任务导向结合阶梯性康复训练在腰椎间盘突出症单侧双通道内镜术患者中的应用效果

张杨西贝; 周平辉; 张晶晶; 邹阳

doi:10.16766/j.cnki.issn.1674-4152.003983

任务导向结合阶梯性康复训练在腰椎间盘突出症单侧双通道内镜术患者中的应用效果

doi: 10.16766/j.cnki.issn.1674-4152.003983

张杨西贝^{1, 2},
周平辉^{1, 2, ,},
张晶晶^{1, 2},
邹阳^{1, 2}

1.
蚌埠医科大学第一附属医院骨科，安徽蚌埠 233004
2.
组织移植安徽省重点实验室，安徽蚌埠 233030

基金项目:

安徽省高校杰出青年科研项目 2022AH020086

详细信息

通讯作者:
周平辉，E-mail：270806423@qq.com

中图分类号: R473.6 R681.57
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- 文章访问数: 1
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- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-06-24
- 网络出版日期: 2025-06-30

Application effect of task-oriented training combined with stepped rehabilitation training on patients with UBE for lumbar disc herniation

ZHANGYANG Xibei^{1, 2},
ZHOU Pinghui^{1, 2
, ,},
ZHANG Jingjing^{1, 2},
ZOU Yang^{1, 2}

1.
Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探究任务导向结合阶梯性康复训练在腰椎间盘突出症(LDH)单侧双通道内镜(UBE)术患者中的应用效果，分析对患者自我效能感、锻炼依从性、腰部功能及生活质量的影响。方法选择2021年9月—2023年9月于蚌埠医科大学第一附属医院接受UBE术治疗的腰椎间盘突出症患者80例，采用随机数字表法分为对照组和观察组，各40例。对照组患者术后接受常规护理及康复训练，观察组患者在对照组干预的基础上接受任务导向结合阶梯性康复训练。采用慢性疼痛自我效能感量表(CPSS)、骨科患者功能锻炼依从性量表、Oswestry功能障碍指数(ODI)、健康调查简表(SF-36)分别评估患者术后1 d和术后1个月的自我效能感、锻炼依从性、腰部功能及生活质量。结果术后1个月，2组患者CPSS量表疼痛管理、躯体功能、症状应对评分均较术后1 d升高(P < 0.05)，且观察组高于对照组(P < 0.05);术后1个月，2组患者与心理方面、主动学习、身体方面相关的锻炼依从性评分及总分均较术后1 d升高(P < 0.05)，且观察组高于对照组(P < 0.05);术后1个月，2组患者ODI评分较术后1 d降低(P < 0.05)，且观察组评分低于对照组[(27.05±3.84)分vs. (29.18±4.16)分, F=5.662，P < 0.05];术后1个月，2组患者SF-36评分较术后1 d升高(P < 0.05)，且观察组评分高于对照组[(65.63±10.58)分vs. (60.70±9.34)分，F=4.881，P=0.030]。结论对LDH患者UBE术后采用任务导向结合阶梯性康复训练可有效提高其自我效能感和锻炼依从性，改善腰部功能障碍，提高生活质量。
- 腰椎间盘突出症 /
- 任务导向 /
- 阶梯性康复训练 /
- 单侧双通道内镜手术
Abstract: Objective To explore the application effect of task-oriented training combined with stepped rehabilitation training on patients with unilateral double-channel endoscope (UBE) for lumbar disc herniation (LDH) and analyze the influence on self-efficacy, exercise compliance, lumbar function and quality of patients. Methods A total of 80 patients with LDH who received UBE were selected in the First Affiliated Hospital of Bengbu Medical University from September 2021 to September 2023 and were divided into a control group (40 cases) and an observation group (40 cases) by random number table method. The patients in the control group received routine nursing agent rehabilitation training after surgery. On the basis of the intervention in the control group, the patients in the observation group were given task-oriented training combined with stepped rehabilitation training. Chronic pain self-efficacy scale (CPSS), functional exercise compliance scale for orthopedic patients, Oswestry dysfunction index (ODI), and 36-item short-form health survey (SF-36) were used to evaluate the self-efficacy, exercise compliance, lumbar function and quality of life of patients at 1 day and 1 month after surgery. Results The scores of pain management, physical function, and symptom coping of the CPSS scale in the two groups 1 month after surgery were enhanced than those 1 day after surgery (P < 0.05), and the above scores in the observation group were higher than those in the control group (P < 0.05). At 1 month after surgery, the exercise compliance scores of psychological aspect, active learning, and physical aspect and total score were risen in both groups compared with those at 1 day after surgery (P < 0.05), and the observation group had higher scores than those in the control group (P < 0.05). The ODI score in the two groups declined at 1 month after surgery than that at 1 day after surgery (P < 0.05), and the ODI score of (27.05±3.84) points in the observation group was lower compared with (29.18±4.16) points in the control group (F=5.662, P < 0.05). At 1 month after surgery, the SF-36 score in both groups was increased compared with that at 1 day after surgery (P < 0.05), and the score in the observation group with (65.63±10.58) points was higher than (60.70±9.34) points in the control group (F=4.881, P=0.030). Conclusion After UBE in LDH patients, task-oriented training combined with stepped rehabilitation training can effectively enhance self-efficacy and exercise compliance, and it is conducive to improving lumbar dysfunction and enhancing the quality of life of patients.
- Lumbar disc herniation /
- Task-oriented training /
- Stepped rehabilitation training /
- Unilateral double-channel endoscope surgery

