中华老年骨科与康复电子杂志 ›› 2023, Vol. 09 ›› Issue (03) : 157 -165. doi: 10.3877/cma.j.issn.2096-0263.2023.03.005 × 扫一扫
康复医学
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Junhua Zhao, Zhengwei Yang†(), Yang Liu, Yinfu Zheng, Jian Liu
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赵俊华, 杨政伟, 刘阳, 郑银福, 刘建. 规范的术后康复训练对PELD术预后的影响[J/OL]. 中华老年骨科与康复电子杂志, 2023, 09(03): 157-165.
Junhua Zhao, Zhengwei Yang, Yang Liu, Yinfu Zheng, Jian Liu. Effect of standardized postoperative rehabilitation training on the prognosis of PELD[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(03): 157-165.
探讨规范的术后康复训练对经皮内镜下腰椎间盘切除术（PELD）预后的影响。
分析我院近年来153例行PELD术的腰椎间盘突出症（LDH）者，其中98例行经椎间孔入路，55例经板间入路。出院时给每位患者一份康复手册，嘱其严格按照手册内容进行康复训练。经随访调查，坚持按康复手册训练，每周训练次数≥4 d的患者82例，列为观察组；每周训练次数≥2 d，<4 d的患者50例，列为对照组a；每周训练次数<2 d的患者21例，列为对照组b。术后2、4、8、12周、6月、12月定期随访，比较三组术前术后的视觉模拟评分（VAS）、Oswestry功能障碍指数评分（ODI）及腰椎日本骨科学会（JOA）腰椎功能评分。
随访128例，平均随访时间（364.34±3.27）d，男性76例，女性52例，平均年龄（54.75±9.86）岁。三组术后VAS、ODI、JOA评分结果经重复测量设计资料的方差分析显示：三组组间差异有统计学意义（P<0.05）；组别与时间点间存在交互作用，各时间点除术前与术后2周外，术后4、8、12周三组的VAS、ODI、JOA评分结果差别均有统计学意义（P<0.05）；术后6、12月，观察组与对照组a的VAS、ODI、JOA评分结果差异均无统计学意义，观察组与对照组b的VAS、ODI、JOA评分结果差异均有统计学意义（P<0.05）。观察组在各时间点间差异均有统计学意义（P<0.05）。
PELD术后应尽早进行规范的康复训练，能改善患者预后，尤其对术后3月内患者腰椎功能改善明显，促进患者更早地恢复术前生活状态。
To analyze effect of standardized postoperative rehabilitation training on the prognosis of Percutaneous Endoscopic Lumbar Discectomy (PELD).
In recent years, 153 cases of lumbar disc herniation (LDH) underwent PELD in our hospital were analyzed. Among them, 98 cases underwent transforaminal approach and 55 cases underwent interlaminar approach. At the time of discharge, each patient was given a rehabilitation manual and instructed to carry out rehabilitation training in strict accordance with the manual. After followup investigation, 82 patients who insisted on training according to the rehabilitation manual and had training times ≥4 days a week were included in the observation group; 50 patients with weekly training times ≥2 days and <4 days were classified as control group a; 21 patients with training times less than 2 days per week were classified as control group b.The patients were followed up regularly at 2, 4, 8, 12 weeks, 6 months and 12 months after operation. The preoperative and postoperative visual analog scale (VAS), Oswestry disability index (ODI) and lumbar function score of Japanese Orthopaedic Association (JOA) were compared among the three groups.
128 cases were followed up, with an average follow-up time of (364.34±3.27) days. There were 76 males and 52 females, with an average age of (54.75±9.86) years. The results of postoperative VAS, ODI, and JOA scores in the three groups were analyzed using repeated measurement design data. The difference between the three groups was statistically significant (P<0.05); There is an interaction between groups and time points. Except for preoperative and postoperative 2 weeks, the VAS, ODI, and JOA scores of the groups at 4, 8, and 12 weeks after surgery showed statistically significant differences (P<0.05); At 6 and 12 months after surgery, there was no statistically significant difference in VAS, ODI, and JOA scores between observation group and control group a (P>0.05), while there was a statistically significant difference in VAS, ODI, and JOA scores between observation group and control group b (P<0.05). The difference between the observation group at each time point was statistically significant (P<0.05).
Standardized rehabilitation training should be carried out as soon as possible after the operation of PELD, which can improve the prognosis of patients, especially the lumbar function of patients within 3 months after the operation, and promote the patients to recover their preoperative life state earlier.