| Objective:Through the clinical observation of phased functional exercise on improving the postoperative efficacy of endoscopic lumbar disc herniation,The traditional Chinese and western medicine efficacy and safety were objectively evaluated,so as to explore the efficacy and safety of phased functional exercise on improving the rehabilitation of patients with lumbar disc herniation after percutaneous spinal endoscopic surgery.Methods:A total of 68 inpatients with lumbar disc herniation in the first Department of Spine,Wangjing Hospital,China Academy of Chinese Medical Sciences were collected.All the patients met the surgical indications and underwent percutaneous spinal endoscopy for lumbar disc nucleus pulposus extraction.SPSS25.0 statistical analysis system was used to randomly assign 68 cases to treatment group and control group.Due to shedding,loss of follow-up and other reasons,62 cases were collected,including 32 cases in the treatment group and 30 cases in the control group.Patients in both groups received general treatment,and the treatment group participated in staged functional exercise after surgery.VAS,ODI and SF-36 scales were scored before surgery,1 month and 3 months after surgery,respectively,and imaging examinations were performed before surgery and 3 months after surgery,respectively,to observe and record the changes of lumbar MRI before surgery and 3 months after surgery.The cross-sectional area of multifidus muscle and the adipose infiltration area of multifidus muscle were calculated.Through statistical analysis,to evaluate the efficacy and safety of phased functional exercise in improving the rehabilitation of patients with lumbar disc herniation after percutaneous spinal endoscopic surgery.Results:①A total of 68 patients were included in this study,of which 62 met the criteria and 32 were in the treatment group,including 16 males and 16 females;There were 30 cases in the control group,including 16 males and 14 females.All patients ranged in age from 18 to 60 years old,with an average age of 40.31 ± 11.59 years in the treatment group and 40.30 ± 11.37 years in the control group.Surgical segment:In the treatment group,a total of 25 cases were L4～L5,6 cases were L5～S1 and 1 case was L3～L4.Control group a total of 21 cases of L4～L5,8 cases of L5～S1 and 1 case of L3～L4.②Evaluation of pain improvement:there was no statistical difference in VAS between the treatment group and the control group before treatment(P>0.05),which was comparable.The VAS scores of the two groups after 1 month and 3 months of treatment were statistically different(P<0.05),and the pain improvement of the treatment group was more obvious than that of the control group after 3 months of treatment.③Evaluation of vertebral dysfunction:there was no statistical difference in ODI scores between the treatment group and the control group before treatment(P>0.05),which was comparable.After 1 month of treatment and after 3 months of treatment,ODI scores of the two groups showed a statistical downward trend,with statistical difference(P<0.05).Intra-group comparison showed that the improvement of lumbar function and symptoms of the two groups after 3 months of treatment was significantly better than that of the control group,and inter-group comparison showed that the downward trend of ODI scores of the treatment group was significantly better than that of the control group.④Quality of life assessment:There was no significant difference in SF-36 scores between the two groups before treatment(P>0.05),which was comparable.The comparison between groups showed that there was no statistical difference in SF-3 6 scores between the two groups before treatment and one month after treatment(P>0.05),but there was statistical difference in SF-36 scores between the two groups after 3 months of treatment(P<0.05),and the score of the treatment group was significantly higher than that of the control group.Therefore,the treatment group is significantly better than the control group in improvement of patients’ quality of life.Comparison within groups showed that the scores of the treatment group and the control group were statistically different after 1 month and 3 months of treatment compared with those before treatment(P<0.05),and the scores of the treatment group at 1 month and 3 months after treatment were significantly better than those of the control group.⑤Cross-sectional area of multifidus muscle:There was no statistical difference in cross-sectional area of multifidus muscle between the two groups before treatment(P>0.05),indicating comparability.There was no significant difference between the two groups before treatment and 3 months after treatment(P>0.05).There was no significant difference between the two groups before treatment and 3 months after treatment(P>0.05).Considering that spinal endoscopy is a minimally invasive surgery with little muscle damage and limited by follow-up time,there was no significant difference between the two groups.⑥Fat infiltrating area of multifidus muscle:There was no statistical difference in fat infiltrating area of multifidus muscle between the two groups before treatment(P>0.05),which was comparable.The comparison between the two groups showed that the area of multi-fidus muscle fat infiltration in the treatment group was lower than that in the control group before and 3 months after treatment,and there was no statistical difference between the two groups(P>0.05).Intra-group comparison showed that there was no statistical difference between the treatment group and the control group at 3 months after treatment,and no statistical difference between the control group and the control group at 3 months after treatment(P<0.05),indicating that functional exercise after spinal endoscopic surgery can reduce therapeutic infiltration and prevent muscle atrophy.⑦ Efficacy evaluation:After 3 months of treatment,the two groups of patients were evaluated.The treatment group:28 excellent,2 good,2 fair,and 0 poor;The excellent and good rate was 93.75%.In the control group,16 were excellent,8 were good,6 were fair,and 0 were poor;The excellent and good rate was 80%,and the treatment difference between the two groups was significant(P<0.05).Conclusion:Phased functional exercise has a definite effect on the rehabilitation of patients with lumbar disc herniation after percutaneous spinal endoscopic surgery,and can effectively relieve the pain after spinal endoscopic surgery for lumbar disc herniation,improve lumbar function and improve the quality of life. |
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