| 腰椎退行性疾病术后不同康复模式的临床疗效分析 |
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Received:June 19, 2020
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| 作者 | Author | 单位 | Unit | E-Mail |
| 石秀秀 |
SHI Xiu-xiu |
解放军总医院第四医学中心, 北京 100048 |
The Fourth Medical Center of PLA General Hospital, Beijing 100048, China |
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| 许王莉 |
XU Wang-li |
中国人民大学, 北京 100872 |
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| 秦江 |
QIN Jiang |
解放军总医院第四医学中心, 北京 100048 |
The Fourth Medical Center of PLA General Hospital, Beijing 100048, China |
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| 孙海燕 |
SUN Hai-yan |
解放军总医院第四医学中心, 北京 100048 |
The Fourth Medical Center of PLA General Hospital, Beijing 100048, China |
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| 胡鸢 |
HU Yuan |
解放军总医院第四医学中心, 北京 100048 |
The Fourth Medical Center of PLA General Hospital, Beijing 100048, China |
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| 唐金树 |
TANG Jin-shu |
解放军总医院第四医学中心, 北京 100048 |
The Fourth Medical Center of PLA General Hospital, Beijing 100048, China |
drtang304@126.com |
| 吴金玲 |
WU Jin-ling |
解放军总医院第四医学中心, 北京 100048 |
The Fourth Medical Center of PLA General Hospital, Beijing 100048, China |
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| 朱家亮 |
ZHU Jia-liang |
解放军总医院第四医学中心, 北京 100048 |
The Fourth Medical Center of PLA General Hospital, Beijing 100048, China |
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| 侯树勋 |
HOU Shu-xun |
解放军总医院第四医学中心, 北京 100048 |
The Fourth Medical Center of PLA General Hospital, Beijing 100048, China |
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| 吴新宝 |
WU Xin-bao |
北京积水潭医院, 北京 100035 |
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| 周谋望 |
ZHOU Mou-wang |
北京大学第三医院, 北京 100083 |
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| 王宁华 |
WANG Ning-hua |
北京大学第一医院, 北京 100034 |
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| 谢欲晓 |
XIE Yu-xiao |
中日友好医院, 北京 100029 |
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| 赵会 |
ZHAO Hui |
首都医科大学附属北京朝阳医院, 北京 100020 |
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| 顾新 |
GU Xin |
北京医院, 北京 100730 |
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| 陆明 |
LU Ming |
战略支援部队特色医学中心, 北京 100101 |
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| 李大伟 |
LI Da-wei |
解放军总医院第八医学中心, 北京 100091 |
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| 期刊信息：《中国骨伤》2021年34卷，第5期，第406-416页 |
| DOI：10.12200/j.issn.1003-0034.2021.05.004 |
| 基金项目:北京市科技计划项目（编号：D13110700490000）；北京市科技计划课题（编号：D131100004913003） |
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目的： 比较腰椎退行性疾病术后不同康复模式的临床疗效差异，探讨康复模式及其他因素对术后疗效的影响。
方法： 前瞻性分析2013年6月至2016年7月治疗的900例就诊于北京9家三级甲等医院因腰椎退行性疾病行单节段植骨融合内固定手术的患者，其中男428例，女472例；年龄>18岁，平均（51.42±12.41）岁；根据患者主观意愿和实际居住地情况分为观察组1、观察组2及对照组共3组。观察组1给予骨科康复一体化康复模式，观察组2给予骨科康复一体化加分级康复模式，对照组给予常规康复模式。运用视觉模拟评分（visual analogue scale，VAS），Oswestry功能障碍指数（Oswestry Disability Index，ODI），日本骨科学会（Japanese Orthopaedic Association，JOA）评分系统评估术后24周的临床疗效。将可能影响术后疗效的因素：年龄，年龄分组，性别，身体质量指数（body mass index，BMI），BMI分组，文化程度，就诊医院，医疗费用支付方式，术前合并症，术前JOA评分，临床诊断，手术节段，手术术式，术中出血量，术后并发症及康复模式作为自变量，以术后24周ODI评分作为因变量，进行单因素分析影响因素和术后疗效的关系。采用多元线性回归分析影响因素、康复模式与术后24周ODI评分之间的关系，找出影响术后疗效的主要原因，分析康复模式对术后疗效的影响程度。
