腰椎退行性疾病术后24周分级康复的疗效研究

Research on the effects of classified rehabilitation after the lumbar surgery

目的研究腰椎退行性疾病术后分级康复的疗效。方法选取北京市9家三级医院2013年5月至2014年4月收治的腰椎退行性疾病患者579例,其中男279例,女300例,年龄49~52岁,平均（50.5±12.7）岁。术后根据患者的实际治疗情况分为实验组1、实验组2和对照组。其中实验组1 165例,其中男82例,女83例,年龄46~51岁,平均（48.9±12.9）岁;实验组2 194例,其中男88例,女106例,年龄49~53岁,平均（51.1±11.4）岁;对照组220例,其中男109例,女111例,年龄49~53岁,平均年龄（51.0±13.4）岁。3组患者在性别、年龄方面差异无统计学意义（P〉0.05）。实验组采用术后康复方案,进行家庭康复治疗（实验组1）或采取就近原则到课题组成员单位接收康复指导和治疗（实验组2）;对照组病例则采用目前常规的术后治疗及康复方案（住院期间按传统方法进行术后康复和管理,出院后由手术医生根据自己经验指导患者自行恢复）。同时,设计并建立与三级医院衔接的腰椎退行性疾病术后患者在二级医院、社区卫生服务中心和家庭的康复模式。所有患者均定期进行随诊及康复评价,并在康复治疗结束后进行资料汇总,通过功能评定数据、并发症发生率比较实验组与对照组之间差异是否有统计学意义。结果术后24周时,视觉模拟评分（visual analogue scale,VAS）、Oswestry功能障碍指数（oswestry disability index,ODI）、日本骨科学会（Japanese orthopedic association,JOA）术后优良率实验组明显优于对照组,差异有统计学意义（P〈0.05）,其中,VAS、ODI评分实验组1与实验组2间差异无统计学意义（P〉0.05）;术后24周时,腰椎活动度、并发症发生情况3组间差异无统计学意义（P〉0.05）。结论腰椎术后实施分级康复保证了可执行性、有效性、安全性,值得在临床中推广应用。

Objective To investigate the effects of classified rehabilitation after the lumbar surgery. Methods A total of 579 cases of lumbar degenerative disease, including 279 male cases and 300 female cases, were collected from May, 2013 to April, 2014 in 9 tertiary hospitals in Beijing. The mean age was（ 50.5 ± 12.7） years（ range： 49- 52 years）. All patients were randomly divided into the experimental group and control group. According to the postoperative treatment, all patients were divided into experimental group 1, experimental group 2 and control group. The experimental group 1 included 165 cases, male 82 cases, female 83 cases, aged 46 to 51 years, mean（ 48.9 ± 12.9） years. The experimental group 2 included 194 cases, male 88 cases, female 106 cases, aged 49 to 53 years, mean（ 51.1 ± 11.4） years. The control group included 220 cases, male 109 cases, female 111 cases, aged 49 to 53 years, mean（ 51.0 ± 13.4） years. The differences of 3 groups in gender and age were not statistically significant（ P〈0.05）. The experimental group was applied with family rehabilitation（ experimental group 1） or received rehabilitation guidance or training in the nearby unit of the research group members under the scheme of rehabilitation after the surgery（ experimental group 2）. Control group underwent routine scheme of treatment and rehabilitation after the surgery（ routine postoperative rehabilitation in the hospital and recovery following the surgery doctor＇s advice based on personal experience）. Meanwhile, rehabilitation modes in the secondary hospital, community medical service center and family following treatments in tertiary hospitals were designed and established for patients after lumbar degeneration surgery. All the cases received visits and rehabilitation assessment at certain times. All the data were assembled after the rehabilitation and compared by function assessment, incidence rate of complications and rehabilitation cost. Results The experimental group was better than the control group in VAS score, ODI score, JOA fine rate 24 weeks after the surgery（ P〈0.05）. There were no significant differences in VAS score, ODI score between the experimental group 1 and experimental group 2（ P〈0.05）. There were no significant differences in lumbar range of motion and complications among the three groups 24 weeks after the surgery（ P〈0.05）. Conclusions Classified rehabilitation after the lumbar surgery is proven to be practical, effective, and safe, which is suitable for popularization in clinical practice.