| Background:With the aging phenomenon in China becoming more and more serious,the incidence of lumbar degenerative lesions is also increasing,which has a serious impact on the quality of life and social activities of patients.At present,it is believed that lumbar degeneration presents an irresistible trend in human development.the degeneration of the lumbar spine can cause disc degeneration and spatial reduction,resulting in instability of the facet joints of the vertebrae,and the formation of secondary osteophytes,spinal stenosis,disc herniation,ligament ischemia calcification,ligament and intervertebral disc space hematoma and other pathological changes.The direct consequence of these changes is nerve compression,psoas muscle damage,resulting in patients with pain in the waist and leg,nerve damage and other clinical conditions,disease development.When the degree is serious,can cause the patient lower extremity paralysis symptom,bring the patient not small trouble.It has been reported in the literature that the most common cause of pain in the waist and leg of middle-aged and elderly people over the age of 60 years is caused by the degeneration of the lumbar spine,and the people who work for long periods of time are the main victims of the disease.As an important hub of human activity,the lumbar spine is under great pressure all the time.All kinds of physical activity will increase the load of the lumbar spine.As the aging of the lumbar spine,the lumbar spine will also degenerate,and the long overload load and excessive activity will lead to this degeneration of the lumbar spine accelerated,the lumbar spine structure pathological changes.After that,pain in the waist and leg as well as neurological dysfunction are called lumbar degenerative diseases.Lumbar degenerative disease is common in clinic and is the main cause of motor function limitation in middle-aged and elderly people.Objective:Treatment of lumbar degenerative disease has been a hot topic for clinicians,but how to improve patients’ symptoms and quality of life and restore their original functional state after lumbar degenerative disease is the focus of attention of our rehabilitation workers.At present,the perioperative rehabilitation plan for patients undergoing posterior lumbar graft fusion surgery is still controversial and imperfect.Therefore,this study is especially aimed at the patients after single-segment lumbar fusion,through the design of scientific perioperative rehabilitation program combined with simplified five-fowl play,group intervention to observe whether the patients can effectively improve the postoperative lumbar function,improve the postoperative residual low back pain patients to prevent degeneration of adjacent segments and paravertebral muscle atrophy.It is expected that the results of this study can provide reference suggestions for patients undergoing lumbar segmental bone graft fusion and improve the quality of life after operation.Methods of study:The patients who were randomly selected from the newly admitted patients in the four spinal areas of Tianjin Hospital,and after admission examination and imaging examination,met the requirements of the experiment,were diagnosed as lumbar degenerative disease,and the patients who underwent single segment bone grafting fusion in the selected stage were informed consent.After signing the informed consent,40 subjects(24 women and 16 men)were determined to enter the experiment,and 40 subjects were divided into two groups of 20 patients in each group for 12weeks(12 weeks after operation).Both groups were given pre-operative education including changing bad living habits and the correct idea of bending from the hip;simplifying the five-fowl play group: performing exercise with simplified five-fowl play,40 m in/ times,five times per week;traditional lumbar dorsal muscle group:traditional lumbar dorsal muscle exercise(five points support and Xiaoyanfei training),40 min/ times,five times per week.The basic information,relevant information and imaging data of all subjects on admission were collected and kept.The data and imaging data of all subjects were collected again at three months after operation.the pain simulation score scale(VAS),the lumbar functional assessment scale(ODI)and the ZWCAD+ software were used to calculate the patient’s proximal segment degeneration,as well as the paravertebral muscle area and change rate.The scores of pain index,lumbar functional score and paravertebral muscle surface were recorded before and after the experiment the rate of product change and the degeneration of adjacent segments include intervertebral height,intervertebral angle, and vertebral body slip.the obtained data are processed by SPSS 22.0 statistical software,independent sample T test,rank sum test and nonparametric test-multiple independent sample rank sum test(Kruscal Wallis H test).Results:1.a total of 40 subjects were enrolled in this experiment.Both groups had the same baseline data and no significant difference in general data(P>0.05).2.VAS score: there was no statistical difference in VAS scores between the two groups before operation(P>0.05).the VAS scores of the subjects in the two groups after three months were statistically different from those before operation(P<0.05).The scores of one month and three months after operation VAS the two groups were statistically significant(P<0.05).3.ODI score: there was no significant difference ODI scores between the two groups before operation(P>0.05).There was a statistical difference in ODI scores between the two groups before and three months after operation(P<0.05).The ODI scores of subjects in the two groups were statistically different(P<0.05).4.paravertebral muscle area size and change rate: there was no statistical difference in paravertebral muscle area size between the two groups before and three months after operation(P>0.05).between the simplified five-fowl play group and the traditional rehabilitation group,there was a statistical difference in the area of paravertebral muscle before and after surgery(P<0.05).Before and after the operation,there was a statistical difference in the change rate of paravertebral muscle area between the two groups(P<0.05).5.height changes between adjacent segments of the vertebral body: there was no statistical difference in height between the two groups of subjects before operation(P>0.05).Before and after the operation,there was a statistical difference in the difference of intervertebral height decline between the two groups(P<0.05).After operation,there was a statistical difference in intervertebral height between the simplified five-fowl play group and the traditional lumbar dorsal muscle training group(P<0.05).between the two groups,the degree of intervertebral height decline was statistically different(P<0.05).6.angle changes between adjacent segments of the vertebral body: there was no statistical difference in adjacent segment vertebral body slip between the two groups before operation(P>0.05).before and after surgery,the values of decreased intervertebral height in the two groups were statistically different(P<0.05).After operation,there was a statistical difference between the five birds play group and the traditional rehabilitation training group(P<0.05).between the two groups,there was a7.statistical difference in the slip difference between the adjacent segments of the vertebral body(P<0.05).8.vertebral body slip changes in adjacent segments: there was no statistical difference in the angle between adjacent segments in the two groups before operation(P>0.05).Before and after the operation,there was a statistical difference in intervertebral angle formation between the two groups(P<0.05).After operation,there was a statistical difference between the adjacent segmental intervertebral angles between the subjects in the simplified five-fowl play group and the traditional rehabilitation training group(P<0.05).difference between the two groups was statistically different(P<0.05).Conclusions:1.The results showed that the five-fowl play training and the traditional psoas muscle training were effective in reducing postoperative pain and improving lumbar function.2.The simplified five-fowl play training and traditional lumbar dorsal muscle training were effective in preventing the degeneration of adjacent segments,including the height,angle and slip of the vertebral body.Moreover,the simplified five-fowl play training was more effective in preventing the degeneration of adjacent segments than traditional lumbar dorsal muscle training.3.After three different interventions,there was no obvious degeneration of adjacent intervertebral disc in the two groups,which indicated that the two interventions were safe and effective. |
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