| Objective:Through comparing the influences of different time of low back muscle exercise on the rehabilitation after lumbar spine surgery,we could confirm the time low back muscle needs to obtain obvious clinical efficiency,and discuss the necessity of long-term low back muscle exercise,thus providing a reference for the development of rehabilitation program after lumbar spine surgery.Methods:90 patients with single segmental lumbar spine were chosen for this study who were hospitalized in Zhangzhou 175 hospital from June 2014 to December 2014.All those patients went through the operation of parallel lumbar posterior decompression and internal fixation plus bone graft fusion.They were randomly divided into three groups:3 months group (patients who kept doing standardized five-point back muscle exercise for 3 months a week after surgery),including 30 cases; 6 month group (patients who kept doing standardized five-point back muscle exercise for 6 months a week after surgery),including 30 cases; 1 year group (patients who kept doing standardized five-point back muscle exercise for 1 year a week after surgery),including 30 cases.We conducted a MRI examination about lumbar spine before operation and at the last follow-up.PACS software was used to measure the cross-sectional area of lesion segments multifidus muscle cross-sectional area, and then record the rate of change of multifidus muscle area. We give VAS scores and ODI score to those patients after surgery for one week,three months, six months and 1 year respectively and shoot lumbar hyperextension flexion radiographs to evaluate the stability of lumbar spine. All patients were asked to complete questionnaire about early symptoms of lumbar spinal instability at the last follow-up.Results:The course of disease, age, weight and other basic information had no statistical difference among all patients who met the inclusion criteria and completed 1 year follow-up.There groups were not significantly different in VAS score,ODI score and stability of lumbar spine at one week after operation (P> 0.05).Compared with the situation of pre-exercises,the VAS scores and ODI scores in three groups descended obviously after exercising for three months,which indicated the exercise had statistical difference (P<0.05).The VAS score and ODI score of 3 months group had not seen obvious improvement when they stopped back muscle exercise, while had obvious significance when compared with the other two groups (P<0.05).The VAS score and ODI score of 6 months group still had descending trend when they stopped back muscle exercise.There was no statistical significance among the 1-year group and 1-year group(P>0.05). Changing rate of the multifidus muscle area among three groups was statistically different, among which the multifidus muscle atrophy area of 3-month group was the most obvious,followed by 6 months group,the multifidus muscle area of 1-year group was increased slightly compared with the pre-operation.There was no radiographic lumbar instability situation among three groups.The outcome of questionnaires about early symptoms of lumbar instability had significant difference between pairwise comparison (P<0.05).the 3 months group had the largest number of patients and the highest frequency with early symptoms of lumbar instability,followed by 6 months group, and 1-year group occupied the minimum number.Conclusion:1. Adhering to three months of back muscle exercise can effectively relieve the Symptom of low back pain after surgery;2.Adhering to six months of back muscle exercise has sustainable curing effect on clinical symptoms.And exercise is still required after these six months;3.Long-term back muscle exercise after surgury can prevent multifidus muscle atrophy,which is significant for the prevention of long-term lumbar instability. |
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