CAJ | 학술논문

目的观察早期康复治疗对复发性腰椎间盘突出症再手术疗效的影响.方法共选取2007年至2009年经手术治疗后的复发性腰椎间盘突出症患者65例,采用随机数字表法将其分为康复治疗组及对照组.2组患者均给予相同手术治疗及常规处理,康复治疗组同时辅以围手术期综合康复干预(包括术前、术后肌肉力量训练,术后坐位、立位平衡训练及针灸治疗等),对照组仅遵医嘱于术后进行一般性锻炼.于手术前、手术后2周、3个月、6个月、12个月及24个月时采用日本骨科学会(JOA)下背痛评分标准对2组患者进行量化评分,并计算JOA改善率,同时观察2组患者术后并发症发生情况及椎间植骨融合情况.结果手术后2组患者JOA评分均较手术前明显提高,差异具有统计学意义(P＜0.05)；康复治疗组术后2周、3个月、6个月、12个月及24个月时JOA评分分别为(25.4±2.4)分、(26.3±2.1)分、(26.9±1.8)分、(26.4±2.1)分、(25.3±2.6)分；对照组术后2周、3个月、6个月、12个月及24个月时JOA评分分别为(23.2±3.0)分、(24.1±2.5)分、(24.5±2.7)分、(23.9±2.4)分、(23.2±2.3)分,组间比较发现,康复治疗组在术后不同时间点的JOA评分及改善率均显著优于对照组(均P＜0.05)；并且康复治疗组术后下肢深静脉血栓(DVT)、尿潴留、便秘等并发症发生率均显著低于对照组(P＜0.05).所有患者椎间植骨均按时融合.结论早期康复干预能显著提高复发性腰椎间盘突出症患者再手术疗效,同时还能减少术后并发症发生,该疗法值得临床推广、应用.
목적 관찰조기강복치료대복발성요추간반돌출증재수술료효적영향.방법 공선취2007년지2009년경수술치료후적복발성요추간반돌출증환자65례,채용수궤수자표법장기분위강복치료조급대조조.2조환자균급여상동수술치료급상규처리,강복치료조동시보이위수술기종합강복간예(포괄술전、술후기육역량훈련,술후좌위、립위평형훈련급침구치료등),대조조부준의촉우술후진행일반성단련.우수술전、수술후2주、3개월、6개월、12개월급24개월시채용일본골과학회(JOA)하배통평분표준대2조환자진행양화평분,병계산JOA개선솔,동시관찰2조환자술후병발증발생정황급추간식골융합정황.결과 수술후2조환자JOA평분균교수술전명현제고,차이구유통계학의의(P＜0.05)；강복치료조술후2주、3개월、6개월、12개월급24개월시JOA평분분별위(25.4±2.4)분、(26.3±2.1)분、(26.9±1.8)분、(26.4±2.1)분、(25.3±2.6)분；대조조술후2주、3개월、6개월、12개월급24개월시JOA평분분별위(23.2±3.0)분、(24.1±2.5)분、(24.5±2.7)분、(23.9±2.4)분、(23.2±2.3)분,조간비교발현,강복치료조재술후불동시간점적JOA평분급개선솔균현저우우대조조(균P＜0.05)；병차강복치료조술후하지심정맥혈전(DVT)、뇨저류、편비등병발증발생솔균현저저우대조조(P＜0.05).소유환자추간식골균안시융합.결론 조기강복간예능현저제고복발성요추간반돌출증환자재수술료효,동시환능감소술후병발증발생,해요법치득림상추엄、응용.
Objective To observe the effect of early rehabilitation therapy on recovery from reoperation for recurrent lumbar disc herniation (RLDH).Methods Sixty-five cases who received surgery for RLDH between 2007 and 2009 were randomly divided into a rehabilitation group and control group.Both groups were treated with the same surgical approach and routine treatment.Early and comprehensive rehabilitation therapy was provided in the rehabilitation group during the perioperative period,including preoperative and postoperative muscle strength training,postoperative sitting and standing balance training,and acupuncture.The control group was instructed only in general exercise.Before the operation and 2 weeks and 3,6,12 and 24 months afterward,the surgical outcomes of all cases were assessed using the JOA score and the improvement rate in the JOA score.Any postoperative complications and intervertebral fusion were also observed.Results The average postoperative JOA scores of both groups were significantly higher than their preoperative scores.At all of the time points after the operation,the average JOA scores and all improvement rates in the rehabilitation group were significantly higher than those in the control group.Postoperative complications such as deep venous thrombosis,urinary retention and constipation were significantly less among the rehabilitation group than among the controls.All the intervertebral bone implants were well fused on time.Conclusion Early rehabilitation can significantly improve the effectiveness of RLDH reoperation and reduce the incidence of postoperative complications.It is recommended for clinical application.