不稳定支撑面与稳定支撑面核心稳定性训练在胸腰段脊柱骨折伴不完全性脊髓损伤术后康复中的应用效果对比

Comparison of the Effects of Core Stability Training on Unstable Support Surface and Stable Support Surface in the Postoperative Rehabilitation of Thoracolumbar Spine Fracture Complicated with Incomplete Spinal Cord Injury

目的对比分析不稳定支撑面与稳定支撑面核心稳定性训练在胸腰段脊柱骨折伴不完全性脊髓损伤患者经皮椎弓根螺钉内固定术后康复中的应用效果。方法选取2019年6月至2021年6月郑州大学第一附属医院收治的行经皮椎弓根螺钉内固定治疗的76例胸腰段脊柱骨折伴不完全性脊髓损伤患者作为研究对象,根据不同康复方法将其分为不稳定组(41例)和稳定组(35例),不稳定组患者在常规康复训练的基础上接受不稳定支撑面核心稳定性训练,稳定组患者在常规康复训练的基础上接受稳定支撑面核心稳定性训练,对比观察两组患者平衡能力、步行能力、下肢运动能力、躯干控制能力、跌倒风险以及生活自理能力。结果治疗12周后,不稳定组患者Brunel平衡量表(BBA)中的站位、步行评分以及总分均明显高于稳定组(t=4.445、4.163-2.852,P<0.001、P<0.001、P=0.006),坐位评分无明显差异(t=0.241,P=0.810);不稳定组患者脊髓损伤步行指数量表Ⅱ(WISCI-Ⅱ)评分、Fugl-Meyer运动功能评定量表(FMA)评分、躯干控制能力测试量表(TCT)评分、Barthel指数评分均明显高于稳定组(t=4.153、2.939、3.568、2.964,P<0.001、P=0.004、P=0.001、P=0.004),Morse跌倒风险评估量表评分明显低于稳定组(t=4.649,P<0.001)。结论与稳定支撑面核心稳定性训练相比,不稳定支撑面核心稳定性训练更能明显改善胸腰段脊柱骨折伴不完全性脊髓损伤患者的平衡、下肢运动及躯体控制能力,降低跌倒风险,提高生活自理能力,临床应用价值较高。

Objective To compared the effects of core stability training on unstable support surface and stable support surface in the postoperative rehabilitation of thoracolumbar spine fracture complicated with incomplete spinal cord injury.Methods 76 patients with thoracolumbar spine fracture complicated with incomplete spinal cord injury,who wereadmitted into The First Affiliation Hospital of Zhengzhou University and underwent the percutaneous pedicle screw fixation between June 2019 and June 2021,were enrolled as research subjects,and divided into unstable group(n=41)and stable group(n=35)based on different rehabilitation methods they received.Patients in the unstable group received the core stability training on unstable support surface based on the routine rehabilitation exercises,while patients in the stable group received the core stability training on stable support surface based on the routine rehabilitation exercises.Patients’balance ability,walking ability,motor ability of lower extremities,trunk control ability,fall risk and selfcare abilities in daily life were compared between the two groups.Results After 12 weeks of treatment,the standing score,walking score and the total score of patients evaluated by Brunel balance assessment(BBA)in the unstable group were all obviously higher than that in the stable group(t=4.445,4.163 and 2.852,P<0.001,P<0.001,P=0.006),but there was no statistically significant difference between the two groups in terms of BBA sitting score(t=0.241,P=0.810).Moreover,the scores of walking index for spinal cord injuryⅡ(WISCI-Ⅱ),Fugl-Meyer assessment(FMA),trunk control test(TCT)and Barthel index of patients were all markedly higher in the unstable group compared with the stable group(t=4.153,2.939,3.568 and 2.964,P<0.001,P=0.004,P=0.001,P=0.004),and the score of Morse fall scale of patients was obviously lower in the unstable group(t=4.649,P<0.001).Conclusion Compared with the core stability training on stable support surface,the core stability training on unstable support surface is more effective in improving the balance ability,motor ability of lower extremities and trunk control ability of patients with thoracolumbar spine fracture complicated with incomplete spinal cord injury,decreasing their falling risk,and enhancing their self-care abilities in daily life,presenting much high value of application in clinical practice.