Clinical Observation Of The Effect Of Lumbar And Abdominal Muscle Functional Exercise On Lumbar Stability After PETD Operation Based On The Theory Of "Jin Shu Gu"

Objective:To observe the clinical efficacy of individualized lumbar and abdominal muscle function exercise after Percuttaneous Endoscopic Transforaminal Discectomy(PETD)operation in patients with LDH,and to observe the effect on lumbar spine stability through imaging data and the improvement of lumbar function,so as to provide the basis for choosing the appropriate exercise for LDH patients after PETD operation.Method:Reviewing the period from January 2019 to December 2020,the patients with lumbar disc herniation who were treated in the Department of Orthopedics of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,met the diagnostic criteria,included criteria,had complete data,were treated by PETD surgery,and had a complete follow-up after operation.According to the different of patient’s preoperative lumbar curvature index and sacral slope angle imaging parameters,individualized functional exercise started 1 week after operation: those with shallow lumbar curvature should perform upper back muscle exercise,those with too large sacral slope angle should perform abdominal muscle exercise,and those with shallow lumbar curvature and excessive sacral slope should perform combined lumbar-abdominal muscle exercise.The postoperative follow-up time was more than or equal to 1 year.Observe the changes of intervertebral space height,intervertebral space angle and motion angle,lumbar curvature index and sacral slope angle of the disc herniation segment and adjacent segment after exercise for 1 year before operation and after operation;the VAS score,JOA lumbar spine function score,and Oswestry Disability Index were collected 1 week after operation,1 month after postoperative exercise,3 months,6months,and 1 year;clinical efficacy was evaluated using the JOA score improvement rate.The collected all data are processed and analyzed by SPSS26.0.Results:1.A total of 32 patients were included in this study,including 15 males(46.88%)and 17females(53.13%).All patients were between 25 and 69 years old,with an average age of51.5±12.62 years.There were 21 patients(65.63%)with L4/5 disc herniation and 11 patients(34.38%)with L5/S1 disc herniation.2.Changes in imaging parameters: Due to the different herniation segments of the patients,the patients with herniation segments of different segments were observed separately.(1)Results of height change of intervertebral space: In patients with L4/5 herniation,the intervertebral space height of the herniation segment and adjacent segment(L3/4,L5/S1)were reduced compared with those before the operation(P<0.05);in patients with L5/S1 herniation,the intervertebral space height of the herniation segment was reduced compared with before the operation(P<0.05),the intervertebral space height of the adjacent segment(L3/4)was no statistical difference(P=0.345>0.05).(2)Results of intervertebral space angulation changes: In patients with L4/5 herniation,the intervertebral space angulation in L4/5 flexion position and L5/S1 extension position was significantly stable compared with preoperative(P<0.05),there was no statistical difference between the anterior and posterior comparisons of intervertebral space angulation in the flexion and extension position of the remaining segments(P>0.05);in patients with L5/S1 herniation,there was no statistical significance before and after the intervertebral space angulation on the flexion and extension position of the herniation segment and the adjacent segment(P>0.05).(3)The results of changes in the angle of intervertebral space motion: In patients with L4/5 herniation,the motion angle of the intervertebral space between the herniation segment and the lower adjacent segment(L5/S1)was significantly reduced compared with that before the operation(P<0.05),the motion angle of the intervertebral space in the upper adjacent segment(L3/4)was not statistically significant compared with that before operation(P>0.05);there was no statistical difference between the herniation segment and the adjacent segment of the intervertebral space in patients with L5/S1 herniation compared with that before operation(P>0.05).(4)The results of the change in the number of unstable segments: All patients had a total of 11 unstable segments before operation,and a total of 4 unstable segments after 1 year of postoperative exercise,and the number of unstable segments decreased compared with before.There was no significant difference in the number of unstable segments before and after L4/5 and L5/S1 herniation patients(P=0.166,P=0.664).(5)The results of the change in the LCI and SS: Before operation,there were 16 cases with shallow lumbar curvature,1 case with excessive sacral slope,and 15 cases with shallow lumbar curvature and excessive sacral slope;after one year’s exercise,there were 19 cases with shallow lumbar curvature,1 case with excessive sacral slope,and 12 cases with shallow lumbar curvature and excessive sacral slope.There was no statistical difference in lumbar parameters between preoperative and postoperative 1 year(P=0.804>0.05).The LCI of all patients after exercise for 1 year was significantly larger than that before operation,the difference was statistically significant(P<0.05);there was no statistical significance in the SS of one year after the operation compared with the preoperative(P=0.701>0.05).3.The VAS scores of the patients were significantly different at 1 week after the operation and postoperative exercise 1 month,3 months,6 months and 1 year after the operation(P<0.05);there is a statistically significant difference in the scores of postoperative exercise between 1 month and 3 months,6 months and 1 year(P<0.05);there was no significant difference in scores between 3 months and 6 months of postoperative exercise,3months and 1 year of postoperative exercise,and 6 months and 1 year of postoperative exercise(P=0.325,P=0.103,P=0.325).The pain basically disappeared after 3 months of postoperative exercise.The JOA and ODI scores of the patients were statistically significant at each time point(P<0.05),the patient’s lumbar spine function was significantly improved,and the lumbar spine dysfunction was significantly relieved.4.The clinical efficacy was evaluated according to the improvement rate of JOA score.Among them,4 cases were cured,25 cases were markedly effective,3 cases were effective,and 0 cases were ineffective,and the total effective rate was 90.26%.Conclusion:1.Individualized exercise of the lumbar and abdominal muscles has a positive effect on the local stability of the lumbar herniated segment and adjacent segments in patients after PETD operation.2.Individualized exercise of the lumbar and abdominal muscles can improve the LCI and SS of the lumbar spine in patients after PETD operation,and has a positive effect on maintaining the overall stability of the lumbar spine.3.Individualized exercise of the lumbar and abdominal muscles has certain significance in relieving pain symptoms and improving lumbar spine function of patients after PETD operation.