腰椎固定融合术后患者居家康复运动与术后症状改善的相关性研究

Investigation of the correlation between home-based rehabilitation exercises and outcomes of patients undergone first lumbar fusion surgery:a cohort one-year study

目的:了解初次行腰椎固定融合手术患者术后1年内的居家康复行为与术后症状改善的相关性。方法:采用前瞻性纵向研究方法,对首次行腰椎固定融合手术患者进行1年的随访,收集居家康复运动以及术后症状等资料。根据患者术后1年内居家康复运动的具体情况,将研究对象分为三组:A组(39例):患者在6个月时已停止所有康复运动并未进行任何规律的全身运动;B组(99例):患者在6个月后以单一运动为主,即或进行腰背肌训练或进行规律全身运动;C组(31例):患者在6个月后继续进行腰背肌训练并结合规律全身运动。三组患者基线资料除病程外,其他无显著性差异(P>0.05)。结果:术后1年时,三组患者的腰椎JOA改善率、ODI改善率、腰痛VAS改善率、腿痛VAS改善率无显著性差异(P=0.441;P=0.299;P=0.329;P=0.176),在"腰部酸胀无力"、"腰椎支撑力量下降"、"脊柱周围肌肉疼痛"三个腰椎不稳定前期症状的发生频率上,B组及C组患者均少于A组患者,差异有显著性意义(P=0.017;P=0.026;P=0.025)。结论:术后1年内不同居家康复运动的实施对于术后1年功能障碍的改善无明显差异;术后6个月后坚持规律运动对于远期腰椎不稳定的预防有重要意义。

Objective： To investigate the correlation between home-based rehabilitation exercises and outcomes of patients undergone first lumbar fusion surgery within one-year post-surgery. Method： A prospective cohort study was proceeded. All the patients who met the inclusion criteria had been followed-up for one-year after surgery, in which the data of ＂home-based exercise＂ and ＂outcome indicators＂ were collected. The patients were categorized into three exercise groups according to their home-based rehabili- tation behaviors. Group A （39 cases）： referred to patients who stopped all regular exercises after six month post-surgery. Group B （99 cases）： referred to patients who only undertook one exercise, regular back-mus- cle-strengthening exercise or general full-body movement. Group C （31 cases）： referred to patients who under- took both exercises. The baseline data of the three groups was met except for duration. Result： One year after surgery in the three groups, no statistics significance was observed at self-change of Jap- anese orthopedic association（JOA）, Oswestry disabitity index（ODI）, visual analogue scale（VAS） （low back） and VAS （leg） （P=0.441; P=-0.299; P=0.329; P=0.176）, whilst at the frequency of three symptoms indicating lumbar instability, that was significantly less in group B and group C than in group A （P=0.017; P=0.026; P=0.025）.Conclusion： One year after surgery, different home-based exercises may not significantly different in improving the outcomes of pain relieve and disability situation. However, six month after surgery sticking to a regular home-based or community-based exercise may effectively prevent the lumbar instabilitv from happening.