Abstract:

Objective　To observe the impact of core muscle strength training based on the ERAS concept on improving the postoperative rehabilitation outcomes in patients with lumbar vertebral fracture. Methods　This was a prospective cohort study. From March 2020 to February 2022, 100 patients with lumbar vertebral fracture in 988 Hospital of People's Liberation Army Joint Service Support Force were divided into a combined group [50 cases, 30 males and 20 females, aged 42-78 (60.26±5.41) years] and a conventional group [50 cases, 25 males and 25 females, aged 40-80 (61.35±5.25) years] by the random number table method. All patients received surgery. The conventional group received conventional rehabilitation treatment after surgery, and the combined group received core muscle strength training based on the ERAS concept to assist conventional rehabilitation treatment. Both groups were followed up for one year to compare the recovery of lumbar structure, lower back pain, balance ability, and long-term improvement of lumbar function before and after treatment. χ² test and t test were used. Results　After 3 months of treatment, the posterior convex angle and the Cobb angle of the injured vertebrae in the combined group were (13.25±3.11)° and (10.45±2.28)°, which were both lower than those in the conventional group [(15.17±3.02)° and (12.23±2.06)°], and the anterior edge height of the injured vertebrae was (75.36±10.24)%, which was higher than that in the conventional group [(69.77±10.21)%] (all P<0.05). The Visual Analogue Scale (VAS) score of the combined group was (5.15±1.24) points after 1 month and (3.28±0.25) points after 3 months, which were both lower than those of the conventional group [(6.65±2.13) points and (4.49±1.25) points]; the Berg Balance Scale (BBS) score of the combined group was (42.14±10.36) points after 1 month and (54.11±10.37) points after 3 months, which were both higher than those of the conventional group [(36.62±10.33) points and (48.24±10.28) points] (all P<0.05). Under different treatment regiments, the Oswestry Disability Index (ODI) scores of the combined group were (35.25±5.41) points and (23.49±5.11) points at the 3rd month and the 9th month of follow up, which were both lower than those of the conventional group [(38.77±5.24) points and (27.12±5.44) points]; the Japanese Orthopaedic Association (JOA) scores of the combined group were (18.33±5.15) points and (26.15±5.14) points at the 3rd month and the 9th month of follow up, which were both higher than those of the conventional group [(15.44±5.33) points and (22.41±5.15) points] (all P<0.05). Conclusion　The core muscle strength training based on the ERAS concept can effectively improve the postoperative vertebral structure in patients with lumbar vertebral fracture, and has positive significance in alleviating the postoperative lumbar pain, enhancing the body balance ability, and promoting the long-term recovery of vertebral function.

Key words:

Lumbar vertebral fracture, Rehabilitation treatment, ERAS, Core muscle strength training

摘要：

目的　观察基于加速康复外科（ERAS）理念的核心肌力训练对改善腰椎骨折患者术后康复效果的影响。方法　本文为前瞻性研究，病例纳入时间为2020年3月至2022年2月，研究对象为中国人民解放军联勤保障部队第九八八医院100例腰椎骨折患者，采用随机数字表法对入组患者进行分组，分别列为联合组［50例，男30例，女20例，年龄42～78（60.26±5.41）岁］和常规组［50例，男25例，女25例，年龄40～80（61.35±5.25）岁］。所有患者均接受手术治疗，常规组术后予以常规康复治疗，联合组采用基于ERAS理念的核心肌力训练辅助常规康复治疗。两组均开展为期1年随访，比较两组患者治疗前后的腰椎结构、腰部疼痛、平衡能力恢复情况及远期腰椎功能改善情况。用χ²检验、t检验。结果　治疗3个月后，联合组的伤椎后凸角为（13.25±3.11）°，伤椎Cobb角为（10.45±2.28）°，均低于常规组［（15.17±3.02）°、（12.23±2.06）°］，伤椎前缘高度为（75.36±10.24）%，高于常规组（69.77±10.21）%（均P<0.05）。联合组治疗1个月后的视觉模拟评分法（VAS）评分为（5.15±1.24）分，3个月后的VAS评分为（3.28±0.25）分，均低于常规组［（6.65±2.13）分、（4.49±1.25）分］；联合组治疗1个月后的Berg平衡量表（BBS）评分为（42.14±10.36）分，3个月后的BBS评分为（54.11±10.37）分，均高于常规组［（36.62±10.33）分、（48.24±10.28）分］（均P<0.05）。在不同治疗方案下，联合随访第3个月时的Oswestry功能障碍指数（ODI）评分为（35.25±5.41）分，第9个月的ODI评分为（23.49±5.11）分，均低于常规组［（38.77±5.24）分、（27.12±5.44）分］；联合组随访第3个月时的日本骨科协会（JOA）治疗分数为（18.33±5.15）分，第9个月时的JOA评分为（26.15±5.14）分，均高于常规组［（15.44±5.33）分、（22.41±5.15）分］（均P<0.05）。结论　基于ERAS理念的核心肌力训练能有效改善腰椎骨折患者术后椎体结构，对缓解术后腰部疼痛、增强机体平衡能力并促进远期椎体功能恢复均有积极意义。

关键词:

腰椎骨折, 康复治疗, 加快康复外科, 核心肌力训练