核心肌群训练在老年腰椎管狭窄症患者内镜治疗术后康复的疗效  

Effect of core muscle exercise on the rehabilitation of elderly patients with spinal stenosis after lumbar endoscopic surgery

作　　者：荣雪芹 王太忠 宋文阁[3] 郑庆玲[1] 赵利涛 林芳轲 刘洪升 邹海涛 Rong Xueqin;Wang Taizhong;Song Wenge;Zheng Qingling;Zhao Litao;Lin Fangke;Liu Hongsheng;Zou Haitao(Department of Pain Spinal Minimally Invasive Center,the Third People's Hospital of Hainan Province,Sanya City,Hainan Province 572000,China;Department of Acupuncture,PLA General Hospital,Beijing 100853,China;Department of Pain Medicine,Shandong Provincial Hospital,Jinan City,Shandong Province 250021,China)

机构地区：[1]海南省第三人民医院疼痛脊柱微创中心,三亚市572000 [2]解放军总医院针灸科,北京100853 [3]山东省立医院疼痛科,济南市250021

出　　处：《中华疼痛学杂志》2020年第4期276-281,共6页Chinese Journal Of Painology

摘　　要：目的评估核心肌群训练对于老年腰椎管狭窄症患者内镜治疗术后康复的效果。方法纳入2017年8月至2019年4月在海南省第三人民医院疼痛脊柱微创中心就诊的老年腰椎管狭窄患者146例,性别不限,年龄≥65岁。根据术后训练方法不同分为未训练组(42例)、传统腰背肌训练组(53例)和核心肌群训练组(51例),分别进行术后静养、核心肌群腰背肌训练、呼吸辅助核心肌群的骨盆稳定和腹肌肌力增强训练。于术前及术后0.5、1和3 d时记录视觉模拟评分(VAS),于术前及术后1、3个月时记录Oswestry功能障碍指数问卷表(ODI)评分和日常生活能力量表(ADL)评分。结果3组患者性别、年龄、病程、手术节段、病变侧别、术前VAS评分等相比差异无统计学意义(P均>0.05)。与术前比较,3组患者术后0.5、1、3 d时VAS评分均降低(P均<0.05);与术前比较,3组患者术后1、3个月ODI指数降低,ADL评分升高(P均<0.05)。核心肌群训练组VAS评分在术后0.5、1 d均低于未训练组、传统腰背肌训练组[术后0.5 d时(3.0±0.8)分比(5.1±0.9)分,(3.0±0.8)分比(4.1±0.9)分,P均<0.05;术后1 d时(2.9±0.8)分比(5.2±1.1)分,(2.9±0.8)分比(3.3±0.7)分,P均<0.05]。核心肌群训练组在术后1、3个月ODI指数低于未训练组、传统腰背肌训练组[术后1个月时(34.0±6.2)分比(56.7±1.6)分,(34.0±6.2)分比(45.6±4.5)分,P均<0.05;术后3个月时(27.3±8.3)分比(53.9±2.2)分,(27.3±8.3)分比(39.6±7.1)分,P均<0.05];核心肌群训练组在术后1、3个月ADL评分高于未训练组、传统腰背肌训练组[术后1个月时(79.7±6.4)分比(72.1±2.5)分,(79.7±6.4)分比(77.2±4.4)分,P均<0.05;术后3个月时(83.5±4.4)分比(78.6±5.2)分,(83.5±4.4)分比(80.2±5.5)分,P均<0.05]。结论术后核心肌群训练能明显增强脊柱内镜术后康复效果,促进运动功能恢复,提高生活质量,核心肌群训练明显优于传统腰背肌训练。Objective To assess the effect of core muscle strengthening exercise on the rehabilitation of elderly patients with spinal stenosis after lumbar endoscopic surgery.Methods A total of 146 elderly patients with lumbar spinal stenosis,both sexes,aged≥65 years old,were enrolled in the Minimally Invasive Center for Spinal Pain in the Third People's Hospital of Hainan Province from August 2017 to April 2019.According to the exercise methods after the operation,the patients were assigned to control group,trunk extensors strengthening group and core strengthening group.Patients were given postoperative repose in bed,core muscles training,or pelvic stabilization of the core muscles with strengthening of the abdominal muscles in the three groups respectively.Visual analogue scale(VAS)was recorded at preoperation and 0.5,1,3 days after the operation.Oswestry disability index(ODI)and activities of daily living(ADL)were recorded at 1,3 months after the operation.Results There was no significant difference in gender,age,course of disease,operative segment,lesion side and preoperative VAS score among the three groups(all P>0.05).Compared with preoperation,VAS was decreased at 0.5,1 and 3 days after the operation in the three groups(all P<0.05).Compared with preoperation,ODI was decreased;ADL was increased at 1,3 months after the operation respectively in the three groups(all P<0.05).VAS was lower in core strengthening group than that in control group and trunk extensors strengthening group[0.5 d after the operation,(3.0±0.8)vs.(5.1±0.9),(3.0±0.8)vs.(4.1±0.9),all P<0.05;1 d after the operation,(2.9±0.8)vs.(5.2±1.1),(2.9±0.8)vs.(3.3±0.7),all P<0.05].ODI was lower in core strengthening group than that in control group and trunk extensors strengthening group[1 month after the operation,(34.0±6.2)vs.(56.7±1.6),(34.0±6.2)vs.(45.6±4.5),all P<0.05;3 months after the operation,(27.3±8.3)vs.(53.9±2.2),(27.3±8.3)vs.(39.6±7.1),all P<0.05].ADL was higher in core strengthening group than that in control group,trunk extensor

关 键 词：椎管狭窄 恢复 修复 老年人 核心肌群训练 

分 类 号：R687.3[医药卫生—骨科学]