Abstract:

Objective　To explore the effect of cluster intervention based on the concept of enhanced recovery after surgery (ERAS) in patients with kinesiophobia after lumbar fusion surgery. Methods　A total of 80 patients with kinesiophobia after lumbar fusion surgery treated in Zhuhai Branch of Guangdong Provincial Hospital of Chinese Medicine from September 2021 to January 2022 were selected for a prospective cohort study. They were divided into an observation group and a control group by the random number table method, with 40 cases in each group. There were 23 males and 17 females in the observation group, aged (61.65±12.17) years; there were 22 cases of lumbar spinal stenosis, 11 cases of lumbar spinal stenosis with nerve injury, 4 cases of lumbar disc herniation, 1 case of lumbar spondylolisthesis, and 2 other cases. There were 22 males and 18 females in the control group, aged (61.78±9.12) years; there were 22 cases of lumbar spinal stenosis, 7 cases of lumbar spinal stenosis with nerve injury, 6 cases of lumbar disc herniation, 3 cases of lumbar spondylolisthesis, and 2 other cases. The control group received routine intervention after lumbar fusion surgery, and the observation group received cluster intervention based on the ERAS concept for postoperative kinesiophobia based on the control group. The two groups were compared before and 1 week, 1 month, and 3 months after intervention in the scores of Tampa Scale for Kinesiophobia (TSK), General Self-Efficacy Scale (GSES), and Oswestry Disability Index (ODI) and the incidence of complications. t test and ANOVA for repeated measurement were used for the measurement data and χ² test was used for the count data. Results　At 1 week, 1 month, and 3 months after intervention, the TSK score of the observation group was lower than that of the control group [(37.95±3.90) points vs. (42.05±5.08) points, (31.90±4.05) points vs. (36.48±4.11) points, (27.15±2.95) points vs. (31.78±3.59) points], with statistically significant differences (t=4.046, 5.016, and 6.295, all P<0.001). At 1 week, 1 month, and 3 months after intervention, the ODI score of the observation group was lower than that of the control group [(41.93±4.75) points vs. (47.55±5.08) points, (29.23±4.69) points vs. (36.83±4.42) points, (23.08±3.41) points vs. (30.15±3.72) points], with statistically significant differences (t=5.115, 7.461, and 8.855, all P<0.001). At 1 week, 1 month, and 3 months after intervention, the GSES score of the observation group was higher than that of the control group [(23.50±3.46) points vs. (19.68±4.03) points, (29.33±3.08) points vs. (24.23±4.31) points, (33.25±1.81) points vs. (28.98±3.63) points], with statistically significant differences (t=4.558, 6.091, and 6.672, all P<0.001). Repeated measurement ANOVA showed that there were statistically significant differences between the two groups in the TSK, GSES, and ODI scores in grouping factors, time factors, and grouping×time interaction (all P<0.001). The incidence of postoperative complications in the observation group was 7.5% (3/40), lower than that in the control group [25.0% (10/40)], with a statistically significant difference (χ²=4.501, P<0.05). Conclusion　Cluster intervention based on the ERAS concept can effectively improve the self-efficacy in patients with kinesiophobia after lumbar fusion surgery, reduce the degree of kinesiophobia and the incidence of postoperative complications, and promote the patients recovery.

Key words:

Enhanced recovery after surgery, Cluster intervention, Lumbar fusion, Kinesiophobia

摘要：

目的　探讨基于加速康复外科（ERAS）理念的集束化干预在腰椎融合术后恐动症患者中的应用效果。方法　选择2021年9月至2022年1月广东省中医院珠海医院收治的80例腰椎融合术后恐动症患者进行前瞻性研究。采用随机数字表法分为观察组和对照组，各40例。观察组男23例，女17例，年龄（61.65±12.17）岁；腰椎管狭窄22例，腰椎管狭窄伴神经损伤11例，腰椎间盘突出4例，腰椎滑脱1例，其他2例。对照组男22例，女18例，年龄（61.78±9.12）岁；腰椎管狭窄22例，腰椎管狭窄伴神经损伤7例，腰椎间盘突出6例，腰椎滑脱3例，其他2例。对照组实施腰椎融合术后常规干预，观察组基于对照组进行基于ERAS理念的术后恐动症集束化干预。比较两组患者在干预前及干预后1周、1个月、3个月时的恐动症评分量表（TSK）评分、一般自我效能感量表（GSES）评分、Oswestry功能障碍指数（ODI）评分以及并发症发生率。采用t检验、重复测量方差分析、χ²检验。结果　干预后1周、1个月及3个月，观察组TSK评分均低于对照组［（37.95±3.90）分比（42.05±5.08）分，（31.90±4.05）分比（36.48±4.11）分，（27.15±2.95）分比（31.78±3.59）分］，差异均有统计学意义（t=4.046、5.016、6.295，均P<0.001）。干预后1周、1个月及3个月，观察组ODI评分均低于对照组［（41.93±4.75）分比（47.55±5.08）分，（29.23±4.69）分比（36.83±4.42）分，（23.08±3.41）分比（30.15±3.72）分］，差异均有统计学意义（t=5.115、7.461、8.855，均P<0.001）。干预后1周、1个月及3个月，观察组GSES评分均高于对照组［（23.50±3.46）分比（19.68±4.03）分，（29.33±3.08）分比（24.23±4.31）分，（33.25±1.81）分比（28.98±3.63）分］，差异均有统计学意义（t=4.558、6.091、6.672，均P<0.001）。重复测量方差分析显示，两组患者在TSK、GSES、ODI得分方面在分组因素、时间因素及分组×时间交互作用方面的差异均有统计学意义（均P<0.001）。观察组术后并发症发生率为7.5%（3/40），低于对照组的25.0%（10/40），差异有统计学意义（χ²=4.501，P<0.05）。结论　基于ERAS理念的集束化干预能够有效改善腰椎融合术后恐动症患者的自我效能，降低恐动程度及术后并发症发生率，促进患者的康复。

关键词:

加速康复外科, 集束化干预, 腰椎融合术, 恐动症