腰椎间盘突出症患者术后康复的研究进展

doi:10.3969/j.issn.1006-9771.2019.04.007

摘要/Abstract

摘要： 腰椎间盘突出症是引起慢性腰腿痛的重要原因之一。手术治疗腰椎间盘突出症取得良好疗效，但依旧存在术后疼痛、功能障碍等问题。术后康复训练能够有效缓解疼痛，改善患者的功能状态及心理状态。虽然其有效性得到证实，但何为最佳的康复训练模式依旧存在争论，包括康复时机、康复地点、康复的频率和强度以及康复方式的选择等。最佳的术后康复模式仍有待进一步研究，同时患者的心理因素亦需重视。

关键词: 腰椎间盘突出症, 术后康复, 康复模式, 心理因素, 综述

Abstract: Lumbar disc herniation is an important cause of chronic low back pain, for which surgery has a great effect. However, there remain some residual symptoms, such as pain, disability, etc. It's effective for postoperative rehabilitation to relieve pain, and improve the disability and psychological status. However, the optimal rehabilitation program is controversial. So it's necessary to consider various aspects including time, site, frequency, intensity and pattern for an optimal rehabilitation choice, which needs further study. Psychological factors shall be concerned by medical workers as well.

Key words: lumbar disc herniation, postoperative rehabilitation, rehabilitation program, psychological factor, review

中图分类号:

R681.5

王银浩, 王翠. 腰椎间盘突出症患者术后康复的研究进展[J]. 《中国康复理论与实践》, 2019, 25(4): 401-406.

WANG Yin-hao, WANG Cui. Advance in Rehabilitation after Lumber Disc Surgery (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2019, 25(4): 401-406.

