核心训练联合高压氧治疗外伤性颈段不完全性脊髓损伤患者的康复效果分析

Rehabilitation effect of core training combined with hyperbaric oxygen on patients with traumatic cervical incomplete spinal cord injury

目的探究核心训练联合高压氧(HBO)治疗对外伤性颈段不完全性脊髓损伤(SCI)患者术后康复效果的影响。方法选择2018年1月至2022年1月山西白求恩医院康复医学科收治的177例外伤性颈段不完全性SCI患者,按随机数字表法将患者分为核心训练组、HBO组和联合组,每组59例,分别予以核心训练、HBO、核心训练联合HBO治疗。连续治疗4周后采用美国脊髓损伤协会(ASIA)评分评估患者感觉、运动等神经功能,采用改良Barthel指数(MBI)评定量表和功能独立性量表(FIM)评定患者日常活动能力,采用简易McGill疼痛问卷(SF-MPQ)评估患者疼痛程度,采用匹兹堡睡眠质量指数(PSQI)量表评定患者睡眠质量,并记录各组患者脊髓功能恢复时间及不良反应情况。结果3组患者治疗后ASIA感觉评分、ASIA运动评分、MBI评分、FIM评分较治疗前升高,SF-MPQ各维度评分及PSQI总分较治疗前降低,且联合组上述指标优于HBO组和核心训练组,差异均有统计学意义(P<0.05);联合组患者括约肌功能恢复时间、独立下床活动时间及总住院时长短于核心训练组、HBO组,差异均有统计学意义(P<0.05);3组患者总不良反应发生率比较差异无统计学意义(P>0.05)。结论采用核心训练联合HBO治疗外伤性颈段不完全性SCI,不仅能改善患者神经、下肢运动功能,减轻疼痛程度,还能提高患者睡眠质量,加速脊髓功能恢复,且不良反应少,值得临床优先选择。

Objective To investigate the effect of core training combined with hyperbaric oxygen(HBO)in postoperative rehabilitation of patients with traumatic cervical incomplete spinal cord injury(SCI).Methods A total of 177 patients with traumatic cervical incomplete SCI admitted to the Department of Rehabilitation Medicine of Shanxi Bethune Hospital between January 2018 and January 2022 were selected and divided into three groups,i.e.,core training group(n=59),HBO group(n=59),and combination group(n=59),according to the random number table method.The patients were treated with core training,HBO,and core training combined with HBO,respectively.After 4 weeks of continuous treatment,the patient’s sensory,motor,and other neurological functions were assessed by American Spinal Injury Association(ASIA)scale.The patients’daily activity ability was assessed using the Modified Barthel Index(MBI)assessment scale and Functional Independence Measure(FIM).The level of pain in patients was evaluated using the simplified McGill Pain Questionnaire(SF-MPQ).The sleep quality of patients was assessed by Pittsburgh Sleep Quality Index(PSQI)scale,and the recovery time of spinal cord function and adverse reactions in each group were recorded.Results After treatment,the ASIA sensory and motor scores,MBI scores,and FIM scores of the patients in the three groups were significantly higher than those before treatment(P<0.05);while each result of the SF-MPQ and the total score of PSQI significantly decreased(P<0.05),and the indicators of the combination group were significantly better than the other two groups(P<0.05),all the differences were statistically significant.The recovery time of sphincter function,the time of getting out of bed independently,and the total length of hospitalization in the combination group were significantly shorter than those in the core training group and the HBO group(P<0.05).There was no statistically significant difference in the total incidence of adverse reactions among the three groups(P>0.05).Conclusion The combination of core training and HBO in the treatment of traumatic cervical incomplete SCI can not only improve the neurologic function and lower limbs’motor functions,reduce the degree of pain,but also improve the quality of sleep and accelerate the recovery of spinal cord function with few adverse reactions,which is worth clinical priority.