结果： 所有患者完成24周随访，术后切口均Ⅰ期愈合，内固定稳定。（1）疗效评价：①术前3组VAS和ODI评分比较差异无统计学意义（P>0.05）；术后疼痛、功能障碍均降低，术后24周3组比较差异有统计学意义（P<0.05），观察组1、2组比较差异无统计学意义（P>0.05），观察组1和对照组、观察组2和对照组比较差异有统计学意义（P<0.05）。②JOA评分术后3组功能不同程度提高。术前、术后24周3组比较差异有统计学意义（P<0.05）。术前、术后24周观察组1和观察组2比较差异均无统计学意义（P>0.05），观察组1和对照组、观察组2和对照组比较差异均有统计学意义（P<0.05）。（2）术后24周疗效影响因素分析：①单因素结果显示性别、年龄、年龄分组、文化程度、术前合并症、临床诊断、手术节段、手术术式、术前JOA评分及康复模式与术后疗效有显著相关性（P<0.05）；BMI、BMI分组、医疗费用支付方式、就诊医院、术中出血量、术后并发症与术后疗效无显著相关性（P>0.05）。②多因素结果显示性别、康复模式、年龄、术前JOA评分最终进入方程，逐步多元线性方程有统计学意义（F=12.294，P=0.000）。其中康复模式中骨科康复一体化加分级康复模式的标准化回归系数绝对值最大（0.176），对术后疗效影响最大。采用常规康复模式较其他两种康复模式术后功能障碍程度更高，男性比女性术后功能障碍程度更高，年龄越大术后功能障碍程度越高，术前JOA总分越低的患者术后功能障碍程度越高。
结论： 术前JOA评分、性别、年龄可不同程度预测行单节段植骨融合内固定手术的腰椎退行性疾病患者术后疗效。采用不同康复模式均可提高该类患者术后疗效，骨科康复一体化康复模式和骨科康复一体化加分级康复模式对改善术后功能和缓解疼痛方面均优于常规康复模式，值得在临床中推广应用。 |
| [关键词]:腰椎 椎间盘退行性病变 康复 |
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| Clinical efficacy of different rehabilitation modes for lumbar degenerative diseases after operation |
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Abstract:
Objective: To compare clinical effects of different postoperative rehabilitation modes on lumbar degenerative diseases, and explore influence of rehabilitation mode and other factors on postoperative effect.
Methods: From June 2013 to July 2016, totally 900 patients were admitted from nine tertiary hospitals in Beijing to perform single segment bone grafting and internal fixation due to lumbar degenerative diseases were prospectively analyzed. There were 428 males and 472 females, the age of patient over 18 years old, with an average of (51.42±12.41) years old;according to patients' subjective wishes and actual residence conditions, all patients were divided into three groups, named as observation group 1(performed integrated rehabilitation approach and orthopedic treatment model intervention), observation group 2(performed integrated rehabilitation approach and orthopedic treatment, classified rehabilitation model intervention), and control group(performed routine rehabilitation model intervention). Visual analogue scale(VAS), Oswestry Disability Index(ODI) and Japanese Orthopaedic Association (JOA) were used to evaluate postoperative efficacy among three groups at 24 weeks. Possible factors affecting the postoperative efficacy including age, age grouping, gender, body mass index(BMI), BMI grouping, education level, visiting hospital, payment method of medical expenses, preoperative complications, preoperative JOA score, clinical diagnosis, surgery section, operative method, intraoperative bleeding volume, postoperative complications and rehabilitation mode were listed as independent variables, and postoperative ODI score at 24 weeks as dependent variables. Univariate analysis was used to analyze relationship between influencing factors and postoperative efficacy. Multiple linear regression was used to analyze relationship between influencing factors, rehabilitation mode and postoperative ODI score at 24 weeks, in further to find out the main reasons which affect postoperative efficacy, and to analyze impact of rehabilitation mode on postoperative efficacy.
