腰椎融合术后早期腰部屈曲训练对腰椎活动度的影响

Efficacy of early flexion exercises in lumbar range of motion after lumbar fusion

目的研究腰椎融合术后早期腰部屈曲训练对于腰椎活动度和内固定安全性的影响。方法纳入2013年9月至2014年6月,66例于我院接受腰椎间盘切除、单节段椎体间植骨融合椎弓根螺钉系统内固定术患者,所有患者术后无神经根损伤、感染、切口延迟愈合等并发症。使用计算机随机分为试验组和对照组。其中试验组33例,男19例,女14例,年龄22~58岁,平均（41.21±9.95）岁;对照组33例,男17例,女16例,年龄29~57岁,平均（42.91±8.17）岁。两组患者均进行常规术后康复锻炼,此外,试验组于腰椎融合术后第4周开始进行循序渐进的腰部屈曲训练。分别于术后第12、24、52周摄腰椎正侧位以及过伸过屈位X线片,评价内固定是否牢固,并测量患者腰椎屈曲活动度。术后18个月行腰椎手术节段CT检查,评价椎体间植骨融合情况。结果术后12周,试验组腰椎最大屈曲角度（20.91±2.58）°显著大于对照组（17.33±3.06）°,差异有统计学意义（P〈0.01）;术后24周,试验组腰椎最大屈曲角度（24.73±3.23）°显著大于对照组（19.09±3.38）°,差异有统计学意义（P〈0.01）;术后52周,试验组腰椎最大屈曲角度（29.85±3.03）°显著大于对照组（20.67±3.34）°,差异有统计学意义（P〈0.01）。术后18个月,CT显示两组融合率均为100%。两组患者均未出现内固定松动、移位、断裂现象。结论对于单节段腰椎融合术后患者,术后早期腰部屈曲训练有助于促进腰椎活动度恢复,同时具有良好的安全性。

Objective To evaluate the efficacy of early flexion exercises in lumbar range of motion in patients with lumbar internal fixation and fusion. Methods From September 2013 to June 2014, 66 patients after posterior single segmental lumbar interbody fusion were enrolled in this study. The patients were randomly allocated into the experimental group（ n = 33, 19 males, 14 females） with the average age of（ 41.21 ± 9.95） years（ range： 22-58 years） and a control group（ n = 33, 17 males, 16 females） with the average age of（ 42.91 ± 8.17） years（ range： 29-57 years）. Both groups received regular rehabilitation after the surgery. Besides this, patients in the experimental group received lumbar flexion exercises 4 weeks after the surgery. The outcomes were evaluated at 12, 24 and 52 weeks after the surgery by lumbar anterioposterior and lateral X-ray, and hyperextension and hyperflexion X-ray. CT scan was performed at 18-month follow-up to evaluate the fusion rate. Results At 12-week follow-up, patients in the experimental group（ 20.91 ± 2.58） ° had significant improvement in lumbar range of motion（ P〈0.01） than those in the control group（ 17.33 ± 3.06） °. At 24-week follow-up, patients in the experimental group（ 24.73 ± 3.23） ° had significant improvement in lumbar range of motion（ P〈0.01） than those in the control group（ 19.09 ± 3.38） °. At 52-week follow-up, patients in the experimental group（ 29.85 ± 3.03） ° had significant improvement in lumbar range of motion（ P〈0.01） than those in the control group（ 20.67 ± 3.34） °. At 18-month follow-up, the fusion rate was 100% and no internal fixator failure（ loosing, dislocation, breakage） occurred in both groups. Conclusions Early flexion exercises after single segmental lumbar fusion can significantly promote the restoration of the lumbar range of motion with satisfactory safety.