[1]李志强,刘佳.后期康复锻炼在腰椎间盘突出症非手术治疗中的作用研究[J].中医正骨,2015,27(06):12-15.
　LI Zhiqiang,LIU Jia.Clinical study on the effect of subsequent rehabilitation exercises in the non-operative treatment of lumbar intervertebral disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):12-15.
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后期康复锻炼在腰椎间盘突出症非手术治疗中的作用研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期数:
2015年06期
页码:
12-15
栏目:
临床研究
出版日期:
2015-06-30

文章信息/Info

Title:
Clinical study on the effect of subsequent rehabilitation exercises in the non-operative treatment of lumbar intervertebral disc herniation
作者:
李志强; 刘佳
河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002
Author(s):
LI Zhiqiang; LIU Jia
Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
关键词:
椎间盘移位;  腰椎;  运动疗法;  功能锻炼;  回顾性研究
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  exercise therapy;  functional exercise;  retrospective studies
摘要:
目的:探讨后期康复锻炼在腰椎间盘突出症非手术治疗中的作用。方法:收集249例采用非手术方法治疗的腰椎间盘突出症 患者的病例资料,住院期间所有患者均采用牵引、中药薰洗、推拿、腰椎整脊手法复位、卧床制动、佩戴腰围等治疗,要求患者 出院后限制工作及活动,并指导患者后期康复锻炼的具体方法。出院后完全遵照医嘱限制工作及活动,进行规范系统的康复锻炼 者125例(康复组); 出院后直接恢复原工作和正常生活,未按要求进行康复锻炼或未进行康复锻炼者124例(非康复组)。比较2组 患者腰部及下肢的疼痛视觉模拟评分(visual analogue score,VAS)、生活自理情况及临床疗效。结果:出院后不同时间腰痛VAS 评分的差异有统计学意义,即存在时间效应(F=585.521,P=0.000)。2组腰痛VAS评分比较总体上有统计学意义,即存在分组效应 (F=176.303,P=0.000); 除出院时外,出院后1个月、3个月时康复组的评分均低于非康复组[(3.59±0.62)分, (3.62±0.62)分,t=-0.368,P=0.713;(2.28±0.80)分,(3.01±0.47)分,t=-8.761,P=0.000;(0.90±0.65)分, (2.05±0.81)分,t=-12.468,P=0.000]。时间因素与分组因素存在交互效应(F=41.847,P=0.000)。出院后不同时间下肢痛 VAS评分的差异有统计学意义,即存在时间效应(F=244.915,P=0.000)。2组下肢痛VAS评分比较总体上有统计学意义,即存在分组 效应(F=151.473,P=0.000); 除出院时外,出院后1个月、3个月时康复组的评分均低于非康复组[(3.34±0.51)分, (3.33±0.51)分,t=0.208,P=0.836;(2.50±0.68)分,(3.28±0.52)分,t=-10.151,P=0.000;(1.55±0.82)分, (2.61±0.67)分,t=-11.185,P=0.000]。时间因素与分组因素存在交互效应(F=62.726,P=0.000)。出院后3个月时康复组109 例生活完全自理,非康复组92例生活能够完全自理,康复组生活自理率高于非康复组(χ2=6.676,P=0.009)。出院后3 个月进行疗效评定,康复组优70例、良38例、可7例、差10例,非康复组优58例、良32例、可11例、差23例,康复组的临床疗效优 于非康复组(R^-康复组=116.08,R^-非康复组=133.99,Z=-2.141,P=0.032)。结论:对采用非手术治疗的 腰椎间盘突出症患者,后期进行系统规范的康复锻炼,可进一步缓解患者的腰腿痛症状,恢复腰部功能,提高患者的生活自理能力 。
Abstract:
Objective:To study the effect of subsequent rehabilitation exercises in the non-operative treatment of lumbar intervertebral disc herniation(LDH).Methods:The medical records of 249 patients with LDH were collected.All of the patients were treated with non-operative therapies including traction,chinese herbal steaming and washing therapy,spinal manipulation,lumbar manipulative adjustment,lying in bed and wearing lumbar balteum during hospitalization period.The patients were asked to restrict themselves in work and activities after discharge from the hospital,furthermore,they were taught the specific methods of subsequent rehabilitation exercises.One hundred and twenty-five patients(rehabilitation group)limited their work and activities and performed systematic and standardized rehabilitation exercises by doctor's advice after discharge from the hospital; while 124 patients(non-rehabilitation group)didn't limit their work and activities,moreover,they didn't do rehabilitation exercises by doctor's advice.Visual analogue score(VAS)for waist and lower limb pain,self-care ability and clinical curative effect were compared between the 2 groups.Results:There was statistical difference in low back pain VAS scores between different time points after discharge from the hospital,in other words,there was time effect(F=585.521,P=0.000).There was statistical difference in low back pain VAS scores between the 2 groups,in other words,there was grouping effect (F=176.303,P=0.000).The scores were lower in rehabilitation group compared to non-rehabilitation group at 1 and 3 months after discharge from the hospital(2.28+/-0.80 vs 3.01+/-0.47 points,t=-8.761,P=0.000; 0.90+/-0.65 vs 2.05+/-0.81 points,t=-12.468,P=0.000)while no statistical difference was found in VAS scores between the two groups at discharge(3.59+/-0.62 vs 3.62+/-0.62 points,t=-0.368,P=0.713).There was interaction between time factor and grouping factor(F=41.847,P=0.000).There was statistical difference in lower limb pain VAS scores between different time points after discharge from the hospital,in other words,there was time effect (F=244.915,P=0.000).There was statistical difference in lower limb pain VAS scores between the 2 groups,in other words,there was grouping effect(F=151.473,P=0.000).The scores were lower in rehabilitation group compared to non-rehabilitation group at 1 and 3 months after discharge from the hospital(2.50+/-0.68 vs 3.28+/-0.52 points,t=-10.151,P=0.000; 1.55+/-0.82 vs 2.61+/-0.67 points,t=-11.185,P=0.000)while no statistical difference was found in VAS scores between the two groups at discharge(3.34+/-0.51 vs 3.33+/-0.51 points,t=0.208,P=0.836).There was interaction between time factor and grouping factor(F=62.726,P=0.000).One hundred and nine patients in rehabilitation group and 92 patients in non-rehabilitation group could care themselves independly at 3 months after discharge from the hospital,and the self-care rate was higher in rehabilitation group compared to non-rehabilitation group(χ2=6.676,P=0.009).At three months after discharge from the hospital,70 patients obtained an excellent result,38 good,7 fair and 10 poor in the rehabilitation group; while 58 patients obtained an excellent result,32 good,11 fair and 23 poor in the non- rehabilitation group.The rehabilitation group surpassed the non-rehabilitation group in the total curative effect(R^-rehabilitation group=116.08,R^-non-rehabilitation group=133.99,Z=- 2.141,P=0.032).Conclusion:For patients with LDH who were treated by non-operative treatment,subsequent systematic and standardized rehabilitation exercises can further relieve their lumbocrural pain and restore their lumbar performance and improve their self-care ability.

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备注/Memo

备注/Memo:
2015-03-04收稿 2015-04-30修回
更新日期/Last Update: 2015-06-30