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表 1 2组LDH患者一般资料比较

Table 1. Comparison of general data between two groups in LDH patients

组别	例数	性别 (男性/女性, 例)	年龄(x±s, 岁)	文化程度(例)			病程 (x±s, 年)	手术部位(例)
组别	例数	性别 (男性/女性, 例)	年龄(x±s, 岁)	初中及以下	中专/高中	大专及以上	病程 (x±s, 年)	L_4~5	L₅~S₁	其他
对照组	40	18/22	53.43±15.53	13	17	10	5.29±1.44	15	18	7
观察组	40	18/22	54.28±14.88	12	19	9	5.18±1.36	16	20	4
统计量			0.250^a		0.016^b		0.351^a		14.297^c
P值			0.803		0.988		0.726		< 0.001
注：^a为t值，^b为Z值，^c为χ²值。

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表 2 2组LDH患者CPSS评分比较(x±s，分)

Table 2. Comparison of CPSS scores between two groups of LDH patients (x±s, point)

组别	例数	疼痛管理		躯体功能		症状应对
组别	例数	术后1 d	术后1个月	术后1 d	术后1个月	术后1 d	术后1个月
对照组	40	8.58±1.87	13.70±2.26^b	19.75±2.27	33.55±4.52^b	17.85±2.14	26.45±4.74^b
观察组	40	8.43±1.51	15.68±2.95^b	19.23±2.34	36.28±4.49^b	18.03±2.27	29.55±4.39^b
统计量		0.395^a	11.355^c	1.009^a	7.344^c	0.365^a	9.209^c
P值		0.694	< 0.001	0.316	< 0.001	0.716	< 0.001
注：^a为t值，^c为F值; 与同组术前1 d比较，^bP < 0.05。

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表 3 2组LDH患者功能锻炼依从性量表评分比较(x±s，分)

Table 3. Comparison of functional exercise compliance scores between two groups of LDH patients (x±s, point)

组别	例数	与心理方面相关		与主动学习相关		与身体方面相关		总分
组别	例数	术后1 d	术后1个月	术后1 d	术后1个月	术后1 d	术后1个月	术后1 d	术后1个月
对照组	40	3.75±1.15	10.35±2.07^b	3.20±0.59	7.15±1.09^b	10.43±2.42	20.45±4.12^b	17.38±4.73	37.95±6.83^b
观察组	40	4.05±1.43	12.10±2.43^b	3.28±0.47	8.40±1.21^b	10.20±2.03	23.38±4.61^b	17.53±4.94	43.88±7.51^b
统计量		1.034^a	12.022^c	0.671^a	23.565^c	0.460^a	8.983^c	0.186^a	13.650^c
P值		0.304	< 0.001	0.504	< 0.001	0.646	< 0.001	0.853	< 0.001
注：^a为t值，^c为F值; 与同组术前1 d比较，^bP < 0.05。

