屈髋屈膝功能锻炼对微创治疗腰椎间盘突出症患者疼痛相关因子水平的影响

Effects of hip and knee flexion exercise on pain-related factors in patients with lumbar disc herniation after minimally invasive treatment

目的探讨屈髋屈膝功能锻炼对手术治疗腰椎间盘突出症患者疼痛相关因子水平的影响。方法选取绍兴第二医院骨科2010年3月—2015年3月收治的294例腰椎间盘突出症患者,按照随机数字表法分为观察组及对照组,各147例。均实施椎间盘手术治疗[经椎间孔椎体间融合(TLIF),部分后路椎间融合术(PLIF)],术后指导直腿抬高功能锻炼、腰背肌功能锻炼。观察组在此基础上加以屈髋屈膝功能锻炼。比较2组患者治疗前后疼痛情况、疼痛相关因子水平等指标。结果 2组患者术后1、7、14 d的视觉模拟评分法(VAS)评分、血清基质金属蛋白酶-3(MMP-3)、白细胞介素-1β(IL-1β)、IL-6、肿瘤坏死因子α(TNF-α)水平均显著降低,观察组术后7 d VAS评分、疼痛相关因子水平显著低于对照组(P<0.05);2组患者术前、术后1、14 d VAS评分、疼痛相关因子水平比较差异无统计学意义(P>0.05)。2组患者术后1、7、14 d JOA评分均显著升高,观察组术后7 d、术后14 d JOA评分均显著高于对照组(P<0.05);2组患者术前、术后1 d JOA评分比较差异无统计学意义(P>0.05)。观察组患者术后3个月总有效率为85.0%,显著高于对照组的66.7%(P<0.05)。结论屈髋屈膝功能锻炼能够降低腰椎间盘突出症患者术后水肿高峰期疼痛,降低患者疼痛相关因子水平,对改善其预后具有重要意义,值得临床推广。

Objective To investigate the effects of hip and knee flexion exercise on pain-related factors in patients with lumbar disc herniation after minimally invasive treatment. Methods Total 294 cases of lumbar disc herniation in our hos- pital between March ,2010 and March,2015 were enrolled and randomly divided into observation group and control group with 147 cases in each group. All patients underwent transforaminal lumbar interbody fusion（TLIF） or posterior lumbar interbody fusion（PLIF） therapy, postoperative straight leg raising exercise and lumbodorsal muscles exercises;the obser- vation group received additional hip and knee flexion exercise. The pain and pain-related factors before and after the treat- ment in two groups were compared. Results VAS score and the levels of MMP-3, IL-1, IL-6 and TNF-alpha at dl, d7 and d14 after the operation were significantly reduced in both groups, and VAS score and pain-related factors levels at d7 after the operation in the observation group were significantly lower than those in the control group （ P 〈 0.05 ） ; there were no significant difference in VAS score and pain-related factors levels before the operation, at dl and d14 after the operation between the two groups （P 〉 0.05 ）. JOA score at dl and d7 after the operation increased significantly in both groups, and JOA score at d7 and d14 in the observation group were significantly higher than control group（ P 〈 0.05 ） ;there were no significant difference in JOA score before the operation, at dl after the operation between the two groups （ P 〉 0. 05 ）. Three months after the operation, the total effective rate was 85% in the observation group, which was higher than that （ 66.7 % ） in the control group （ P 〈 0.05 ）. Conclusion Hip and knee flexion exercise can reduce the postoperative pain in patients with lumbar disc herniation after minimally invasive treatment, and decrease pain-related factors levels, improve the outcome of patients. It is worthy of clinical promotion.