS评分、ODI评分下降程度大,与对照组比较差异有统计学意义(P0.05)。在椎间高度的下降、椎体滑移、椎间成角上,两组患者术后均出现了不同程度的退变,而试验组比对照组的退变程度轻,差异有统计学意义(P0.05)。两组患者椎旁肌面积经过锻炼后均较术前增加,其中试验组面积较对照组增加,差异有统计学意义。两组患者术前椎间盘退变、椎管狭窄程度比较差异无统计学意义,二组患者经锻炼后椎间盘较术前无明显退变、而椎管的面积情况出现了不同程度的狭窄,其中试验组的退变情况较对照组轻。结论:1.渐进性功能锻炼方法可明显改善腰椎融合术后早期腰腿痛和功能障碍,可预防腰椎术后早期邻近节段退变(ASDeg);2.由易到难、简到繁的锻炼方法,可锻炼多块脊柱稳定肌,在改善术后早期疼痛、功能恢复以及在预防早期邻近节段退变上优于常规腰背肌功能锻炼。
[Abstract]:Objective: to summarize a set of progressive functional exercise methods from easy to difficult in the chapter of lumbar fusion in orthopedic rehabilitation guidelines, and to compare them with the methods of lumbar dorsalis muscle function exercise commonly used in our hospital. The degenerative changes of adjacent segments after different functional exercise were observed in two groups after lumbar fusion surgery. Methods: from August 2015 to January 2016, 60 female patients were treated in the orthopedic department of Zhangzhou 175 Hospital and treated with lumbar posterior decompression and internal fixation (L4-S1). They were randomly divided into two groups: progressive exercise group (30 cases) and psoas muscle exercise group (30 cases). Both patients were in hospital. According to the methods of pre- and post-operative progressive functional exercise and lumbar and dorsal muscle exercise, we should return to hospital regularly and teach or correct the exercise movements. At the same time after discharge from the hospital according to telephone and WeChat social communication tools to track its completion. The lumbar vertebrae were examined with MRI before operation and at the last follow-up after operation, and the lumbar vertebrae were photographed in the positive and lateral position, extension and flexion position. Before operation, 6 weeks, 3 months, 6 months and 1 year after operation, the VAS score and ODI score were evaluated. ZWCAD software was used to measure the height, angle, slippage, cross-sectional area of paraspinal muscle (psoas major, vertical spinal muscle, polyfissure muscle), stenosis of spinal canal, record the changes of data, and evaluate the results before operation according to Pfirrmann's method [19], using ZWCAD software to measure the intervertebral height, intervertebral angle, vertebral slip, paraspinal muscle (psoas major muscle, vertical spinal muscle, polyfissure muscle). Postoperative degeneration of adjacent segments of intervertebral disc. Results: all the patients met the inclusion criteria and completed a year follow-up. There was no significant difference in preoperative age, weight, height and BMI index. The VAS scores and ODI scores of the two groups were significantly lower than those of the patients before operation, but the VAS scores and ODI scores of the patients in the trial group were significantly lower than those in the control group at 6 weeks and 3 months after operation (P0.05). In the reduction of intervertebral height, slippage of vertebral body and intervertebral angle, there were different degrees of degeneration in the two groups after operation, but the degree of degeneration in the experimental group was lighter than that in the control group, the difference was statistically significant (P0.05). The area of paravertebral muscle in the two groups was increased after exercise, and the area of the experimental group was higher than that of the control group, and the difference was statistically significant. There was no significant difference in the degree of intervertebral disc degeneration and spinal canal stenosis between the two groups before operation. There was no obvious degeneration of intervertebral disc after exercise in both groups, and the area of spinal canal had different degree of stenosis. The degeneration of the experimental group was lighter than that of the control group. Conclusion 1. Progressive functional exercise can significantly improve early lumbago and leg pain and dysfunction after lumbar fusion, and can prevent early adjacent segment degeneration (ASDeg) after lumbar vertebrae fusion. From easy to difficult, simple to complex exercise method, can exercise a number of spinal stabilizer muscle, in improving early postoperative pain, functional recovery and prevention of early adjacent segment degeneration of the regular lumbar muscle functional exercise.
【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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