[1]张怀栓,潘玉林,郭小伟,等.生物电刺激在腰椎退行性疾病合并足下垂腰椎减压术后康复中的应用[J].中医正骨,2021,33(05):28-33.
　ZHANG Huaishuan,PAN Yulin,GUO Xiaowei,et al.Application of bio-electric stimulation therapy to postoperative rehabilitation of patients undergoing lumbar decompression surgery for lumbar degenerative diseases and foot drop[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(05):28-33.
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生物电刺激在腰椎退行性疾病合并足下垂腰椎减压术后康复中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年05期
页码:
28-33
栏目:
临床研究
出版日期:
2021-05-20

文章信息/Info

Title:
Application of bio-electric stimulation therapy to postoperative rehabilitation of patients undergoing lumbar decompression surgery for lumbar degenerative diseases and foot drop
作者:
张怀栓; 潘玉林; 郭小伟; 张猛; 李宝田; 尚林; 池红万
(郑州市骨科医院,河南 郑州 450052)
Author(s):
ZHANG Huaishuan; PAN Yulin; GUO Xiaowei; ZHANG Meng; LI Baotian; SHANG Lin; CHI Hongwan
Zhengzhou Orthopedic Hospital,Zhengzhou 450052,Henan,China
关键词:
腰椎;  椎间盘移位;  椎管狭窄;  脊椎滑脱;  足下垂;  电刺激疗法;  临床试验
Keywords:
lumbar vertebrae;  intervertebral disc displacement;  spinal stenosis;  spondylolysis;  foot drop;  electric stimulation therapy;  clinical trial
摘要:
目的:探讨生物电刺激在腰椎退行性疾病合并足下垂腰椎减压术后康复中的应用价值。方法:将102例符合要求的腰椎退行性疾病合并足下垂患者随机分为3组。所有患者均行腰椎减压手术。术后常规锻炼组(34例)进行常规功能锻炼,经皮电刺激组(36例)在常规功能锻炼的基础上进行经皮电刺激治疗,针刺电刺激组(32例)在常规功能锻炼的基础上进行针刺电刺激治疗; 经皮电刺激治疗和针刺电刺激治疗均持续6周。通过测定下肢疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、胫骨前肌肌力及足下垂康复率进行疗效评价。结果:①下肢疼痛VAS评分。时间因素和分组因素存在交互效应(F=3.558,P=0.002)。3组患者下肢疼痛VAS评分总体比较,差异无统计学意义,即不存在分组效应(F=1.082,P=0.340)。手术前后不同时间点之间下肢疼痛VAS评分的差异有统计学意义,即存在时间效应(F=275.441,P=0.000); 3组患者下肢疼痛VAS评分随时间延长均呈逐渐降低趋势[(5.59±1.84)分,(3.50±1.52)分,(2.38±1.02)分,(1.76±0.99)分,F=49.742,P=0.000;(6.64±2.05)分,(3.72±1.23)分,(1.86±0.87)分,(1.06±0.86)分,F=123.021,P=0.000;(6.19±1.77)分,(3.44±0.98)分,(1.84±0.81)分,(0.97±0.86)分,F=122.715,P=0.000]; 术前及术后2 d,3组患者的下肢疼痛VAS评分比较,差异均无统计学意义(F=2.699,P=0.072; F=0.481,P=0.620); 术后6周及术后6个月,3组患者下肢疼痛VAS评分的差异均有统计学意义(F=3.907,P=0.023; F=7.872,P=0.001),经皮电刺激组和针刺电刺激组的下肢疼痛VAS评分均低于常规锻炼组(P=0.018,P=0.017; P=0.001,P=0.001),经皮电刺激组和针刺电刺激组下肢疼痛VAS评分的差异均无统计学意义(P=0.937; P=0.694)。②ODI。时间因素和分组因素存在交互效应(F=2.707,P=0.031)。3组患者ODI总体比较,差异有统计学意义,即存在分组效应(F=14.775,P=0.000)。手术前后不同时间点之间ODI的差异有统计学意义,即存在时间效应(F=189.455,P=0.000); 3组患者ODI随时间延长均呈逐渐降低趋势[(30.47±7.33)分,(23.74±6.27)分,(18.29±5.78)分,F=30.017,P=0.000;(29.69±5.73)分,(19.03±4.97)分,(11.86±4.24)分,F=115.087,P=0.000;(29.84±7.03)分,(19.34±5.95)分,(12.16±4.87)分,F=70.049,P=0.000]; 术前3组患者的ODI比较,差异无统计学意义(F=0.130,P=0.879); 术后6周及术后6个月,3组患者ODI的差异均有统计学意义(F=7.181,P=0.001; F=18.057,P=0.000),经皮电刺激组和针刺电刺激组的ODI均低于常规锻炼组(P=0.001,P=0.002; P=0.000,P=0.000),经皮电刺激组和针刺电刺激组ODI的差异均无统计学意义(P=0.821; P=0.808)。③胫骨前肌肌力。时间因素和分组因素不存在交互效应(F=0.693,P=0.655)。3组患者胫骨前肌肌力总体比较,差异无统计学意义,即不存在分组效应(F=2.743,P=0.066)。手术前后不同时间点之间胫骨前肌肌力的差异有统计学意义,即存在时间效应(F=81.044,P=0.000); 3组患者胫骨前肌肌力随时间延长均呈逐渐增大趋势[(1.38±1.02)级,(2.47±1.35)级,(3.09±1.26)级,(3.68±1.39)级,F=20.484,P=0.000;(1.50±0.97)级,(2.42±1.34)级,(3.78±1.07)级,(4.00±1.10)级,F=39.381,P=0.000;(1.66±1.04)级,(2.50±1.50)级,(3.75±1.16)级,(4.00±1.22)级,F=25.012,P=0.000]。④足下垂康复率。所有患者均获得随访,随访时间18～30个月。术后2 d、术后6个月及末次随访时,3组患者的足下垂康复率比较,组间差异均无统计学意义(χ2=0.067,P=1.000; χ2=1.457,P=0.483; χ2=1.094,P=0.579); 术后6周3组患者足下垂康复率的差异有统计学意义(χ2=6.338,P=0.045),进一步两两比较(α’=0.017),组间差异均无统计学意义(χ2=4.666,P=0.035; χ2=4.855,P=0.048; χ2=0.014,P=1.000)。结论:对于接受腰椎减压手术治疗的腰椎退行性疾病合并足下垂患者,术后进行生物电刺激治疗不能明显提高胫骨前肌肌力和足下垂康复率,但能在早期缓解下肢疼痛、改善患者生活质量; 经皮电刺激治疗和针刺电刺激治疗的效果没有明显差异。