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表 4 2组LDH患者ODI评分比较(x±s，分)

Table 4. Comparison of ODI scores between two groups of LDH patients (x±s, point)

组别	例数	术后1 d	术后1个月	t值	P值
对照组	40	34.45±4.63	29.18±4.16	7.671	< 0.001
观察组	40	35.10±5.29	27.05±3.84	11.112	< 0.001
统计量		0.585^a	5.662^b
P值		0.560	0.020
注：^a为t值，^b为F值。

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表 5 2组LDH患者SF-36评分比较(x±s，分)

Table 5. Comparison of SF-36 scores between two groups of LDH patients (x±s, point)

组别	例数	术后1 d	术后1个月	t值	P值
对照组	40	51.58±12.36	60.70±9.34	4.320	< 0.001
观察组	40	50.98±13.68	65.63±10.58	6.333	< 0.001
统计量		0.206^a	4.881^b
P值		0.838	0.030
注：^a为t值，^b为F值。

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参考文献(20)

[1]	廖雪英, 杜娟, 曾兴玲, 等. 椎间孔镜手术治疗腰椎间盘突出症疗效及对患者炎性因子的影响[J]. 西部医学, 2021, 33(11): 1679-1682. doi: 10.3969/j.issn.1672-3511.2021.11.024 LIAO X Y, DU J, ZENG X L, et al. Efficacy of intervertebral foraminal endoscopic surgery in the treatment of lumbar disc herniation and its influence on inflammatory factors[J]. Med J West China, 2021, 33(11): 1679-1682. doi: 10.3969/j.issn.1672-3511.2021.11.024
[2]	芦怀旺, 田霖, 胡鹏, 等. 单侧双通道内镜治疗单责任节段腰椎管狭窄症的短期临床疗效分析[J]. 中华全科医学, 2023, 21(3): 413-416. doi: 10.16766/j.cnki.issn.1674-4152.002896 LU H W, TIAN L, HU P, et al. Short-term clinical effect analysis of unilateral biportal endoscopic surgery for of single responsible segment lumbar spinal stenosis[J]. Chinese Journal of General Practice, 2023, 21(3): 413-416. doi: 10.16766/j.cnki.issn.1674-4152.002896
[3]	UYSAL E, CINE H S, CETIN E. The necessity and timing of exercise after lumbar disc herniation surgery[J]. Eur Rev Med Pharmacol Sci, 2023, 27(20): 9521-9529. http://openurl.ebsco.com/contentitem/gcd:173510354?sid=ebsco:plink:crawler&id=ebsco:gcd:173510354
[4]	中国康复医学会脊柱脊髓专业委员会基础研究与转化学组. 腰椎间盘突出症诊治与康复管理指南[J]. 中华外科杂志, 2022, 60(5): 401-408. doi: 10.3760/cma.j.cn112139-20211122-00548 Basic Research and Transformation Society, Professional Committee of Spine and Spinal Cord, Chinese Association of Rehabilitation Medicine. Guideline for diagnosis, treatment and rehabilitation of lumbar disc herniation[J]. Chin J Surg, 2022, 60(5): 401-408. doi: 10.3760/cma.j.cn112139-20211122-00548
[5]	梁森, 蔡庆, 陈曦, 等. 任务导向训练改善脑卒中患者上肢运动功能和日常生活能力的系统评价[J]. 中华物理医学与康复杂志, 2021, 43(8): 744-747. doi: 10.3760/cma.j.issn.0254-1424.2021.08.018 LIANG S, CAI Q, CHEN X, et al. Task oriented training to improve the upper limb movement function in patients with cerebral apoplexy and daily life ability of system evaluation[J]. Chin J Phys Med Rehabil, 2021, 43(8): 744-747. doi: 10.3760/cma.j.issn.0254-1424.2021.08.018