Results: All patients were followed up for 24 weeks after operation. All incisions healed at stage I with stable internal fixation. (1) Evaluation of postoperative efficacy:① There were no statistical differences in preoperative VAS and ODI among three groups(P>0.05), the degree of pain and dysfunction decreased among three groups after operation, and had differences in postoperative VAS and ODI among three groups (P<0.05). There were no significant differences between observation group 1 and observation group 2 (P>0.05); while compared with observation group 1 and control group, observation group 2 and control group, there were significant differences (P<0.05). ②The function among three groups were improved in varying degrees after operation. There was difference in JOA score among three groups before operation and 24 weeks after operation (P<0.05). There were no difference in JOA score among three groups between observation group 1 and observation group 2 (P>0.05);while compared with observation group 1 and control group, observation group 2 and control group, there were significant differences (P<0.05). (2) nfluencing factors at 24 weeks after operation:①Univariate analysis showed gender, age, age grouping, education level, preoperative complications, clinical diagnosis, operative section, operative method, preoperative JOA score and rehabilitation mode had statistical significance with postoperative ODI score at 24 weeks (P<0.05). BMI, BMI grouping, payment method of medical expenses, visiting hospital, intraoperative bleeding volume, postoperative complications had no statistical significance with postoperative ODI score at 24 weeks (P<0.05).②Multivariate analysis results showed gender, rehabilitation mode, age, preoperative JOA score entered the equation eventually, stepwise multiple linear equation obtained had statistical significance(F=12.294, P=0.000). Among rehabilitation mode, standardized regression coefficient of the integrated rehabilitation approach and orthopedic treatment with classified rehabilitation model was absolute value of the largest (0.176), which had the greatest influence on postoperative curative effect. The degree of dysfunction in control group was higher than that in observation group 1 and observation group 2. Postoperative dysfunction was more severe in males than that of in females. Older age has higher degree of dysfunction after operation. Lower preoperative JOA score has higher degree of dysfunction after operation.
Conclusion: Preoperative JOA score, gender, age could predict postoperative clinical effects of lumbar degenerative diseases in varying degrees treated with single level bone graft fusion and internal fixation. Different rehabilitation modes could improve clinical effects. Intergrated rehabilitation orthopedic treatment model and integrated rehabilitation approach and orthopedic treatment with classified rehabilitation model are superior to conventional rehabilitation model in improving patients' postoperative function and relieving pain, which is worthy of promoting in clinical. |
| KEYWORDS:Lumar vertebrae Intervertebral disc degerneration Rehabilitation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 石秀秀,许王莉,秦江,孙海燕,胡鸢,唐金树,吴金玲,朱家亮,侯树勋,吴新宝,周谋望,王宁华,谢欲晓,赵会,顾新,陆明,李大伟.腰椎退行性疾病术后不同康复模式的临床疗效分析[J].中国骨伤,2021,34(5):406~416 |
| 英文格式: | SHI Xiu-xiu,XU Wang-li,QIN Jiang,SUN Hai-yan,HU Yuan,TANG Jin-shu,WU Jin-ling,ZHU Jia-liang,HOU Shu-xun,WU Xin-bao,ZHOU Mou-wang,WANG Ning-hua,XIE Yu-xiao,ZHAO Hui,GU Xin,LU Ming,LI Da-wei.Clinical efficacy of different rehabilitation modes for lumbar degenerative diseases after operation[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(5):406~416 |
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