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[1]李志強(qiáng),劉佳.后期康復(fù)鍛煉在腰椎間盤突出癥非手術(shù)治療中的作用研究[J].中醫(yī)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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后期康復(fù)鍛煉在腰椎間盤突出癥非手術(shù)治療中的作用研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期數(shù):
2015年06期
頁碼:
12-15
欄目:
臨床研究
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:
李志強(qiáng); 劉佳
河南省洛陽正骨醫(yī)院/河南省骨科醫(yī)院,河南 洛陽 471002
Author(s):
LI Zhiqiang; LIU Jia
Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
關(guān)鍵詞:
椎間盤移位;  腰椎;  運(yùn)動(dòng)療法;  功能鍛煉;  回顧性研究
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  exercise therapy;  functional exercise;  retrospective studies
摘要:
目的:探討后期康復(fù)鍛煉在腰椎間盤突出癥非手術(shù)治療中的作用。方法:收集249例采用非手術(shù)方法治療的腰椎間盤突出癥 患者的病例資料,住院期間所有患者均采用牽引、中藥薰洗、推拿、腰椎整脊手法復(fù)位、臥床制動(dòng)、佩戴腰圍等治療,要求患者 出院后限制工作及活動(dòng),并指導(dǎo)患者后期康復(fù)鍛煉的具體方法。出院后完全遵照醫(yī)囑限制工作及活動(dòng),進(jìn)行規(guī)范系統(tǒng)的康復(fù)鍛煉 者125例(康復(fù)組); 出院后直接恢復(fù)原工作和正常生活,未按要求進(jìn)行康復(fù)鍛煉或未進(jìn)行康復(fù)鍛煉者124例(非康復(fù)組)。比較2組 患者腰部及下肢的疼痛視覺模擬評分(visual analogue score,VAS)、生活自理情況及臨床療效。結(jié)果:出院后不同時(shí)間腰痛VAS 評分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=585.521,P=0.000)。2組腰痛VAS評分比較總體上有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng) (F=176.303,P=0.000); 除出院時(shí)外,出院后1個(gè)月、3個(gè)月時(shí)康復(fù)組的評分均低于非康復(fù)組[(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]。時(shí)間因素與分組因素存在交互效應(yīng)(F=41.847,P=0.000)。出院后不同時(shí)間下肢痛 VAS評分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=244.915,P=0.000)。2組下肢痛VAS評分比較總體上有統(tǒng)計(jì)學(xué)意義,即存在分組 效應(yīng)(F=151.473,P=0.000); 除出院時(shí)外,出院后1個(gè)月、3個(gè)月時(shí)康復(fù)組的評分均低于非康復(fù)組[(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]。時(shí)間因素與分組因素存在交互效應(yīng)(F=62.726,P=0.000)。出院后3個(gè)月時(shí)康復(fù)組109 例生活完全自理,非康復(fù)組92例生活能夠完全自理,康復(fù)組生活自理率高于非康復(fù)組(χ2=6.676,P=0.009)。出院后3 個(gè)月進(jìn)行療效評定,康復(fù)組優(yōu)70例、良38例、可7例、差10例,非康復(fù)組優(yōu)58例、良32例、可11例、差23例,康復(fù)組的臨床療效優(yōu) 于非康復(fù)組(R^-康復(fù)組=116.08,R^-非康復(fù)組=133.99,Z=-2.141,P=0.032)。結(jié)論:對采用非手術(shù)治療的 腰椎間盤突出癥患者,后期進(jìn)行系統(tǒng)規(guī)范的康復(fù)鍛煉,可進(jìn)一步緩解患者的腰腿痛癥狀,恢復(fù)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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備注/Memo:
2015-03-04收稿 2015-04-30修回
更新日期/Last Update: 2015-06-30