[6]	中华医学会骨科学分会脊柱外科学组, 中华医学会骨科学分会骨科康复学组. 腰椎间盘突出症诊疗指南[J]. 中华骨科杂志, 2020, 40(8): 477-487. doi: 10.3760/cma.j.cn121113-20200402-00213 Subspecialty Group of Spinal Surgery of Chinese Orthopedic association, Subspecialty Group of Orthopedic Rehabilitation of Chinese Orthopedic Association. Clinical practice guideline for diagnosis and treatment of lumbar disc herniation[J]. Chin J Orthop, 2020, 40(8): 477-487. doi: 10.3760/cma.j.cn121113-20200402-00213
[7]	杨心雨, 赵菁, 郭红, 等. 慢性疼痛病人自我效能感现状调查及影响因素分析[J]. 中国疼痛医学杂志, 2024, 30(2): 108-113. doi: 10.3969/j.issn.1006-9852.2024.02.005 YANG X Y, ZHAO J, GUO H, et al. Analysis on the status and influencing factors of self-efficacy in patients with chronic pain[J]. Chin J Pain Med, 2024, 30(2): 108-113. doi: 10.3969/j.issn.1006-9852.2024.02.005
[8]	谭媛媛, 和晖, 杨秀贤, 等. 骨科患者功能锻炼依从性量表的编制及信度效度检验[J]. 中国护理管理, 2019, 19(11): 1626-1631. doi: 10.3969/j.issn.1672-1756.2019.11.007 TAN Y Y, HE H, YANG X X, et al. Development and reliability and validity test of the compliance scale of functional exercise for orthopedic patients[J]. Chin Nurs Manag, 2019, 19(11): 1626-1631. doi: 10.3969/j.issn.1672-1756.2019.11.007
[9]	廉凯龙, 高京生, 贾子普, 等. CT引导下射频联合臭氧治疗腰椎间盘突出症日间手术的疗效[J]. 西部医学, 2023, 35(8): 1233-1238. doi: 10.3969/j.issn.1672-3511.2023.08.027 LIAN K L, GAO J S, JIA Z P, et al. The clinical effect of day surgery for lumbar disc herniation using spiral CT guided ozone injection and radio frequency thermocoagulation[J]. Med J West China, 2023, 35(8): 1233-1238. doi: 10.3969/j.issn.1672-3511.2023.08.027
[10]	周非非, 张一龙, 李舒扬, 等. SF-36量表用于国人脊髓型颈椎病的信度分析及其与神经功能的相关性研究[J]. 中国脊柱脊髓杂志, 2020, 30(3): 256-262. doi: 10.3969/j.issn.1004-406X.2020.03.11 ZHOU F F, ZHANG Y L, LI S Y, et al. The reliability of quality of life evaluation using SF-36 and its correlation with neurological function assessment in Chinese patients with cervical spondylotic myelopathy[J]. Chin J Spine Spinal Cord, 2020, 30(3): 256-262. doi: 10.3969/j.issn.1004-406X.2020.03.11
[11]	SADEGHPOUR EZBARAMI S, ZAREI F, HAGHANI S. Evaluation of a mobile-application educational intervention on the knowledge, attitude, and practice of patients in postoperative care for lumbar disk herniation surgery: a randomized control trial[J]. SAGE Open Med, 2023, 11: 20503121231203684. DOI: 10.1177/20503121231203684.
[12]	朱金凤, 狄恒丹, 季翠玲, 等. 中青年脑卒中患者运动自我效能及锻炼计划与运动依从性的相关性研究[J]. 护理学杂志, 2022, 37(23): 36-39. doi: 10.3870/j.issn.1001-4152.2022.23.036 ZHU J F, DI H D, JI C L, et al. Relationships among exercise self-efficacy, exercise plan and exercise compliance in young and middle-aged stroke patients[J]. J Nurs Sci, 2022, 37(23): 36-39. doi: 10.3870/j.issn.1001-4152.2022.23.036
