运动疗法在腰椎退行性疾病患者脊柱融合术后康复中的作用

Effect of exercise therapy on the rehabilitation of patients with degenerative disease of lumbar spine treated by spinal fusion operation

目的探讨运动疗法在腰椎退行性疾病患者脊柱融合术后康复中的作用。方法选取2010年1～12月入院符合研究纳入标准的腰椎退行性疾病患者192例。采用数字抽取法将患者分为高强度组、低强度组、对照组。运动方法包括直腿抬高运动、四点支撑背伸运动、飞燕式运动。高强度组每天训练90min,分3次完成,每次完成3组运动。低强度组每天训练30min,分2次完成,每次完成3组运动。对照组进行常规训练,不控制运动时间。于入院时、出院时、术后6个月和12个月评估患者疼痛、日本骨科学会(JOA)评分、直腿抬高角度和腰背伸高度。结果 3组患者与自身基线情况相比,功能恢复均有改善,高强度组优于其他两组,低强度组优于对照组,3组在不同时间段内各评价指标之间差异均有统计学意义(P<0.05)。在术后6个月、12个月,高强度组疼痛评分明显低于其他两组,低强度组疼痛评分低于对照组。结论运动疗法能有效促进腰椎退行性疾病患者脊柱融合术后功能恢复,减轻腰腿疼痛,提高疗效;运动强度和运动的坚持程度与术后疗效有关。

Objective To evaluate the effect of exercise therapy on the rehabilitation in patients with degenerative disease of lumbar spine treated by spinal fusion operation. Methods Totally 192 patients with degenerative disease of lumbar spine treated by spinal fusion operation were divided into three groups. All patients performed prone straight leg raising, bridging and prone extension exercises after operation. The patients did exercises 30 minute three times a day in the high-intensity exercise group and 15 minute twice a day in the low-intensity exercise group, while the patients in the control group conducted routine exercise training. The patients＇ pain rated by visual analogue scale（VAS）, JOA score, the straight-leg-raising angle and the of back extension angle were assessed at the moment of admission, discharge, 6 months and 12 months after operation, Results The functional recovery rated by JOA score in the high-intensity exercise group was significantly better than the those in the other two groups（P〈0.01）, and the functional recovery in the low-intensity exercise group was better than the control group（P〈0.05）. The patients＇ VAS score was significantly lower in the high-intensity exercise group than those in the other two groups（P〈0.01）, and the VAS score in the low-intensity exercise group was lower than that in the control group at 6 months and 12 months after operation（P〈0.05）. Conclusion Exercise therapy can effectively promote the rehabilitation and relieve low back pain in patients after the spinal fusion operation, and the intensity of exercise can influence the efficacy.