Abstract:
Objective:To explore the applied values of bio-electric stimulation(BES)therapy in postoperative rehabilitation of patients undergoing lumbar decompression surgery for treatment of lumbar degenerative diseases and foot drop.Methods:One hundred and two patients with lumbar degenerative diseases and foot drop were enrolled in the study and were randomly divided into 3 groups.All patients in the 3 groups were treated with lumbar decompression surgery,followed by conventional functional exercises.Thirty-four patients were merely treated with conventional functional exercises(conventional exercise group),moreover,36 patients were further treated with transcutaneous electrical stimulation(TES)therapy(TES therapy group),and 32 patients with acupuncture electrical stimulation(AES)therapy(AES therapy group)for consecutive 6 weeks.The curative effects were evaluated by measuring lower limb pain visual analogue scale(VAS)scores,Oswestry disability index(ODI),tibialis anterior(TA)muscle strength and recovery rate of foot drop.Results:There was interaction between time factor and group factor in lower limb pain VAS scores(F=3.558,P=0.002).There was no statistical difference in lower limb pain VAS scores between the 3 groups in general,in other words,there was no group effect(F=1.082,P=0.340).There was statistical difference in lower limb pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=275.441,P=0.000).The lower limb pain VAS scores presented a time-dependent decreasing trend in the 3 groups(5.59±1.84,3.50±1.52,2.38±1.02,1.76±0.99 points,F=49.742,P=0.000; 6.64±2.05,3.72±1.23,1.86±0.87,1.06±0.86 points,F=123.021,P=0.000; 6.19±1.77,3.44±0.98,1.84±0.81,0.97±0.86 points,F=122.715,P=0.000).There was no statistical difference in lower limb pain VAS scores between the 3 groups before the surgery and at 2 days after the surgery(F=2.699,P=0.072; F=0.481,P=0.620); while the differences between the 3 groups at 6 weeks and 6 months after the surgery were statistically significant(F=3.907,P=0.023; F=7.872,P=0.001).The lower limb pain VAS scores were lower in TES therapy group and AES therapy group compared to conventional exercise group(P=0.018,P=0.017; P=0.001,P=0.001),and there was no statistical difference between TES therapy group and AES therapy group(P=0.937; P=0.694).There was interaction between time factor and group factor in ODI(F=2.707,P=0.031).There was statistical difference in ODI between the 3 groups in general,in other words,there was group effect(F=14.775,P=0.000).There was statistical difference in ODI between different timepoints before and after the surgery,in other words,there was time effect(F=189.455,P=0.000)...

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