腰椎手术后 6 个月时身体功能大幅改善的预测因素：术后早期行走重要吗？一项前瞻性队列研究。
Predictors of substantial improvement in physical function six months after lumbar surgery: is early post-operative walking important? A prospective cohort study.
机构信息
St Vincent's Private Hospital Melbourne, 59 Victoria Parade, Fitzroy, VIC, 3065, Australia.
La Trobe University, Plenty Rd, Bundoora, Melbourne, VIC, 3086, Australia.
出版信息
BMC Musculoskelet Disord. 2019 Sep 11;20(1):418. doi: 10.1186/s12891-019-2806-7.
BACKGROUND
Resuming walking after lumbar surgery is a common focus of early post-operative rehabilitation, however there is no knowledge about whether increased walking is associated with better functional outcomes. This study aimed to determine whether time spent walking in the week after lumbar surgery, along with co-morbidities, pre-operative pain duration, pre-operative physical activity or function, or surgical variables predict substantial improvement in physical function six months after lumbar surgery.
METHODS
A prospective cohort study design was utilized. Participants undergoing lumbar surgery (discectomy, decompression, fusion) were recruited between April and November 2016. Predictor variables were collected pre-operatively (age, sex, smoking status, obesity, diabetes, depression, anxiety, pre-operative pain duration, neurological deficit, physical activity levels, mobility restriction, function) and early post-operatively (post-operative walking time, surgical procedure, single/multi-level surgery). Outcome variables (physical function, back pain and leg pain severity) were measured pre-operatively and six-months post-operatively. Logistic regression analysis was used to establish prediction of substantial improvement in outcome at six months.
RESULTS
Participants (N = 233; 50% female; age 61 (SD = 14) years) who walked more in the first post-operative week were more likely to have substantially improved function on the Oswestry Disability Questionnaire at six months (OR 1.18, 95%CI 1.02-1.37), as were participants with < 12 months pre-operative pain (OR 2.71, 95%CI 1.28-5.74), and those with lower pre-operative function (OR 4.02, 95%CI 2.33-6.93). Age < 65 years (OR 2.36, 95%CI 1.14-4.85), and < 12 months pre-operative pain (OR 3.52 95%CI 1.69-7.33) predicted substantial improvement on the SF-36 Physical Component Summary. There were no significant predictors for substantial improvement in either leg or back pain.
CONCLUSIONS
Walking time in the week after lumbar surgery is one of several predictors of substantial improvement in function at six months. Further research is required to determine whether intervention designed to increase walking early after lumbar surgery results in improved longer-term recovery of function.
TRIAL REGISTRATION
Australian New Zealand Clinical Trials Registry (ANZCTR), registration number 12616000747426 . Retrospectively registered on the 7th of June 2016.
背景
腰椎手术后恢复行走是早期术后康复的一个常见重点，但尚不清楚增加行走是否与更好的功能结果相关。本研究旨在确定腰椎手术后一周内的行走时间以及合并症、术前疼痛持续时间、术前体力活动或功能或手术变量是否可预测腰椎手术后 6 个月时体力功能的显著改善。
方法
采用前瞻性队列研究设计。2016 年 4 月至 11 月期间招募了接受腰椎手术（椎间盘切除术、减压术、融合术）的参与者。术前收集预测变量（年龄、性别、吸烟状况、肥胖、糖尿病、抑郁、焦虑、术前疼痛持续时间、神经功能缺损、体力活动水平、活动受限、功能）和术后早期（术后行走时间、手术程序、单/多节段手术）。在术前和术后 6 个月测量结局变量（体力功能、腰背疼痛和腿痛严重程度）。使用逻辑回归分析确定 6 个月时结局显著改善的预测因素。
结果
接受更多术后第 1 周行走的参与者（N=233；50%为女性；年龄 61（SD=14）岁）在术后 6 个月时更有可能在 Oswestry 残疾问卷上有显著改善的功能（OR 1.18，95%CI 1.02-1.37），术前疼痛持续时间<12 个月（OR 2.71，95%CI 1.28-5.74）和术前功能较低的参与者（OR 4.02，95%CI 2.33-6.93）也是如此。年龄<65 岁（OR 2.36，95%CI 1.14-4.85）和<12 个月的术前疼痛（OR 3.52 95%CI 1.69-7.33）可预测 SF-36 体力成分综合量表的显著改善。在腿或腰背疼痛方面没有显著的改善预测因素。
结论
腰椎手术后一周内的行走时间是术后 6 个月功能显著改善的几个预测因素之一。需要进一步研究以确定旨在增加腰椎手术后早期行走的干预措施是否会改善功能的长期恢复。
试验注册
澳大利亚新西兰临床试验注册中心（ANZCTR），注册号 12616000747426。于 2016 年 6 月 7 日进行回顾性注册。
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