| Objective:In this study,pelvic floor muscle training was added to the routine rehabilitation training program for women with lumbar disc herniation after Percutaneous Transforaminal Endoscopic Discectomy.Ability to prevent pelvic floor dysfunction has a positive effect in order to improve the postoperative rehabilitation training program.It is hoped that the research results can provide reference suggestions for improving the postoperative rehabilitation training program of lumbar disc herniation.Methods:With the approval of the Tianjin Medical Research Ethics Committee of the Tianjin Hospital,based on the principle of voluntary participation of the subjects,33 cases of female patients with simple lumbar disc herniation were treated with percutaneous endoscopic discectomy in the spinal minimally invasive ward of Tianjin Hospital.In the consent form,the patients were divided into three groups using a parallel,non-random,single-blind method: the experimental group,the control group,and the conventional treatment group,with 11 people in each group,and the rehabilitation intervention time was 12 weeks.A professional rehabilitation therapist guides patients during hospitalization to perform rehabilitation function training at the bedside,and the patients practice at home after discharge.All three groups of patients were given conventional clinical basic treatment after surgery,including "neurotolerin" intravenous drip nutritional nerves,"cefixime sodium" to prevent infection,and "lansoprazole" to protect gastric mucosa to prevent stress ulcers.2.Double lower limb pressure antithrombotic pump promotes lower limb blood circulation,orthopedic laser treatment and low frequency pulsed magnetic field treatment to alleviate pain and promote wound healing in patients.Routine treatment group: clinical routine treatment plus rehabilitation education.Control group: Routine rehabilitation training was added to the conventional treatment group.Experimentalgroup: Routine rehabilitation training and pelvic floor muscle training were added on the basis of the conventional treatment group.The experimental group started the first training at 8 hours after surgery.Three examinations or follow-up scores were recorded during the study: first collection before surgery,second collection one month after surgery,and third collection three months after surgery.Collect and organize the scores of each examination,including the simple questionnaire for the impact of pelvic floor disorders 7(PFIQ-7),the urinary incontinence questionnaire(ICI-Q-SF),and the visual analogue scale(VAS)to measure the waist and legs of patients Pain level,Lumbar spine dysfunction index questionnaire(The Oswestry Disability Index(ODI)),walking speed,lumbar joint mobility,MRI multifidus cross-sectional area,vertical distance from MRI multifidus to lamina,pelvic floor muscle strength.SPSS22.0 statistical software was used to analyze the data.Quantitative data were expressed as mean standard deviation(XSD).The comparison of indicators between groups was based on whether they obeyed normal distribution and homogeneity of variance,and it was decided to use single-factor analysis of variance or rank sum test of multiple independent samples;the pairwise comparison was based on LSD post-hoc multiple comparison analysis or independent sample Kruskal-Wallis test.The intra-group analysis used multiple related samples Friedman test and paired sample Wilcoxon rank sum test,the significance level was P <0.05.Result:1.A total of 33 subjects were enrolled in this study.Two cases interrupted the experimental process and 31 cases were actually completed.There was no significant difference in the basic data of the three groups of patients(P> 0.05),and the baseline data were uniform.2.Pelvic floor muscle strength: within three months,the fast and slow muscle strength of the pelvic floor muscles of the experimental group were significantly improved(P <0.05),and the muscle strength was significantly stronger than the control group and the conventional treatment group(P <0.05);fast muscle strength and slow muscle strength decreased significantly in the conventional treatment group(P <0.05),and there was no significant change in slow muscle endurance(P> 0.05);fast muscle strength,slow muscle strength,There was no significant change in muscle endurance(P> 0.05).3.MRI multifidus muscle area(CSA): within three months,the CSA of the protruded and non-protruded sides of the experimental group and the control group increased significantly(P <0.05),and the conventional treatment group decreased significantly(P <0.05);the three groups There was no significant difference between the CSA of the protruding side and the CSA of the non-protruding side(P> 0.05).4.The vertical distance between MRI multifidus muscle and laminae(MLD):within three months,the MLD of the protruding side and the non-protruding side of the experimental group and the control group were significantly reduced(P <0.05),while the conventional treatment group was significantly increased(P <0.05);MLD in the protruded side(P = 0.013)and MLD in the unprotruded side(P = 0.014)were better than those in the conventional treatment group,but there was no significant difference between the two groups(P> 0.05).5.Waist pain(VAS)score: The pain scores of the three groups of patients were significantly reduced within three months(P <0.05),and pain relief was improved by adding pelvic floor muscle training to the conventional training group and the control group(P = 0.000).6.The Oswestry Disability Index(ODI): The degree of lumbar Oswetry dysfunction in three groups of patients was significantly reduced within three months(P <0.05).The scores of the experimental group and the control group were significantly higher than those of the conventional treatment group,but There was no significant difference between the two groups(P = 0.635).7.Lumbar spine joint mobility: within three months,the lumbar spine flexion and extension motion increased significantly in the three groups(P <0.05),and the lumbar spine flexion(P = 0.935)and posterior extension motion(P = 0.935)between the three groups.= 0.551)No significant difference.8.Walking speed: within three months,the walking speed of the three groups of patients increased significantly(P <0.05).The experimental group was better than the conventional treatment group(P = 0.007).The experimental and control groups(P =0.287),the control group,and There was no significant difference between the conventional treatment groups(P = 0.87).9.Simple questionnaire for the impact of pelvic floor disorders 7(PFIQ-7): This scale combined with pelvic floor muscle assessment showed that there was no significant pelvic floor dysfunction in the three groups of patients(P> 0.05).10.Urinary incontinence questionnaire(ICI-Q-SF): 4 patients had urine leakage before surgery(1 in the conventional treatment group,2 in the experimental group,and 1 in the control group),and 2 patients still had urine leakage after surgery(routine There was 1 person in the treatment group and 1 person in the control group),and 2patients with leakage in the experimental group did not experience leakage again.Conclusion:Rehabilitation function training for female patients with lumbar disc herniation after percutaneous transforaminal surgery can improve patient pain,reduce lumbar dysfunction,reduce the area of laminar multifidus muscle fat,improve physical activity,and provide a basis for rehabilitation The addition of pelvic floor muscle training has a significant positive effect on further reducing postoperative lower back pain,enhancing pelvic floor muscle strength,improving urine leakage,and preventing pelvic floor muscle dysfunction.Post-rehabilitation training is of great significance.In clinical practice,more attention should be paid to functional training of the pelvic floor muscles.It is recommended that pelvic floor muscle training be incorporated into conventional rehabilitation training programs. |
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