腰椎术后康复锻炼指导学习培训课件

2年来劳累后出现腰背部疼痛，伴双下肢疼痛不适，休息可缓

解。反复发病。近半年疼痛疼痛频繁，平躺无明显不适，站

立及活动疼痛加重，行走约100米出现双下肢疼痛无力症状。查

体

：腰骶部压痛(+),双侧小腿外侧、足背感觉减退。

SLR(-)64

岁女性主因：腰痛伴双下肢疼痛不适2年，加重半年54Y期：2018-17-02:2018-11-02062

1.171影像号：0342608检查号：547655影像号?检查号：右L4/5诊断：腰椎管狭窄症(L3/44/5)治疗：PTLIF(L3-5)e

话

禁

址☆兰顺复目2

37139术后二一真下肢疼痛症状完全缓解，行走无不适，但长时间步行后背部疼痛。弯腰及久站背部疼痛加重术后1年随访4!L什么原因?

t+Comparisonofparaspinal

muscle

degenerationand

decompressioneffect

between

conventional

open

andminimal

invasiveapproaches

for

posterior

lumbarspine

surgeryChen-Ju

Fu³,2.5,Wen-Chien

Chen¹,3.5,Meng-Ling

Lu3,.5,Chih-Hsiu

Cheng³,6&Chi-Chien

Niu¹,5,72Laminotomy

and

transforaminal

lumbar

interbody

fusion(TLIF)is

usually

used

to

treat

unstable

spinastenosis.Minimally

invasive

surgery(MIS)can

cause

less

muscle

injury

than

conventional

open

surger(COS).Thepurposeofthisstudywastocomparethedegree

ofpostoperative

fatty

degenerationinthe

paraspinal

musclesandthespinaldecompression

betweenCOS

and

MIS

based

on

MRI.Forty-sixpatients

received

laminotomy

andTLIF(21COS,25MIS)from

February2016to

January2017were

included

in

this

study.Lumbar

MRI

was

performed

within

3

months

before

surgery

and

1yearafter

surgery

to

compare

muscle-fat-index(MFI)change

oftheparaspinal

musclesand

the

dural

saccross-sectional

area(DSCAS)change.The

average

MFI

change

at

L2-S1erector

spinae

muscle

wassignificantly

greater

in

the

COS

group(27.37±21.37%vs.14.13±19.19%,P=0.044).A

significantMFIchangedifferencebetweentheCOSand

MIS

groupwas

alsofound

in

the

erector

spinae

muscleat

the

caudaladjacent

level

(54.47±37.95%vs.23.60±31.59%,P=0.016).DSCSA

improvement

wassignificantly

greaterin

the

COS

group(128.15±39.83mm²vs.78.15±38.5mm²,P=0.0005).COSisassociated

with

more

prominent

fatty

degeneration

of

the

paraspinal

muscles.Statically

significantpost-operative

MFI

changewas

only

noted

in

erectorspinae

muscle

at

caudal

adjacent

level

and

L2-S1meanglobal

level.COS

producesagreaterareaofdecompressiononfollow

up

MRI

than

MISwith

nostatisticalsignificanceonclinicalgrounds.6040-20-MF

ESmuscleL2-S1

average10080FI

change(%)空军军馨大学腰椎术后康复锻炼指导汇报人：董鑫

Dongxin

spine回AAOS骨科术后康复PostoperativeOrthopaedicRehabilitation1)安感器

-

cGcod(218or³irou1三T

c(oC

Hor土

课

2

5

2

描腰椎融合术后如何康复锻炼A

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0

s

骨

科

术

后

康

复4

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9

时5成止世锻炼方案推荐术后1周：1.牵拉训练：防止神经根粘连，激活肌肉(术后当日开始)2.静力核心肌群稳定性训练：增强腰背肌稳定性(术后当日开始)术后6周：1.动态躯干稳定性训练：增强力量及稳定性术后9周：有氧运动术后12周：可耐受的体力活动牵拉训练腘绳肌牵拉锻炼术后当日开始

3次/2组股四头肌牵拉锻炼术后当日开始

3次/2组稳定性训练骨盆后倾训练(2次/2组)目标肌群：竖脊肌、背阔肌100惚定性训练骨盆后倾训练(2次/2组)目标肌群：竖脊肌、背阔肌静态稳定性训练卧位行军(30

秒/4组)目标肌群：股四头肌静态稳定性训练桥式运动(5~10次/4组)目标肌群

臀肌、股四头肌、腹肌婴静态稳定性训练坐姿划船运动(5次/2组)目标肌群：斜方肌、背阔肌、竖脊肌静态稳定性训练背部伸展(3次30

秒/2组)目标肌群：斜方肌、背阔肌、竖脊肌动态稳定性训练对角卷腹(5~1

)脊肌、腹肌、腰方肌：竖组目标肌群0次/2动态稳定性训练手膝位交叉伸展训练(3~5次10秒/2组)目标肌群：斜方肌、竖脊肌、三角肌、臀大肌、股四头肌14动态稳定性训练斜拉训练(5~10次/2组)目标肌群：腹肌、三角肌、背阔肌1动态稳定