参考文献

[1] DavisR A. A long-term outcome analysis of 984 surgically treated herniated lumbar discs [J]. J Neurosurg, 1994, 80(3): 415-421.
[2] StromqvistF, StromqvistB, JonssonB, et al. Gender differences in patients scheduled for lumbar disc herniation surgery: a national register study including 15,631 operations [J]. Eur Spine J, 2016, 25(1): 162-167.
[3] StromqvistF, StromqvistB, JonssonB, et al. Lumbar disc herniation surgery in children: outcome and gender differences [J]. Eur Spine J, 2016, 25(2): 657-663.
[4] ArmaghaniS J, ArcherK R, RolfeR, et al. Diabetes is related to worse patient-reported outcomes at two years following spine surgery [J]. J Bone Joint Surg Am, 2016, 98(1): 15-22.
[5] RihnJ A, HilibrandA S, RadcliffK, et al. Duration of symptoms resulting from lumbar disc herniation: effect on treatment outcomes: analysis of the Spine Patient Outcomes Research Trial (SPORT) [J]. J Bone Joint Surg Am, 2011, 93(20): 1906-1914.
[6] AlviM A, KerezoudisP, WahoodW, et al. Operative approaches for lumbar disc herniation: a systematic review and multiple treatment meta-analysis of conventional and minimally invasive surgeries [J]. World Neurosurg, 2018, 114: 391-407.
[7] OosterhuisT, CostaL O, MaherC G, et al. Rehabilitation after lumbar disc surgery [J]. Cochrane Database Syst Rev, 2014(3): D3007.
[8] JuS, ParkG, KimE. Effects of an exercise treatment program on lumbar extensor muscle strength and pain of rehabilitation patients recovering from lumbar disc herniation surgery [J]. J Phys Ther Sci, 2012, 24(6): 515-518.
[9] DolanP, GreenfieldK, NelsonR J, et al. Can exercise therapy improve the outcome of microdiscectomy? [J]. Spine (Phila Pa1976), 2000, 25(12): 1523-1532.
[10] ErdogmusC B, ReschK L, SabitzerR, et al. Physiotherapy-based rehabilitation following disc herniation operation: results of a randomized clinical trial [J]. Spine (Phila Pa1976), 2007, 32(19): 2041-2049.
[11] FilizM, CakmakA, OzcanE. The effectiveness of exercise programmes after lumbar disc surgery: a randomized controlled study [J]. Clin Rehabil, 2005, 19(1): 4-11.
[12] YilmazF, YilmazA, MerdolF, et al. Efficacy of dynamic lumbar stabilization exercise in lumbar microdiscectomy [J]. J Rehabil Med, 2003, 35(4): 163-167.
[13] OzkaraG O, OzgenM, OzkaraE, et al. Effectiveness of physical therapy and rehabilitation programs starting immediately after lumbar disc surgery [J]. Turk Neurosurg, 2015, 25(3): 372-379.
[14] Kjellby-WendtG, StyfJ. Early active training after lumbar discectomy. A prospective, randomized, and controlled study [J]. Spine (Phila Pa1976), 1998, 23(21): 2345-2351.
[15] Kjellby-WendtG, StyfJ, CarlssonS G. Early active rehabilitation after surgery for lumbar disc herniation: a prospective, randomized study of psychometric assessment in 50 patients [J]. Acta Orthop Scand, 2001, 72(5): 518-524.
[16] OsteloR W, CostaL O, MaherC G, et al. Rehabilitation after lumbar disc surgery: an update Cochrane review [J]. Spine (Phila Pa1976), 2009, 34(17): 1839-1848.
[17] ChoiG, RaiturkerP P, KimM J, et al. The effect of early isolated lumbar extension exercise program for patients with herniated disc undergoing lumbar discectomy [J]. Neurosurgery, 2005, 57(4): 764-772.
[18] ZhangR, ZhangS J, WangX J. Postoperative functional exercise for patients who underwent percutaneous transforaminal endoscopic discectomy for lumbar disc herniation [J]. Eur Rev Med Pharmacol Sci, 2018, 22(1 Suppl): 15-22.
[19] Santana-RiosJ S, Chivez-AriasD D, Coronado-ZarcoR, et al. [Postoperative treatment for lumbar disc herniation during rehabilitation. Systematic review] [J]. [in Spanish]. Acta Ortop Mex, 2014, 28(2): 113-124.
[20] NewsomeR J, MayS, ChivertonN, et al. A prospective, randomised trial of immediate exercise following lumbar microdiscectomy: a preliminary study [J]. Physiotherapy, 2009, 95(4): 273-279.
[21] OosterhuisT, OsteloR W, van DongenJ M, et al. Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation [J]. J Physiother, 2017, 63(3): 144-153.
[22] OestergaardL G, ChristensenF B, NielsenC V, et al. Early versus late initiation of rehabilitation after lumbar spinal fusion: economic evaluation alongside a randomized controlled trial [J]. Spine (Phila Pa1976), 2013, 38(23): 1979-1985.
[23] LobnerM, LuppaM, KonnopkaA, et al. Inpatient or outpatient rehabilitation after herniated disc surgery? - Setting-specific preferences, participation and outcome of rehabilitation [J]. PLoS One, 2014, 9(3): e89200.
[24] LobnerM, SteinJ, LuppaM, et al. Choosing the right rehabilitation setting after herniated disc surgery: Motives, motivations and expectations from the patients' perspective [J]. PLoS One, 2017, 12(8): e0183698.
[25] JohanssonA C, LintonS J, BergkvistL, et al. Clinic-based training in comparison to home-based training after first-time lumbar disc surgery: a randomised controlled trial [J]. Eur Spine J, 2009, 18(3): 398-409.
[26] KimB J, AhnJ, ChoH, et al. Early individualised manipulative rehabilitation following lumbar open laser microdiscectomy improves early post-operative functional disability: a randomized, controlled pilot study [J]. J Back Musculoskelet Rehabil, 2016, 29(1): 23-29.
[27] JohannsenF, RemvigL, KrygerP, et al. Supervised endurance exercise training compared to home training after first lumbar diskectomy: a clinical trial [J]. Clin Exp Rheumatol, 1994, 12(6): 609-614.
[28] GravesJ E, PollockM L, FosterD, et al. Effect of training frequency and specificity on isometric lumbar extension strength [J]. Spine (Phila Pa1976), 1990, 15(6): 504-509.
