中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (9): 1398-1403.doi: 10.3969/j.issn.2095-4344.4008

• 脊柱植入物Spinal implants • 上一篇    下一篇

基于McKenzie技术的腰椎运动链训练应用于腰椎间孔镜术后分期康复的前瞻性研究

吕  振1,2,3,白金柱1,2,3   

  1. 1中国康复研究中心北京博爱医院脊柱外科,北京市   100068;2首都医科大学康复医学院,北京市   100068;3首都医科大学骨外科学系,北京市   100070
  • 收稿日期:2020-05-23 修回日期:2020-05-27 接受日期:2020-06-19 出版日期:2021-03-28 发布日期:2020-12-15
  • 通讯作者: 白金柱,主任医师,中国康复研究中心北京博爱医院脊柱外科,北京市 100068;首都医科大学康复医学院,北京市100068;首都医科大学骨外科学系,北京市 100070
  • 作者简介:吕振,男,1980年生,山东省淄博市人,汉族,2008年首都医科大学毕业,博士,主治医师,主要从事脊柱脊髓外科与康复研究。
  • 基金资助:
    北京市丰台区卫生健康系统科研项目(2019-117)

A prospective study on the application of staged lumbar motion chain rehabilitation based on McKenzie’s technique after lumbar percutaneous transforaminal endoscopic discectomy

Lü Zhen1, 2, 3, Bai Jinzhu1, 2, 3   

  1. 1Department of Spinal Surgery, Beijing Bo’ai Hospital of China Rehabilitation Research Center, Beijing 100068, China; 2School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China; 3Department of Orthopedics, Capital Medical University, Beijing 100070, China
  • Received:2020-05-23 Revised:2020-05-27 Accepted:2020-06-19 Online:2021-03-28 Published:2020-12-15
  • Contact: Bai Jinzhu, Chief physician, Department of Spinal Surgery, Beijing Bo'ai Hospital of China Rehabilitation Research Center, Beijing 100068, China; School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China; Department of Orthopedics, Capital Medical University, Beijing 100070, China
  • About author:Lü Zhen, MD, Attending physician, Department of Spinal Surgery, Beijing Bo'ai Hospital of China Rehabilitation Research Center, Beijing 100068, China; School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China; Department of Orthopedics, Capital Medical University, Beijing 100070, China
  • Supported by:
    the Scientific Research Project of Health System in Fengtai District of Beijing, No. 2019-117

摘要:

文题释义:
腰椎运动链训练:人体核心通过全身运动链的相互协同来产生力量,并对抗异常力量实现动力性稳定。有效的核心力量是保持功能性运动链的最佳运动学表现的关键,并提供整个运动链的神经肌肉高效率和下肢运动的近端稳定性。腰椎间盘突出症椎间孔镜手术,摘除突出髓核,同时会对腰椎小关节和黄韧带进行必要的成形操作,不可避免会导致整体运动链的运动学改变和对抗异常外力的能力下降,所以引入腰椎运动链训练,以提高腰椎间盘突出症微创术后疗效,预防复发。
McKenzie技术:该技术治疗腰痛的基本原则是通过特殊姿势训练和(或)动作指导使脊柱各关节回到中立位,使椎间盘回到椎间隙的中央位置,避免使椎间盘向边缘移动的运动或姿势。该技术首先帮助患者获得脊柱中立位的本体感觉,然后再恢复伴有运动范围受限的肢体活动。腰椎间盘突出症微创术后解除了神经根的机械性压迫,而对于腰椎退变导致的软组织源性腰痛尚无直接作用,残余间盘结构需要修复和再稳定,为预防突出复发,重建脊柱中立位姿态,在术后康复中引入McKenzie技术。

