系统腰腹肌功能锻炼对经皮椎间孔镜靶向穿刺定位治疗 LDH 术后功能恢复的临床研究

目的：评价功能锻炼在腰椎间盘突出症（lumbar disc herniation，LDH）术后的时效性及对腰椎功能恢复的影响。方法：将纳入标准的 100 例患者随机分为治疗组和对照组各 50 例，治疗组在经皮椎间孔镜靶向穿刺定位治疗后给予系统腰腹肌功能锻炼，对照组给予直腿抬高练习和背伸肌适度锻炼，随访 1 年；分别于术前及术后１ d、3 月、6 月及 1 年采用VAS、ODI 评分和术后 1 年的腰背部不适例数、腰椎稳定性进行对比。结果：两组术后不同时间点腰痛、腿痛 VAS 评分、ODI 评分术均低于术前（P<0.05），两组术前、术后 1 d 腰痛、腿痛 VAS 评分、ODI 评分比较，差异均无统计学意义（P>0.05）；治疗组腰痛 VAS 评分术后 3 月 [(1.31±0.42) 分 vs (2.01±1.03) 分 ]、术后 6 月 [(0.67±0.32) 分 vs (1.58±0.74) 分 ]、术后 1 年 [(0.41±0.17) 分 vs (1.37±0.64) 分 ] 均低于对照组（P<0.05）；治疗组腿痛 VAS 评分术后 3 月 [(1.31±0.42) 分 vs (2.01±1.03) 分 ]、术后 6 月 [(0.67±0.32) 分 vs (1.58±0.74) 分 ]、术后 1 年 [(0.41±0.17) 分 vs (1.37±0.64) 分 ] 均低于对照组（P<0.05）；治疗组 ODI 评分术后 3 月 [(10.14±1.07) 分 vs (12.33±1.28) 分]、6 月 [(8.21±0.14) 分 vs (10.34±0.75)分 ]、1 年 [(7.92±0.05) 分 vs (9.28±0.42) 分 ] 均低于对照组（P<0.05）。术后 1 年，两组腰椎曲度、前凸指数、骶骨倾斜角方面与术前比较差异均有统计学意义（P<0.05）；治疗组术后 1 年前凸指数 [(2.52±0.27) cm vs (2.32±0.58) cm]、骶骨倾斜角 [(31.08±4.81)° vs (28.19±3.05)° ] 均高于对照组（P<0.05）。两组术后 1 年腰腿部不适阳性率比较，P<0.05。结论：经皮椎间孔镜靶向穿刺定位治疗 LDH 术后给予系统腰腹肌功能锻炼，可明显缓解疼痛不适，维持腰椎的稳定性，降低复发率，且症状随系统功能锻炼次数的增加改善越明显。

Application of Functional Exercise after Lumbar Disc Herniation Surgery

Objective To evaluate the timeliness of functional exercise after LDH surgery and its effect on lumbar function recovery. Methods Totally 100 patients accorded with the inclusion criteria were selected and randomly divided into treatment group and control group (n = 50 ). The patients in treatment group were given system lumbar dorsal and abdominal muscle function exercise after targeted percutaneous transforaminal endoscopic discectomy, and the patients in control group were given straight leg lift exercise and extensor moderate exercise after targeted percutaneous transforaminal endoscopic discectomy, follow-up of one year; the VAS and ODI scores were used for the ?rst day, 3 months, 6 months and 1 year after surgery. The number of lumbar back discomfort and lumbar stability were compared and analyzed after 1 year of operation. Results The VAS and ODI scores of the lumbar pain and leg pain were lower in both groups than before (P < 0 . 05). There was no statistically signi?cant difference between the two groups before and after 1 d of lumbar pain and leg pain VAS and ODI scores (P>0.05). The VAS score of lumbar pain in the treatment group was lower than that in the control group after 3 months [(1.31±0.42) vs (2.01±1.03)], 6 months [(0.67±0.32) vs (1.58±0.74)] and 1 year [(0.41±0.17) vs (1.37±0.64)] of operation (P<0.05). The VAS score of leg pain in the treatment group was lower than that in the control group at 3 months [(1. 31± 0.42) vs (2.01± 1. 03)], 6 months [(0.67± 0.32) vs (1.58±0. 74)] and 1 year [(0. 41± 0.17) vs (1.37±0. 64)] (P < 0. 05) after operation. The ODI score of the treatment group was lower than that of the control group at 3 months [( 10 . 14± 1 . 07 ) vs (12.33 ± 1 . 28 )], 6 months [( 8 . 21 ± 0 . 14 ) vs ( 10 . 34 ± 0 . 75 )] and 1 year [( 7 . 92 ± 0.05) vs (9.28 ± 0.42)] after operation (P < 0 . 05). After 1 year operation, the lumbar curvature, lordosis index and sacrum inclination angle of the two groups were significantly different from those before operation (P < 0 . 05 ). One year after operation, the lordosis index [(2.52±0.27) cm vs (2.32±0.58) cm], sacrum inclination angle [(31.08±4.81) ? vs (28.19±3.05)?] in the treatment group were all higher than those in the control group (P<0.05). There were statistically signi?cant differences compared with the control group in the anterior convex index and the oblique angle of the sacrum (P<0.05) of 1 year after operation. In the two groups, the positive rate of the lumbar leg was less than that after 1 year of surgery (P<0.05). Conclusion Targeted percutaneous transforaminal endoscopic discectomy for postoperative ef?cacy of LDH and the recovery of lumbar function can obviously alleviate the postoperative pain and discomfort, maintain the stability of the lumbar vertebra, reduce the recurrence rate, and the symptoms improve with the increase of the number of exercise times of the system.