[29] RainvilleJ, JouveC A, HartiganC, et al. Comparison of short- and long-term outcomes for aggressive spine rehabilitation delivered two versus three times per week [J]. Spine J, 2002, 2(6): 402-407.
[30] TucciJ T, CarpenterD M, PollockM L, et al. Effect of reduced frequency of training and detraining on lumbar extension strength [J]. Spine (Phila Pa1976), 1992, 17(12): 1497-1501.
[31] KimY S, ParkJ, HsuJ, et al. Effects of training frequency on lumbar extension strength in patients recovering from lumbar dyscectomy [J]. J Rehabil Med, 2010, 42(9): 839-845.
[32] HartsC C, HelmhoutP H, de BieR A, et al. A high-intensity lumbar extensor strengthening program is little better than a low-intensity program or a waiting list control group for chronic low back pain: a randomised clinical trial [J]. Aust J Physiother, 2008, 54(1): 23-31.
[33] ZidanN, SimsC, FennJ, et al. A randomized, blinded, prospective clinical trial of postoperative rehabilitation in dogs after surgical decompression of acute thoracolumbar intervertebral disc herniation [J]. J Vet Intern Med, 2018, 32(3): 1133-1144.
[34] LimkeJ C, RainvilleJ, PenaE, et al. Randomized trial comparing the effects of one set vs two sets of resistance exercises for outpatients with chronic low back pain and leg pain [J]. Eur J Phys Rehabil Med, 2008, 44(4): 399-405.
[35] GreenwoodJ, McGregorA, JonesF, et al. Rehabilitation following lumbar fusion surgery: a systematic review and meta-analysis [J]. Spine (Phila Pa1976), 2016, 41(1): E28-E36.
[36] McGregorA H, DoreC J, MorrisT P, et al. ISSLS prize winner: Function After Spinal Treatment, Exercise, and Rehabilitation (FASTER): a factorial randomized trial to determine whether the functional outcome of spinal surgery can be improved [J]. Spine (Phila Pa1976), 2011, 36(21): 1711-1720.
[37] HebertJ J, FritzJ M, ThackerayA, et al. Early multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle function [J]. Br J Sports Med, 2015, 49(2): 100-106.
[38] ScrimshawS V, MaherC G. Randomized controlled trial of neural mobilization after spinal surgery [J]. Spine (Phila Pa1976), 2001, 26(24): 2647-2652.
[39] MannicheC, AsmussenK, LauritsenB, et al. Intensive dynamic back exercises with or without hyperextension in chronic back pain after surgery for lumbar disc protrusion. A clinical trial [J]. Spine (Phila Pa1976), 1993, 18(5): 560-567.
[40] HakkinenA, YlinenJ, KautiainenH, et al. Effects of home strength training and stretching versus stretching alone after lumbar disk surgery: a randomized study with a 1-year follow-up [J]. Arch Phys Med Rehabil, 2005, 86(5): 865-870.
[41] Gencay-CanA, GunendiZ, SuleymanC S, et al. The effects of early aerobic exercise after single-level lumbar microdiscectomy: a prospective, controlled trial [J]. Eur J Phys Rehabil Med, 2010, 46(4): 489-496.
[42] HwangR, LambrechtsS, LiuH, et al. Decisional conflict among patients considering treatment options for lumbar herniated disc [J]. World Neurosurg, 2018, 116: e680-e690.
[43] LurieJ D, HendersonE R, McDonoughC M, et al. Effect of expectations on treatment outcome for lumbar intervertebral disc herniation [J]. Spine (Phila Pa1976), 2016, 41(9): 803-809.
[44] JohanssonA C, OhrvikJ, SoderlundA. Associations among pain, disability and psychosocial factors and the predictive value of expectations on returning to work in patients who undergo lumbar disc surgery [J]. Eur Spine J, 2016, 25(1): 296-303.
[45] Engel-YegerB, KerenA, BerkovichY, et al. The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation [J]. Disabil Rehabil, 2018, 40(3): 302-308.
[46] DorowM, LobnerM, SteinJ, et al. The course of pain intensity in patients undergoing herniated disc surgery: a 5-year longitudinal observational study [J]. PLoS One, 2016, 11(5): e156647.
[47] GrovleL, HaugenA J, KellerA, et al. Prognostic factors for return to work in patients with sciatica [J]. Spine J, 2013, 13(12): 1849-1857.
[48] KuligK, BeneckG J, SelkowitzD M, et al. An intensive, progressive exercise program reduces disability and improves functional performance in patients after single-level lumbar microdiskectomy [J]. Phys Ther, 2009, 89(11): 1145-1157.
[49] KimY S, ParkJ, ShimJ K. Effects of aquatic backward locomotion exercise and progressive resistance exercise on lumbar extension strength in patients who have undergone lumbar diskectomy [J]. Arch Phys Med Rehabil, 2010, 91(2): 208-214.
[50] EbenbichlerG R, InschlagS, PflugerV, et al. Twelve-year follow-up of a randomized controlled trial of comprehensive physiotherapy following disc herniation operation [J]. Clin Rehabil, 2015, 29(6): 548-560.
[51] OosterhuisT, van TulderM, PeulW, et al. Effectiveness and cost-effectiveness of rehabilitation after lumbar disc surgery (REALISE): design of a randomised controlled trial [J]. BMC Musculoskelet Disord, 2013, 14: 124.
[52] DalagerT, BredahlT G, PedersenM T, et al. Does training frequency and supervision affect compliance, performance and muscular health? A cluster randomized controlled trial [J]. Man Ther, 2015, 20(5): 657-665.
[53] StromqvistF, StromqvistB, JonssonB, et al. Predictive outcome factors in the young patient treated with lumbar disc herniation surgery [J]. J Neurosurg Spine, 2016, 25(4): 448-455.
[54] WongJ J, CoteP, SuttonD A, et al. Clinical practice guidelines for the noninvasive management of low back pain: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration [J]. Eur J Pain, 2017, 21(2): 201-216.