关键词: 老年人, 中年人, 结核, 脊柱, 手术后医护, 早日下床活动, 疗效比较研究

Abstract:

Objective To explore the long-term effect of retrograde resistance exercise on postoperative rehabilitation of middle-aged and elderly patients with spinal tuberculosis complicated with osteoporosis.Methods From May 2014 to September 2016, 108 cases of middle-aged and old patients with spinal tuberculosis complicated with osteoporosis were admitted to the Spinal Minimally Invasive Department of the Eighth Medical Center of PLA General Hospital (the 309th Hospital of PLA), among whom 40 cases were selected randomly (control group). From October 2016 to May 2018, 92 middle-aged and old patients with spinal tuberculosis complicated with osteoporosis were admitted to the same department, among whom 40 patients were selected randomly (observation group). In the control group, the patients received routine functional exercise after the debridement and bone graft fixation, and patients of the observation group received retrograde resistance exercise by wearing a brace in the condition that the plate was well fixed by CT examination on the 14th day after the surgery. Disability index (ODI), intervertebral bone graft block total integration, functional recoveryⅠlevel degree, bone mineral density (BMD) of the right femoral neck were compared between the two groups of patients after 1 month, 3 months and 6 months discharged from hospital.Results The ODI of the patients of observation group were (10.35±3.26), (8.86±2.94) and (6.78±2.84) respectively after 1 month, 3 months and 6 months discharge, which were significantly lower than those of the control group ((12.34±3.56), (10.95±3.12) and (8.94±2.76) respectively) (t=2.607, 3.083, 3.449, P=0.005, 0.001, 0.000). The numbers of patients with the intervertebral bone graft fusion of recorery Ⅱ level in observation group were 5 (12.5%), 30 (75.0%) and 40 (100.0%) after 1 month, 3 months and 6 months respectively, which were significantly higher than those in control group (0 (0.0%), 20 (50.0%) and 34 (85.0%) respectively) (χ ²=5.333, 5.333, 6.486, P=0.021, 0.021, 0.011). The numbers of patients with the function of recovery I level in observation group were 5 (12.5%), 15 (37.5%) and 35 (87.5%) respectively, which were also significantly better than those in control group (0 (0.0%), 6 (15.0%), and 26 (70.0%)) (t=5.333, 5.230, 5.591, P=0.021, 0.022, 0.018). The BMD of the right femoral neck in observation group were (0.45±0.02)g/cm ², (0.47±0.02)g/cm ² and (0.47±0.03)g/cm ² respectively after 1 month, 3 months and 6 months, which were lower than those of control group ((0.46±0.01)g/cm ², (0.46±0.03)g/cm ², (0.46±0.02)g/cm ²)). There were significant differences of BMD of the right femoral neck after 3 months and 6 months between the two groups (t=1.701, 1.682, P=0.046, 0.048). Conclusion The intervention of retrograde resistance movement is conducive to postoperative functional recovery, complete fusion recovery of intervertebral bone grafts, and increase of bone density in the right femoral neck, and in order to promote the recovery of patients.

Key words: Aged, Middle aged, Tuberculosis, spinal, Postoperative care, Early ambulation, Comparative effectiveness research