Sinaki M, Lutness M P, Ilstrup D M, Chu C P, Gramse R R
Department of PM&R, Mayo Clinic, Rochester, MN 55905.
Arch Phys Med Rehabil. 1989 Aug;70(8):594-8.
Forty-eight patients with symptomatic back pain secondary to spondylolisthesis who were treated conservatively were followed for three years after initial examination to compare the outcomes of two exercise programs. The patients were divided into two groups--those doing flexion and those doing extension back strengthening exercises. All patients received instructions on posture, lifting techniques, and the use of heat for relief of symptoms. After three months, only 27% of patients who were instructed in flexion exercises had moderate or severe pain and only 32% were unable to work or had limited their work. Of the patients who were instructed in extension exercises, 67% had moderate or severe pain and 61% were unable to work or had limited their work. At three-year follow-up, only 19% of the flexion group had moderate or severe pain and 24% were unable to work or had limited their work. The respective figures for the extension group were 67% and 61%. The overall recovery rate after three months was 58% for the flexion group and 6% for the extension group. At three years these figures improved to 62% for the flexion group and dropped to 0% for the extension group. The literature is scarce regarding the applicability of conservative treatment programs for lumbar spondylolisthesis. On the basis of our findings, we suggest that if a conservative treatment program is elected, back flexion or isometric back strengthening exercises should be considered. The three-year follow-up data presented here lend support to this point of view.
48例因腰椎滑脱导致有症状性背痛且接受保守治疗的患者，在初次检查后随访3年，以比较两种锻炼方案的效果。患者被分为两组——一组进行前屈锻炼，另一组进行后伸背部强化锻炼。所有患者均接受了关于姿势、提举技巧以及使用热敷缓解症状的指导。3个月后，接受前屈锻炼指导的患者中，只有27%有中度或重度疼痛，只有32%无法工作或限制了工作。接受后伸锻炼指导的患者中，67%有中度或重度疼痛，61%无法工作或限制了工作。在3年随访时，前屈组只有19%有中度或重度疼痛，24%无法工作或限制了工作。后伸组的相应数字分别为67%和61%。前屈组3个月后的总体恢复率为58%，后伸组为6%。3年时，前屈组这些数字提高到62%，后伸组则降至0%。关于腰椎滑脱保守治疗方案的适用性，文献资料较少。基于我们的研究结果，我们建议，如果选择保守治疗方案，应考虑背部前屈或等长背部强化锻炼。此处呈现的3年随访数据支持了这一观点。
