综合康复干预与手术治疗反复发作腰椎间盘突出症患者的疗效对比观察

Comprehensive rehabilitation is superior to surgical intervention for many patients with recurrent lumbar disc herniation

目的 对比观察综合康复干预与手术治疗反复发作腰椎间盘突出症患者的疗效。 方法 选取入住北京军区总医院骨科的62例反复发作腰椎间盘突出症且拒绝手术治疗患者纳入实验组；另选取同期在我院脊柱外科病区行手术治疗的同质患者62例纳入对照组。实验组患者给予综合康复干预，包括药物、物理因子治疗、核心肌群训练等，对照组患者均接受单节段髓核摘除、椎间植骨融合内固定手术治疗。于入院时、出院时、出院后3个月及1年时对2组患者腰痛、下肢痛及腰椎功能恢复情况进行评定，于入院时、出院后3个月时对2组患者焦虑、抑郁情绪进行评定。 结果 2组患者出院时、出院3个月及1年时其腰痛和下肢痛评分均明显低于入院时水平，并且各时间点2组患者腰痛及下肢痛评分组间差异均无统计学意义（P〉0.05）；2组患者出院时、出院3个月及1年时其腰椎Oswestry功能障碍指数（ODI）评分均明显低于入院时水平，并且各时间点2组患者ODI指数评分组间差异均无统计学意义（P〉0.05）。入院时2组患者焦虑、抑郁评分组间差异均无统计学意义（P〉0.05）；出院时2组患者焦虑、抑郁评分均较入院时明显降低（P〈0.05），并且实验组患者抑郁评分亦显著优于对照组水平（P〈0.05）。 结论 综合康复干预较手术治疗能进一步改善反复发作腰椎间盘突出症患者抑郁情绪；2组患者在疼痛、腰椎功能改善方面，虽然手术治疗具有优于综合康复干预的趋势，但2组间差异无统计学意义（P〉0.05），提示对于反复发作的腰椎间盘突出症患者可首选综合康复干预，当综合康复干预无效时则建议选择手术治疗。

Objective To compare the effectiveness of comprehensive rehabilitation therapy with that of surgical intervention for patients with recurrent lumbar disc herniation （LDH）. Methods A total of 124 LDH patients were recruited and randomly divided into an experimental group and a control group, each of 62. The experimental group was given comprehensive rehabilitation consisting of medicine, physical therapy, and spinal stabilization exercises, while the control group received lumbar spine surgery. The patients′ back and leg pain scores and their Oswestry Disability Index （ODI） scores were compared at admission and discharge, as well as 3 and 12 months after discharge. Anxiety and depression were also assessed at admission and 3 months after discharge. Results At discharge and 3 and 12 months later the average back and leg pain scores and ODI ratings were significantly lower than that at admission for both groups. There were no significant inter-group differences. In terms of anxiety and depression, however, these had decreased significantly in both groups, but the experimental group′s average rating was significantly better at discharge. Conclusions Comprehensive rehabilitation is superior to surgical intervention in relieving the depression of patients with recurrent LDH. Comprehensive rehabilitation should be considered as the first choice for patients with recurrent LDH, and only supplemented by surgical intervention if it is not effective.