经皮椎间孔镜联合石氏强筋功法治疗腰椎管狭窄症的临床观察  

Clinical Observation of Percutaneous Transforaminal Endoscopic Discectomy Combined with Shi’s Strengthening Exercise for Lumbar Spinal Stenosis

作　　者：王辉昊[1] 俞仲翔[1] 冯俊涛[1] 石金玉 邓真 王楠[3] 王玉鹏 史萌[1] 詹红生[1] WANG Huihao;YU Zhongxiang;FENG Juntao;SHI Jinyu;DENG Zhen;WANG Nan;WANG Yupeng;SHI Meng;ZHAN Hongsheng(Shi's Center of Orthopedics and Traumatology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai 201999,China;Shanghai Yangzhi Rehabilitation Hospital,Shanghai 201619,China)

机构地区：[1]上海中医药大学附属曙光医院石氏伤科医学中心/上海市中医药研究院骨伤科研究所,上海201203 [2]上海市宝山区中西医结合医院/上海中医药大学附属曙光医院宝山分院 [3]同济大学附属养志康复医院/上海市阳光康复中心

出　　处：《中国中医骨伤科杂志》2021年第9期22-26,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：国家自然科学基金项目(81973871,81804114);上海市重中之重临床重点学科建设项目“中医骨伤科学”(2017ZZ02024);上海申康医院发展中心临床三年行动计划(SHDC2020CR1051B);上海市卫计委詹红生上海市名老中医学术经验研究工作室建设项目(SHGS-2017025)。

摘　　要：目的:评价经皮椎间孔镜联合石氏强筋功法治疗腰椎管狭窄症(LSS)的临床疗效及腰椎最大等长肌力(MIS)的影响。方法:2017年1月至2018年8月期间符合纳入标准的76例患者,随机分为对照组和强筋功法组各38例。强筋功法组采用PTED联合石氏强筋功法,即在PTED术后1周开始石氏强筋功法锻炼,每天早晚各做5次,共3周;对照组采用PTED治疗,术后常规康复训练。评价指标为腰痛和腿痛程度(VAS评分)、ODI评分与MIS,随访时间节点为术前、术后及术后4周、8周、12周。结果:所有患者均完成随访,两组均未见明显不良反应。术后两组的腰痛和腿痛程度(VAS评分)和ODI评分较术前明显降低,差异有统计学意义(P<0.05),并在4周、8周和12周能保持疗效。术后第4周时,强筋功法组的腰椎前屈MIS明显高于对照组,差异有统计学意义(P<0.05);术后第4周和第8周时,强筋功法组的腰椎右侧屈MIS明显高于对照组,差异有统计学意义(P<0.05)。腰椎后伸和左侧屈时,两组的MIS几乎无差别,差异无统计学意义(P>0.05)。结论:PTED联合石氏强筋功法治疗LSS临床疗效明确,安全性高,依从性好;强筋功法在增加腰椎前屈肌肉群力量方面优于常规康复训练。Objective:To investigate the clinical efficacy of percutaneous transforaminal endoscopic discectomy(PTED) combined with Shi’s strengthening exercise for patients with lumbar spinal stenosis(LSS) and the influence of lumbar spinal maximal isometric strength(MIS).Methods:76 patients who met the inclusion criteria from January 2017 to August 2018 were selected.These subjects were randomly divided into the Gongfa group(n=38) and the control group(n=38).PTED combined with Shi’s muscle strengthening exercise was used in the Gongfu group, that is, Shi’s muscle strengthening exercise began one week after PTED,and was done five times every morning and evening for three weeks.The control group was treated with routine rehabilitation training after PTED.VAS score, ODI score and lumbar MIS score were performed in all patients before operation, after operation and at 4 weeks, 8 weeks and 12 weeks of follow-up.Results:All 76 patients were followed up for 12 weeks without obvious and serious complications and there were no exfoliation cases.The scores of low back pain and leg pain(VAS) and ODI score in the two groups were significantly lower than those before operation(P<0.05),and it was maintained at 4 weeks, 8 weeks and 12 weeks.At 4 weeks after operation, the MIS of Gongfa group’s flexor muscle was significantly higher than that of the control group(P<0.05).The MIS of Gongfa group’s right flexor muscle at 8 weeks and 12 weeks postoperative were significantly higher than that of the control group(P<0.05).However, there was no obvious difference in the maximal isometric strength of the extensor and right flexor muscles at these points(P>0.05).Conclusion:PTED combined with Shi’s strengthening exercise(Gongfa) has clear clinical efficacy, high safety and ideal compliance, and Shi’s strengthening exercise(Gongfa) is superior to conventional rehabilitation training in increasing the strength of lumbar flexion muscles.

关 键 词：腰椎管狭窄症 石氏伤科 强筋功法 经皮椎间孔镜 最大等长肌力 

分 类 号：R681.5[医药卫生—骨科学]