Lyu Zhen, Bai Jinzhu, Chen Shizheng, Liu Jiesheng, Yu Wenlong
Department of Spine and Spinal Cord Surgery, Beijing Bo'ai Hospital, Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, 10th JiaoMen North Road, Fengtai District, Beijing, China.
Department of Physical Therapy, Beijing Bo'ai Hospital,China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China.
BMC Musculoskelet Disord. 2021 Sep 15;22(1):793. doi: 10.1186/s12891-021-04674-y.
Percutaneous endoscopic lumbar discectomy (PELD) is a promising minimally invasive treatment for lumbar disc herniation (LDH). Postoperative rehabilitation can improve patient outcomes. Not only rehabilitation for surgical trauma but also rehabilitation for lumbar spine and lower kinetic chain dysfunction should be performed. The aims of this study were to investigate the efficacy of a lumbar kinetic chain training for staged rehabilitation after PELD for LDH.
Fifty one LDH patients treated with PELD were studied. After surgery, patients underwent lumbar kinetic chain training for staged rehabilitation( staged group) or regular low back rehabilitation (regular group). The staged rehabilitation programme included three phases from 2 to 6, 7-12, and 13-24 weeks postoperatively, and different physical therapies were performed during these phases. The low back pain visual analogue scale (VAS), JOA score, ODI, SF-36, and cross-sectional area of the lumbar multifidus on MRI were assessed, and gait analysis was performed.
Twenty five patients in staged group and twenty six patients in regular group were included. There were no significant differences in age or sex between the two groups at baseline (p > 0.05). The VAS score decreased and the JOA and SF-36 scores increased in both groups from baseline to 6 weeks (P < 0.05). In the staged group, compared with the regular group, the VAS and ODI scores were lower and the JOA and SF-36 scores were higher at 6 weeks (P < 0.05); the VAS and ODI scores were lower and the SF-36 score was higher at 12 weeks (P < 0.05); the SF-36 score was higher at 24 weeks (P < 0.05); the cross-sectional area of the lumbar multifidus showed no differences at 12 weeks (P > 0.05); and the left-right support ratio of gait was higher at 24 weeks (P < 0.05).
The staged rehabilitation programme for LDH after PELD promoted postoperative recovery, and the efficacy of lumbar kinetic chain training was higher than that of regular low back muscle exercise.
经皮内镜下腰椎间盘切除术（PELD）是一种有前景的腰椎间盘突出症（LDH）微创治疗方法。术后康复可改善患者预后。不仅要进行手术创伤的康复，还应进行腰椎和下肢运动链功能障碍的康复。本研究的目的是探讨腰椎运动链训练对PELD治疗LDH后分阶段康复的疗效。
对51例行PELD治疗的LDH患者进行研究。术后，患者接受分阶段康复的腰椎运动链训练（分阶段组）或常规的下背部康复（常规组）。分阶段康复计划包括术后2至6周、7至12周和13至24周三个阶段，在这些阶段进行不同的物理治疗。评估腰痛视觉模拟量表（VAS）、日本骨科协会（JOA）评分、Oswestry功能障碍指数（ODI）、简明健康状况调查量表（SF-36）以及MRI上腰大肌的横截面积，并进行步态分析。
分阶段组纳入25例患者，常规组纳入26例患者。两组在基线时的年龄和性别无显著差异（p>0.05）。两组从基线到6周时VAS评分均降低，JOA和SF-36评分均升高（P<0.05）。在分阶段组中，与常规组相比，6周时VAS和ODI评分更低，JOA和SF-36评分更高（P<0.05）；12周时VAS和ODI评分更低，SF-36评分更高（P<0.05）；24周时SF-36评分更高（P<0.05）；12周时腰大肌横截面积无差异（P>0.05）；24周时步态的左右支撑比更高（P<0.05）。
PELD治疗LDH后的分阶段康复计划促进了术后恢复，且腰椎运动链训练的疗效高于常规的下背部肌肉锻炼。