背景:腰椎间孔镜手术解除了腰椎间盘突出所致的神经根压迫,而术后康复不仅包括手术创伤的康复,还应包括腰椎间盘突出症伴随的腰肌损害和骨盆下肢功能失衡的康复。
目的:将基于McKenzie技术的腰椎运动链训练应用于椎间孔镜术后分期康复,评估该康复方案的有效性和可行性。
方法:选择中国康复研究中心北京博爱医院2012年1月至2018年12月收治的腰椎间盘突出症患者62例,均接受侧路椎间孔镜治疗,术后利用随机数字表法分为试验组与对照组,每组31例。试验组术后根据预设康复方案进行基于McKenzie技术的腰椎运动链远程分期康复指导,一期术后2-6周、二期术后7-12周,三期术后13-24周;对照组进行常规的腰椎术后康复指导。术后康复前及康复训练6,12,24周,评估两组腰痛目测类比评分、日本骨科协会下腰痛JOA评分、Oswestry功能障碍指数评分、SF-36健康调查简表评分;康复训练12周,利用MRI扫描检测腰椎多裂肌横截面积;康复训练24周,利用三维运动采集与分析系统进行步态分析。研究通过中国康复研究中心北京博爱医院伦理委员会审查,审批号(2019-011-1)。
结果与结论:①康复训练后,两组的腰痛目测类比评分、Oswestry功能障碍指数评分、JOA评分、SF-36评分均较康复前有不同程度的改善;试验组康复训练6,12周的目测类比评分、Oswestry功能障碍指数评分低于对照组(P < 0.05),康复训练6周的JOA评分高于对照组     (P < 0.05),康复训练6,12,24周的SF-36评分高于对照组(P < 0.05);②两组腰椎多裂肌横截面积比较差异无显著性意义(P > 0.05);③步态分析显示,试验组康复训练24周的支撑相左右侧比值大于对照组(P < 0.05);④结果表明,腰椎间盘突出症椎间孔镜术后分期康复方案符合该疾病术后恢复特点,具有良好的有效性和可行性。
https://orcid.org/0000-0002-4259-9635 (吕振) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 骨, 腰椎间孔镜, 腰椎间盘突出症, 康复, 多裂肌, 步态异常, 骨盆功能, 腰痛, 麦肯基技术

Abstract: BACKGROUND: Lumbar percutaneous transforaminal endoscopic discectomy can decompress nerve root compression caused by herniated lumbar disc. Postoperative rehabilitation not only includes the recovery of surgical trauma, but also the recovery of lumbar muscle damage accompanied by lumbar disc herniation and the recovery of pelvic-leg function imbalance. 
OBJECTIVE: To evaluate the effectiveness and feasibility of staged rehabilitation program of lumbar motor chain based on McKenzie’s technique after lumbar percutaneous transforaminal endoscopic discectomy.
METHODS: Totally sixty-two patients with lumbar disc herniation who were treated in the Beijing Bo’ai Hospital of China Rehabilitation Research Center from January 2012 to December 2018 underwent percutaneous transforaminal endoscopic discectomy. The patients were randomly divided into experimental group and control group, 31 cases in each group. The experimental group performed remote staged rehabilitation guidance based on McKenzie’s technology according to pre-set rehabilitation program for postoperative rehabilitation of lumbar motion chain: 2-6 weeks after operation as the first stage, 7-12 weeks as the second stage and 13-24 weeks as the third stage. Control group received regular postoperative rehabilitation. Visual analogue scale score, Japanese Orthopaedic Association score, Oswestry Disability Index, and SF-36 score were assessed in both groups pre-rehabilitation and 6, 12, and 24 weeks post-rehabilitation. Cross sectional area of the multifidus of the lumbar spine was detected under MRI 12 weeks post-rehabilitation. Gait analysis was conducted 24 weeks post-rehabilitation by using three-dimensional motion acquisition and analysis system. This study was approved by the Ethics Committee of Beijing Bo’ai Hospital of China Rehabilitation Research Center (approval No. 2019-011-1). 
RESULTS AND CONCLUSION: (1) After rehabilitation, visual analogue scale score, Japanese Orthopaedic Association score, Oswestry Disability Index, and SF-36 score were improved to different degrees in both groups compared with those before rehabilitation. Visual analogue scale score and Oswestry Disability Index were lower in the experimental group than those in the control group at 6 and 12 weeks (P < 0.05). Japanese Orthopaedic Association score was higher in the experimental group than in the control group at 6 weeks (P < 0.05). At 6, 12, and 24 weeks, SF-36 score was higher in the experimental group than that in the control group (P < 0.05). (2) No significant difference in cross sectional area of the multifidus of the lumbar spine was found between the two groups (P > 0.05). (3) Gait analysis exhibited that the ratio of left to right in the supporting phase of the experimental group was higher than that of the control group at 24 weeks         (P < 0.05). (4) Results suggest that the staged rehabilitation program after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation is in line with the characteristics of postoperative recovery of lumbar disc herniation, and has good effectiveness and feasibility.

Key words: bone, percutaneous transforaminal endoscopic discectomy, lumbar disc herniation, rehabilitation, multifidus muscle, gait abnormality, pelvic function, low back pain, McKenzie’s technique

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