早期强化康复在颈椎后路术后加速康复外科模式中的应用:一项混合方法研究  

Application of early intensive rehabilitation in enhanced recovery after surgery protocol after laminoplasty:a mixed methods research

作　　者：张之良 褚红玲[2] 刘小燮[1] 周谋望[1] 周非非[3] ZHANG Zhiliang;CHU Hongling;LIU Xiaoxie;ZHOU Mouwang;ZHOU Feifei(Department of Rehabilitation,Peking University Third Hospital,Beijing 100191,China;Research Center of Clinical Epidemiology,Peking University Third Hospital,Beijing 100191,China;Department of Orthopedics,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院康复医学科,北京市100191 [2]北京大学第三医院临床流行病学研究中心,北京市100191 [3]北京大学第三医院骨科,北京市100191

出　　处：《中国康复理论与实践》2024年第4期468-478,共11页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的采用混合方法探讨颈椎后路手术加速康复外科(ERAS)模式中纳入术后早期强化康复治疗的效果。方法定量研究选择2018年1月至2019年1月行颈椎后路椎管扩大成形术的患者,根据术后康复方案分为强化康复组41例和骨科治疗组33例。两组均按照ERAS模式进行围手术期管理,强化康复组术后在康复专业团队指导下进行7 d住院强化康复治疗,骨科治疗组术后由骨科医师及护士进行常规宣教指导后于家中自行锻炼。术前和术后(90±14)d,采用疼痛视觉模拟评分(VAS)、改良日本骨科协会评分(mJOA)、颈椎功能障碍指数(NDI)和SF-36进行评定。定性研究另选取2019年5月至2019年11月行颈椎后路椎管扩大成形术的两组患者各12例,术后(7±2)d进行半结构式访谈。将定量研究和定性研究中相同维度结果进行比较与整合分析。结果定量研究结果表明,对于无C5神经根麻痹患者,两组术后90 d时VAS评分、mJOA评分、NDI评分均无显著性差异(U>0.140,P>0.05),SF-36评分的生理功能评分有显著性差异(U=2.031,P<0.05)。术后90 d的VAS评分(ρ_(1)=-0.522,ρ_(2)=-0.334,P<0.05)、NDI评分(ρ1=-0.681,ρ2=-0.590,P<0.05)与SF-36躯体健康和精神健康评分呈负相关,mJOA评分(ρ_(1)=0.408,ρ_(2)=0.304,P<0.05)与SF-36躯体健康和精神健康评分呈正相关。定性研究中,强化康复组在术后7 d时疼痛、颈椎功能、神经功能和生活质量方面的改善均优于骨科治疗组。结论术后早期强化康复治疗的效果主要体现在术后早期功能改善。对于无C5神经根麻痹患者,进行术后早期强化康复治疗可提高其术后90 d时的生活质量。Objective To explore the effect of early postoperative intensive rehabilitation within the Enhanced Recovery After Surgery(ERAS)protocol for posterior cervical spine surgery using a mixed-methods approach.Methods For the quantitative study,the inpatients with cervical spondylotic myelopathy undergoing decompression surgery from January,2018 to January,2019,were divided into intensive rehabilitation group(n=41)and orthopedic treatment group(n=33).Two groups accepted ERAS protocol.The intensive rehabilitation group received seven days of intensive rehabilitation under the guidance of a professional team post-surgery,whereas the orthopedic treatment group received routine education by orthopedic surgeons and nurses and then exercised at home.Before and(90±14)days after surgery,both groups were assessed with Visual Analog Scale(VAS)for pain,modified Japanese Orthopedic Association(mJOA),Neck Disability Index(NDI)and Short Form-36 Health Survey(SF-36).For qualitative study,other twelve patients from each group who underwent surgery from May,2019 to November,2019 were interviewed with a semi-structured questionnaire(7±2)days after surgery.The results from the quantitative and qualitative studies were compared and integrated for analysis.Results The quantitative study revealed that for patients without C5 palsy,there were no significant differences in the VAS score,mJOA score,and NDI score at 90 days after surgery between the two groups(U>0.140,P>0.05).However,there was a significant difference in the physical function score of the SF-36(U=2.031,P<0.05).The VAS score(ρ_(1)=-0.522,ρ_(2)=-0.334,P<0.05)and NDI score(ρ_(1)=-0.681,ρ_(2)=-0.590,P<0.05)90 days after surgery were negatively correlated with the body health and mental health scores of SF-36,while the mJOA score(ρ_(1)=0.408,ρ_(2)=0.304,P<0.05)was positively correlated with the body health and mental health scores of SF 36.In qualitative study,the intensive rehabilitation group showed better improvement than the orthopedic treat‐ment group in terms of pai

关 键 词：脊髓型颈椎病 椎管扩大成形术 加速康复外科 强化康复 

分 类 号：R681.5[医药卫生—骨科学]