早期康复治疗对复发性腰椎间盘突出症再手术疗效的影响  

The efficacy of rehabilitation after reoperation for recurrent lumbar disc herniation

作　　者：林阳[1] 陈安民[1] 李锋[1] 陈文坚[1] 祝文涛[1] 杨卿[1] 熊伟[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《中华物理医学与康复杂志》2013年第1期33-36,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：湖北省自然科学基金资助项目（2010CDB09302）

摘　　要：目的观察早期康复治疗对复发性腰椎间盘突出症再手术疗效的影响。方法共选取2007年至2009年经手术治疗后的复发性腰椎间盘突出症患者65例，采用随机数字表法将其分为康复治疗组及对照组。2组患者均给予相同手术治疗及常规处理，康复治疗组同时辅以围手术期综合康复干预（包括术前、术后肌肉力量训练，术后坐位、立位平衡训练及针灸治疗等），对照组仅遵医嘱于术后进行一般性锻炼。于手术前、手术后2周、3个月、6个月、12个月及24个月时采用日本骨科学会（JOA）下背痛评分标准对2组患者进行量化评分，并计算JOA改善率，同时观察2组患者术后并发症发生情况及椎间植骨融合情况。结果手术后2组患者JOA评分均较手术前明显提高，差异具有统计学意义（P〈0．05）；康复治疗组术后2周、3个月、6个月、12个月及24个月时JOA评分分别为（25．4±2．4）分、（26．3±2．1）分、（26．9±1．8）分、（26．4±2．1）分、（25．3±2．6）分；对照组术后2周、3个月、6个月、12个月及24个月时JOA评分分别为（23．2±3．0）分、（24．1±2．5）分、（24．5±2．7）分、（23．9±2．4）分、（23．2±2．3）分，组问比较发现，康复治疗组在术后不同时问点的JOA评分及改善率均显著优于对照组（均P〈0．05）；并且康复治疗组术后下肢深静脉血栓（DVT）、尿潴留、便秘等并发症发生率均显著低于对照组（P〈0．05）。所有患者椎问植骨均按时融合。结论早期康复干预能显著提高复发性腰椎间盘突出症患者再手术疗效，同时还能减少术后并发症发生，该疗法值得临床推广、应用。Objective To observe the effect of early rehabilitation therapy on recovery from reoperation for recurrent lumbar disc herniation （ RLDH）. Methods Sixty-flve cases who received surgery for RLDH be- tween 2007 and 2009 were randomly divided into a rehabilitation group and control group. Both groups were treated with the same surgical approach and routine treatment. Early and comprehensive rehabilitation therapy was provided in the rehabilitation group during the perioperative period, including preoperative and postoperative muscle strength training, postoperative sitting and standing balance training, and acupuncture. The control group was instructed only in general exercise. Before the operation and 2 weeks and 3, 6, 12 and 24 months after- ward, the surgical outcomes of all cases were assessed using the JOA score and the improvement rate in the JOA score. Any postoperative complications and intervertebral fusion were also observed. Results The average postoperative JOA scores of both groups were significantly higher than their preoperative scores. At all of the time points after the operation, the average JOA scores and all improvement rates in the rehabilitation group were sig- nificantly higher than those in the control group. Postoperative complications such as deep venous thrombosis, u- rinary retention and constipation were significantly less among the rehabilitation group than among the controls. All the intervertebral bone implants were well fused on time. Conclusion Early rehabilitation can significantly improve the effectiveness of RLDH reoperation and reduce the incidence of postoperative complications. It is recommended for clinical application.

关 键 词：复发性腰椎间盘突出症 康复 疗效 并发症 

分 类 号：R687.3[医药卫生—骨科学]