本文選題：漸進性功能鍛煉 + 腰背肌鍛煉�。� 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過骨科術(shù)后康復(fù)指南中腰椎融合術(shù)章節(jié)所介紹的鍛煉方法總結(jié)一套由易到難的漸進性功能鍛煉方法、同時和我院臨床常用腰背肌功能鍛煉方法進行對比;觀察兩組腰椎融合術(shù)后患者通過不同功能鍛煉后鄰近節(jié)段退變的情況。方法:選取2015年8月到2016年1月在漳州175醫(yī)院骨科住院治療,并行腰椎后路雙節(jié)段減壓內(nèi)固定+植骨融合術(shù)(L4-S1)的女性患者60例,隨機分成兩組:漸進性功能鍛煉組30例(以下簡稱試驗組)和腰背肌功能鍛煉組30例(以下簡稱對照組),兩者患者均在住院期間,根據(jù)術(shù)前宣教和術(shù)后分別教授患者漸進性功能鍛煉和我院常用腰背肌鍛煉方法,定期返院復(fù)查并指導(dǎo)并教授或糾正其鍛煉動作,同時出院后根據(jù)電話及微信等社交通訊工具跟蹤其完成情況。術(shù)前及術(shù)后末次隨訪時進行腰椎MRI檢查,并且拍攝腰椎站立正側(cè)位、過伸過屈位X線片,術(shù)前、術(shù)后6周、3個月、6個月及1年進行VAS評分、ODI評分,使用ZWCAD+軟件測量鄰近節(jié)段椎間高度、椎間成角、椎體滑移、椎旁肌(腰大肌、豎脊肌、多裂肌)的橫截面積、椎管狹窄情況,記錄各數(shù)據(jù)的變化情況,根據(jù)Pfirrmann法[19]評估術(shù)前、術(shù)后鄰近節(jié)段椎間盤退變情況。結(jié)果:所有患者均符合納入標(biāo)準(zhǔn)并完成1年隨訪,患者術(shù)前年齡、體重、身高、BMI指數(shù)等一般資料差異無統(tǒng)計學(xué)意義。兩組患者術(shù)后VAS評分、ODI評分較術(shù)前明顯下降,但試驗組患者在術(shù)后6周、術(shù)后3個月的VAS評分、ODI評分下降程度大,與對照組比較差異有統(tǒng)計學(xué)意義(P0.05)。在椎間高度的下降、椎體滑移、椎間成角上,兩組患者術(shù)后均出現(xiàn)了不同程度的退變,而試驗組比對照組的退變程度輕,差異有統(tǒng)計學(xué)意義(P0.05)。兩組患者椎旁肌面積經(jīng)過鍛煉后均較術(shù)前增加,其中試驗組面積較對照組增加,差異有統(tǒng)計學(xué)意義。兩組患者術(shù)前椎間盤退變、椎管狹窄程度比較差異無統(tǒng)計學(xué)意義,二組患者經(jīng)鍛煉后椎間盤較術(shù)前無明顯退變、而椎管的面積情況出現(xiàn)了不同程度的狹窄,其中試驗組的退變情況較對照組輕。結(jié)論:1.漸進性功能鍛煉方法可明顯改善腰椎融合術(shù)后早期腰腿痛和功能障礙,可預(yù)防腰椎術(shù)后早期鄰近節(jié)段退變(ASDeg);2.由易到難、簡到繁的鍛煉方法,可鍛煉多塊脊柱穩(wěn)定肌,在改善術(shù)后早期疼痛、功能恢復(fù)以及在預(yù)防早期鄰近節(jié)段退變上優(yōu)于常規(guī)腰背肌功能鍛煉。
[Abstract]:Objective: to summarize a set of progressive functional exercise methods from easy to difficult in the chapter of lumbar fusion in orthopedic rehabilitation guidelines, and to compare them with the methods of lumbar dorsalis muscle function exercise commonly used in our hospital. The degenerative changes of adjacent segments after different functional exercise were observed in two groups after lumbar fusion surgery. Methods: from August 2015 to January 2016, 60 female patients were treated in the orthopedic department of Zhangzhou 175 Hospital and treated with lumbar posterior decompression and internal fixation (L4-S1). They were randomly divided into two groups: progressive exercise group (30 cases) and psoas muscle exercise group (30 cases). Both patients were in hospital. According to the methods of pre- and post-operative progressive functional exercise and lumbar and dorsal muscle exercise, we should return to hospital regularly and teach or correct the exercise movements. At the same time after discharge from the hospital according to telephone and WeChat social communication tools to track its completion. The lumbar vertebrae were examined with MRI before operation and at the last follow-up after operation, and the lumbar vertebrae were photographed in the positive and lateral position, extension and flexion position. Before operation, 6 weeks, 3 months, 6 months and 1 year after operation, the VAS score and ODI score were evaluated. ZWCAD software was used to measure the height, angle, slippage, cross-sectional area of paraspinal muscle (psoas major, vertical spinal muscle, polyfissure muscle), stenosis of spinal canal, record the changes of data, and evaluate the results before operation according to Pfirrmann's method [19], using ZWCAD software to measure the intervertebral height, intervertebral angle, vertebral slip, paraspinal muscle (psoas major muscle, vertical spinal muscle, polyfissure muscle). Postoperative degeneration of adjacent segments of intervertebral disc. Results: all the patients met the inclusion criteria and completed a year follow-up. There was no significant difference in preoperative age, weight, height and BMI index. The VAS scores and ODI scores of the two groups were significantly lower than those of the patients before operation, but the VAS scores and ODI scores of the patients in the trial group were significantly lower than those in the control group at 6 weeks and 3 months after operation (P0.05). In the reduction of intervertebral height, slippage of vertebral body and intervertebral angle, there were different degrees of degeneration in the two groups after operation, but the degree of degeneration in the experimental group was lighter than that in the control group, the difference was statistically significant (P0.05). The area of paravertebral muscle in the two groups was increased after exercise, and the area of the experimental group was higher than that of the control group, and the difference was statistically significant. There was no significant difference in the degree of intervertebral disc degeneration and spinal canal stenosis between the two groups before operation. There was no obvious degeneration of intervertebral disc after exercise in both groups, and the area of spinal canal had different degree of stenosis. The degeneration of the experimental group was lighter than that of the control group. Conclusion 1. Progressive functional exercise can significantly improve early lumbago and leg pain and dysfunction after lumbar fusion, and can prevent early adjacent segment degeneration (ASDeg) after lumbar vertebrae fusion. From easy to difficult, simple to complex exercise method, can exercise a number of spinal stabilizer muscle, in improving early postoperative pain, functional recovery and prevention of early adjacent segment degeneration of the regular lumbar muscle functional exercise.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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