椎板回植内固定配合阶段性锻炼对椎管内肿瘤的治疗效果

Effect of lamina replantation and internal fixation combined with staged exercise in treating intraspinal tumors

目的观察椎板回植型微型钛板内固定术结合阶段性功能康复锻炼对腰骶部椎管内肿瘤患者的治疗效果及对康复情况的影响。方法选择2020年1月至2021年9月期间在焦作市人民医院接受肿瘤切除术治疗的123例腰骶部椎管内肿瘤患者作为研究对象,通过抽签法将入组患者进行分组。对照组61例患者中男31例,女30例,年龄(50.44±5.37)岁,采用椎板回植微型钛板内固定肿瘤切除术治疗,术后予以常规康复锻炼;观察组62例患者中男30例,女32例,年龄(51.24±5.62)岁,在对照组手术治疗基础上术后予以阶段性功能康复锻炼,对两组患者开展为期1年的随访。比较两组患者的椎体视觉模拟评分法(VAS)评分、日本骨科协会评估治疗分数(JOA)评分、Fugl-Meyer运动功能量表(FMA)评分,观察Cobb角变化情况。采用独立样本t检验、χ^(2)检验。结果治疗前,两组患者的VAS评分、伤椎Cobb角差异均无统计学意义(均P>0.05)。术后15 d、1个月、3个月后,观察组的VAS评分分别为(4.42±1.33)分、(3.77±0.25)分、(2.55±0.21)分,Cobb角分别为(25.12±5.33)°、(18.45±4.36)°、(12.27±2.37)°,对照组分别为(5.68±1.24)分、(4.82±1.33)分、(3.77±0.82)分、(28.44±5.15)°、(21.33±5.17)°、(15.44±4.49)°,观察组各时间点的VAS评分均低于对照组、Cobb角均小于对照组(t=5.432、6.108、11.344、3.512、3.342、4.908,均P<0.05)。随访期间,观察组的JOA评分高于对照组[(23.47±3.72)比(20.44±2.37)分]、FMA下肢评分高于对照组[(29.25±5.11)分比(25.44±5.36)分](t=5.378、4.036,均P<0.001)。结论在椎板回植微型钛板内固定辅助肿瘤切除术治疗基础上,配合阶段性功能锻炼的疗效显著,对增强患者康复效果有积极意义。

Objective To observe the therapeutic effect of lamina replantation type mini titanium plate internal fixation combined with staged functional rehabilitation exercise on patients with lumbosacral intraspinal tumors and its impact on rehabilitation.Methods In this study,123 patients with intraspinal tumors in the lumbosacral region who underwent tumor resection treatment in Jiaozuo People's Hospital from January 2020 to September 2021 were selected as the study subjects.The enrolled patients were divided into two groups by lot drawing.In the control group,there were 31 males and 30 females,aged(50.44±5.37)years;in the observation group,there were 30 males and 32 females,aged(51.24±5.62)years.The control group was treated with tumor resection with vertebral lamina replantation and internal fixation with mini titanium plate,followed by routine rehabilitation exercise;the observation group was given staged functional rehabilitation exercise after surgery on the basis of surgical treatment in the control group.A one-year follow-up was conducted to compare the vertebral Visual Analogue Scale(VAS),Japanese Orthopedic Association(JOA),and Fugl Meyer Lower Limb Motor Function Assessment(FMA)scores of the two groups,and observe the changes in Cobb angle in patients.Independent sample t test andχ^(2)test were used.Results Before treatment,there were no statistically significant differences in the VAS score and Cobb angle of the injured vertebra between the two groups(both P>0.05).After 15 days,1 month,and 3 months of treatment,the VAS scores of the observation group were(4.42±1.33)points,(3.77±0.25)points,and(2.55±0.21)points,the Cobb angles were(25.12±5.33)°,(18.45±4.36)°,and(12.27±2.37)°,and those of the control group were(5.68±1.24)points,(4.82±1.33)points,(3.77±0.82)points,(28.44±5.15)°,(21.33±5.17)°,and(15.44±4.49)°.The VAS scores and Cobb angles of the observation group were lower than those of the control group at all time points(t=5.432,6.108,11.344,3.512,3.342,and 4.908;all P<0.05).During the follow-up period,the lumbar JOA score of the observation group was higher than that of the control group[(23.47±3.72)points vs.(20.44±2.37)points],and the FMA lower limb score was higher than that of the control group[(29.25±5.11)points vs.(25.44±5.36)points](t=5.378 and 4.036,both P<0.001).Conclusion Based on the treatment of vertebral lamina replantation and mini titanium plate internal fixation assisted tumor resection,combined with staged functional exercise has a significant effect,which has a positive significance in enhancing the rehabilitation effect in patients.