不稳定支撑面核心稳定性训练对胸腰段脊柱骨折伴不完全性脊髓损伤患者的康复疗效

Effect of unstable support surface core stability training on the rehabilitation of patients with thoracolumbar spinal fracture and incomplete spinal cord injury

目的探讨不稳定支撑面核心稳定性训练(CST)对胸腰段脊柱骨折伴不完全性脊髓损伤(ISCI)患者的康复疗效。方法选取2019年1月至2022年12月于四川省骨科医院行康复治疗的96例胸腰段脊柱骨折伴ISCI患者,应用随机数字表法分为A组和B组,各48例。2组均接受坐位及卧位的CST,A组在不稳定支撑面(训练球)上训练,B组在稳定支撑面(训练床)上训练,均连续训练8周。分别于训练前和训练后10周,评估美国脊柱损伤协会脊髓损伤分级(ASIA)改善效果;分别于训练前和训练后2、4、6、8、10周,采用脊髓功能独立性评分(SCIM)、功能独立性测定评分(FIM)和脊髓损伤步行指数Ⅱ量表(WISCIⅡ)评分评估2组脊髓功能恢复情况;评估2组立位姿势控制能力和静态平衡能力,复查X线片检查伤椎矢状位Cobb′s角。结果训练后10周,A组B、C、D级分别为8、23、17例,B组分别为11、30、7例,A组ASIA分级改善效果均优于B组(P<0.05)。训练后4、6、8、10周,A组SCIM、FIM和WISCIⅡ评分均高于B组(均P<0.05);A组静态睁眼轨迹长度、静态闭眼轨迹长度、单位时间轨迹长度、动态稳定轨迹长度和动态达目的时间均长于B组(均P<0.05);A组各时间点Cobb′s角均明显小于B组(均P<0.05)。结论不稳定支撑面CST可显著改善胸腰椎脊柱骨折伴ISCI患者脊髓残损修复和步行功能,可在无视觉反馈帮助下有效促进患者立位姿势控制能力。

Objective To investigate the effect of unstable support surface core stability training(CST)on the rehabilitation of patients with thoracolumbar spinal fracture and incomplete spinal cord injury(ISCI).Methods A total of 96 patients with thoracolumbar spinal fracture with ISCI who underwent rehabilitation treatment in Sichuan Orthopedic Hospital from January 2019 to December 2022 were selected and divided into group A and group B by random number table method,with 48 cases in each group.Both groups received CST in sitting and recumbent positions.Group A was trained on an unstable support surface(training ball)and group B was trained on a stable support surface(training bed)for 8 weeks.The effects of improvement of American spinal injury association(ASIA)grading were evaluated before training and 10 weeks after training.Before training and 2,4,6,8 and 10 weeks after training,spinal cord independence measure(SCIM),functional independence measure(FIM)and walking index for spinal cord injuryⅡScale(WISCIⅡ)scores were used to evaluate the recovery of spinal cord function in the two groups.The standing postural control ability and static balance ability of the two groups were evaluated,and the sagittal Cobb′s angle of the injured vertebra was examined by X-ray film.Results At 10 weeks after training,the cases of grade B,C,and D in group A were 8,23 and 17,respectively,and those in group B were 11,30 and 7,respectively.The improvement of ASIA grading in group A was better than that in group B(P<0.05).The SCIM,FIM and WISCIⅡscores of group A were higher than those of group B at 4,6,8 and 10 weeks after training(all P<0.05).The static eye opening trajectory length,static eye closing trajectory length,unit time trajectory length,dynamic stable trajectory length and dynamic time to reach the goal in group A were longer than those in group B(all P<0.05).The Cobb′s angle of group A was significantly smaller than that of group B at each time point(all P<0.05).Conclusion The CST of unstable support surface can significantly improve the repair of spinal cord damage and walking function in patients with thoracolumbar spine fracture with ISCI.It can effectively promote the standing posture control ability of patients without the help of visual feedback.