成人腰椎手术后的评估与康复
Evaluation and Rehabilitation after Adult Lumbar Spine Surgery.
作者信息
Sakaguchi Tomoyoshi, Gunjotikar Sharvari, Tanaka Masato, Komatsubara Tadashi, Latka Kajetan, Ekade Shashank J, Prabhu Shrinivas P, Takamatsu Kazuhiko, Yasuda Yosuke, Nakagawa Masami
机构信息
Department of Rehabilitation, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan.
Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan.
出版信息
J Clin Med. 2024 May 15;13(10):2915. doi: 10.3390/jcm13102915.
With an increase in the proportion of elderly patients, the global burden of spinal disease is on the rise. This is gradually expected to increase the number of surgical procedures all over the world in the near future. As we know, rehabilitation following spine surgery is critical for optimal recovery. However, the current literature lacks consensus regarding the appropriate post-operative rehabilitation protocol. The purpose of this review is to evaluate the optimal protocol for rehabilitation after lumbar spine surgery in adults. The goals of rehabilitation after lumbar spine surgery are to improve physical and psychosocial function and may include multiple modalities such as physical therapy, cognitive behavioral therapy, specialized instruments, and instructions to be followed during activities of daily living. In recent years, not only are a greater number of spine surgeries being performed, but various different techniques of lumbar spine surgery and spinal fusion have also emerged. (1) Our review summarizes post-operative rehabilitation under the following headings-1. Historical aspects, 2. Subjective functional outcomes, and (3) Actual rehabilitation measures, including balance. Physical therapy programs need to be patient-specific and surgery-specific, such that they consider patient-reported outcome measures and take into consideration the technique of spinal fusion used and the muscle groups involved in these surgeries. By doing so, it is possible to assess the level of functional impairment and then specifically target the strengthening of those muscle groups affected by surgery whilst also improving impaired balance and allowing a return to daily activities. Rehabilitation is a multi-faceted journey to restore mobility, function, and quality of life. The current rehabilitation practice focuses on muscle strengthening, but the importance of spinal balance is less elaborated. We thus equally emphasize muscle strengthening and balance improvement post-lumbar spine surgery.
随着老年患者比例的增加,脊柱疾病的全球负担正在上升。预计在不久的将来,这将逐渐增加全球范围内的手术数量。众所周知,脊柱手术后的康复对于最佳恢复至关重要。然而,目前的文献对于合适的术后康复方案缺乏共识。本综述的目的是评估成人腰椎手术后的最佳康复方案。腰椎手术后康复的目标是改善身体和心理社会功能,可能包括多种方式,如物理治疗、认知行为治疗、专用器械以及日常生活活动中应遵循的指导。近年来,不仅进行脊柱手术的数量增多,而且还出现了各种不同的腰椎手术和脊柱融合技术。(1)我们的综述在以下标题下总结术后康复:1. 历史方面,2. 主观功能结果,以及(3) 实际康复措施,包括平衡。物理治疗方案需要针对患者和手术制定,即要考虑患者报告的结果测量,并考虑所使用的脊柱融合技术以及这些手术中涉及的肌肉群。通过这样做,可以评估功能障碍的程度,然后专门针对受手术影响的那些肌肉群进行强化,同时改善受损的平衡并允许恢复日常活动。康复是恢复活动能力、功能和生活质量的多方面过程。目前的康复实践侧重于肌肉强化,但对脊柱平衡的重要性阐述较少。因此,我们同样强调腰椎手术后的肌肉强化和平衡改善。