基于动静结合理论指导的重症腰椎间盘突出症围手术期康复治疗研究

发布时间：2019-03-29 17:46

【摘要】：目的:本研究主要讨论在中医骨伤动静结合理论指导下,探索腰椎融合术围手术期功能康复的最优方案,并观察期临床效果。方法:1.选取襄阳市中医院2014年6月-2015年6月住院期间行腰椎融合术LDH患者60名,采取随机分组、平行对照设计实验方案。2.实验方式:所有患者术前均教授康复功能锻炼方法,采用同种手术方式治疗。研究组:依据动静结合理论个性化指导患者康复功能锻炼,并配合中药调理。对照组:采用常规指导患者康复功能锻炼及常规用药处理。3.各项指标观测:(1)临床症状及功能改善指标;(2)患者下地时间及术后感染率;(3)术后影像学资料。4.统计学分析实验结束后采用SPSS17.0统计软件进行数据分析,计数资料用卡方检验,计量数据均以喁±s表示,显著性检验采用t检验,得出研究结果。结果:1.两组患者术后1周、术后1个月、术后6个月功能障碍及疼痛较术前均有较大的改善,差异具有统计学意义(P0.05),且治疗组在术后1周、1个月、6个月的改善幅度较对照组更加明显(P0.05)。两组患者在治疗后中医症候均有较大程度改善,差异具有统计学意义(P0.05),且治疗组改善幅度较对照组更加明显(P0.05)。2.两组患者均未发生术后感染;治疗组与对照组相比,卧床时间较短,具有统计学差异(P0.05)。3.两组患者邻近腰椎移动度比较:治疗组与对照组的邻近腰椎移动度在术后1个月未见明显统计学差异(P0.05);术后6个月,对照组腰椎移动度高于治疗组,具有统计学差异(P0.05)。两组患者术后后1个月、术后6个月腰大肌直径较术前均有的增加,差异具有统计学意义(P0.05),且治疗组在术后1个月、6个月的改善幅度较对照组更加明显(P0.05)。结论:动静结合理论指导功能锻炼有助于患者腰背部肌双下肢肌力恢复,既为患者早期下地活动创造有利条件,又增强了脊柱稳定性;针对患者术前薄弱部位强化训练,做到有的放矢,促进相应节段神经修复;中药调理有助于术后下肢麻木、疼痛、大便困难等症状的改善,减轻患者痛苦,值得临床推广。
[Abstract]:Aim: under the guidance of the theory of dynamic and static bone injury of traditional Chinese medicine (TCM), this study aims to explore the optimal scheme for functional rehabilitation of lumbar spine fusion operation during perioperative period, and to observe the clinical effect during the period. Methods: 1. From June 2014 to June 2015, 60 LDH patients underwent lumbar fusion in Xiangyang traditional Chinese Medicine Hospital were randomly divided into two groups. 2. Experimental method: all patients were taught rehabilitation exercise before operation and treated with the same operation. Study group: according to the combination of dynamic and static theory personalized guide patients rehabilitation exercise, and Chinese medicine conditioning. Control group: routine guidance for patients' rehabilitation function exercise and routine administration of drugs. 3. Each index observation: (1) the clinical symptom and the function improvement index; (2) the patient below the ground time and the postoperative infection rate; (3) the postoperative imaging data. 4. At the end of the statistical analysis experiment, the data were analyzed by SPSS17.0 software. The counting data were measured by chi-square test. The measured data were expressed as 卤s. The t-test was used for significance test to obtain the results of the study. Results: 1. After 1 week, 1 month, 6 months after operation, the dysfunction and pain of the two groups were improved significantly (P0.05), and in the treatment group, 1 week and 1 month after operation, there was a significant difference between the two groups (P0.05), and there was a significant difference between the two groups in the treatment group at 1 week and 1 month after the operation. The improvement of 6 months was more obvious than that of the control group (P0.05). After treatment, the TCM symptoms of the two groups were improved to a great extent, the difference was statistically significant (P0.05), and the improvement in the treatment group was more obvious than that in the control group (P0.05). There was no postoperative infection in the two groups. Compared with the control group, the time of bed rest in the treatment group was shorter than that in the control group (P0.05). Comparison of adjacent lumbar mobility between the two groups: there was no significant difference in the adjacent lumbar mobility between the treatment group and the control group 1 month after operation (P0.05). 6 months after operation, lumbar mobility in the control group was significantly higher than that in the treatment group (P0.05). 1 month after operation and 6 months after operation, the diameter of the psoas major muscle in the two groups increased significantly (P0.05), and in the treatment group, the diameter of the psoas major muscle was significantly increased at 1 month after the operation (P0.05). The improvement of 6 months was more obvious than that of the control group (P0.05). Conclusion: dynamic and static combined with theoretical guidance of functional exercise is helpful to the recovery of muscle strength of both lower limbs of waist and back muscles, which not only creates favorable conditions for early lower ground movement of patients, but also enhances the stability of spine. Aim at the weak part of the patient before operation, strengthen the training, make the target, promote the corresponding segment nerve repair; traditional Chinese medicine can help the lower limb numbness, pain, difficulty of defecation and other symptoms after operation, alleviate the patient's pain, it is worth clinical popularization.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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