[13]	王春红, 陆明. 普适性阶梯康复训练促进股骨转子间骨折术后股四头肌功能恢复[J]. 中国组织工程研究, 2024, 28(26): 4216-4220. doi: 10.12307/2024.433 WANG C H, LU M. Universal stepwise rehabilitation training promotes the functional recovery of quadriceps femoris after intertrochanteric femoral fracture surgery[J]. Clin Rehabil Tis Eng Res, 2024, 28(26): 4216-4220. doi: 10.12307/2024.433
[14]	兰曼丽, 朱莹莹. 正性暗示结合任务导向性训练对脑梗死后偏瘫患者情绪状态及功能康复的影响[J]. 国际护理学杂志, 2023, 42(14): 2574-2577. doi: 10.3760/cma.j.cn221370-20211010-00629 LAN M L, ZHU Y Y. Effect of positive suggestion combined with task-oriented training on emotional state and functional rehabilitation of patients with hemiplegia after cerebral infarction[J]. Int J Nurs, 2023, 42(14): 2574-2577. doi: 10.3760/cma.j.cn221370-20211010-00629
[15]	彭德清, 林艳, 李婉丽, 等. 双向回馈式健康教育在腰椎间盘突出症术后病人居家康复中的应用[J]. 护理研究, 2023, 37(5): 926-930. PENG D Q, LIN Y, LI W L, et al. Application of bidirectional feedback health education in home rehabilitation of patients after lumbar disc herniation operation[J]. Chin Nurs Res, 2023, 37(5): 926-930.
[16]	刘四维, 关敏, 高强. 任务导向性训练在脑卒中后偏瘫康复中的应用进展[J]. 中国康复医学杂志, 2020, 35(3): 374-378. doi: 10.3969/j.issn.1001-1242.2020.03.026 LIU S W, GUAN M, GAO Q. Application progress of task-oriented training in rehabilitation of hemiplegia after stroke[J]. Chin J Rehabil Med, 2020, 35(3): 374-378. doi: 10.3969/j.issn.1001-1242.2020.03.026
[17]	王华勇, 周莉娜. 术后系统化康复功能锻炼在腰椎间盘突出症行经皮椎间孔镜技术治疗的辅助价值[J]. 颈腰痛杂志, 2019, 40(4): 512-514. doi: 10.3969/j.issn.1005-7234.2019.04.026 WANG H Y, ZHOU L N. Auxiliary value of postoperative systematic rehabilitation functional exercise in the treatment of lumbar disc herniation by percutaneous transforaminal endoscopic technique[J]. J Cervic Lumb, 2019, 40(4): 512-514. doi: 10.3969/j.issn.1005-7234.2019.04.026
[18]	吕智海, 寻冰冰, 缪文静, 等. 任务导向性训练对脑性瘫痪高危儿运动功能的影响[J]. 中国康复医学杂志, 2021, 36(8): 958-962. doi: 10.3969/j.issn.1001-1242.2021.08.010 LYU Z H, XUN B B, MIAO W J, et al. Effects of task oriented training on motor function of children with high risk of cerebral palsy[J]. Chin J Rehabil Med, 2021, 36(8): 958-962. doi: 10.3969/j.issn.1001-1242.2021.08.010
[19]	LYU Z, BAI J, CHEN S, et al. Efficacy of lumbar kinetic chain training for staged rehabilitation after percutaneous endoscopic lumbar discectomy[J]. BMC Musculoskelet Disord, 2021, 22(1): 793. DOI: 10.1186/s12891-021-04674-y.
[20]	陈姝. 围术期多层次护理需求在腰椎间盘突出症术后患者功能恢复中的作用[J]. 重庆医学, 2022, 51(S1): 312-314. CHEN S. Role of perioperative multi-level nursing needs in functional recovery of patients with lumbar disc herniation after operation[J]. Chongqing Med, 2022, 51(S1): 312-314.