早期康复治疗对退变性腰椎失稳伴椎管狭窄症手术疗效的影响

Effect of early rehabilitation therapy on operative effectiveness of degenerative lumbar instability with spinal stenosis.

目的观察早期综合康复治疗对退变性腰椎失稳伴椎管狭窄症手术疗效的影响。方法选择2008年1月至2009年12月行手术治疗的退变性腰椎失稳伴椎管狭窄症患者60例,随机分为康复治疗组和对照组;两组患者手术方式及常规处理相同,康复治疗组在围手术期开始给予综合康复治疗,对照组则行一般性锻炼;于手术前、手术后2周及3、6、12、24个月时采用日本骨科学会(JOA)下腰痛评分标准对两组患者进行评分,并计算JOA改善率,同时观察两组患者术后并发症发生情况及椎间植骨融合率。结果两组患者术后JOA评分组内比较均明显高于术前,差异有统计学意义(P<0.01);术后2周及3、6、12、24个月,组间JOA评分及改善率比较康复治疗组明显高于对照组,差异有统计学意义(均P<0.01);康复治疗组术后下肢深静脉血栓形成(DVT)、尿潴留、便秘发生率明显低于对照组,差异有统计学意义(P<0.05);所有患者椎间植骨按时融合。结论早期康复治疗能显著提高退变性腰椎失稳伴椎管狭窄症患者再手术疗效,同时还能减少术后并发症发生。

Objective To observe the effect of early rehabilitation therapy on operative effectiveness of degenerative lumbar instability with spinal stenosis. Methods Sixty cases of degenerative lumbar instability with spinal stenosis undergoing surgical treatment from Jan. 2008 to Dec. 2009 were randomly divided into rehabilitation group and control group. Both groups were treated with the same surgical approach and routine treatment. Early rehabilitation therapy was performed on the rehabilitation group perioperatively, and the control group was only treated with general exercise. Before operation, 2 weeks and 3, 6, 12, 24 months after operation, the surgical outcomes of all cases were assessed with JOA score and the improvement rate of JOA score. The postoperative complications and the intervertebral fusion rate were observed at the same time. Results The postoperative JOA scores of both groups were significantly higher than those preoperation （P〈0. 0l）. At 2nd week and 3rd, 6th, 12th, 24th month after operation, the JOA scores and the improvement rate of the rehabilitation group were higher than those of the control group （P〈0.01）. The postoperative complications including deep venous thromlaosis （DVT）, urinary retention and constipation in observation group were obviously less than in control group （P〈0. 05）. All the intervertebral bone implantation was well fused on time. Conclusion Early rehabilitation therapy can significantly improve the surgical effectiveness of degenerative lumbar instability with spinal stenosis, and also can reduce the incidence of postoperative complications.