2013-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/659193摘要：背景:當腰椎相關疾病使用保守性治療無法達到預期效果後，腰椎融合術為最常見的手術療法。然而許多研究指出，多數接受腰椎融合術的病人具高度再次手術的風險。手術後開刀處的肌肉會有水腫、萎縮或脂肪浸潤的現象，造成無力和疼痛。又接受融合術後的脊椎因動作受到限制，促使鄰近椎節產生過度的代償動作，進而增加其脊椎退化的速度。故如何保護開刀後的脊椎，避免脊椎的再次傷害，是臨床上面臨的困境，但卻鮮少有相關的研究提供適宜的術後評估與復健。已有證據顯示核心肌群在穩定與支持脊椎上扮演重要角色，腰椎融合術造成鄰近節過度代償的動作，是否可用核心肌群穩定運動來強化術後脊椎的穩定度，目前國內外皆無此類的研究。因此本研究將探索脊椎周圍的核心肌群對腰椎融合手術成果的重要性。本研究為三年期計畫，將有層次性及系統性地探索此問題，其具體研究目的如下:目的:本研究為期三年的計劃中，我們預期達到下列幾個目的：目的 1. 建立以功能性動作中之生物力學變化以及核磁共振影像為指標的評估模式，以評估腰椎融合手術後病患之核心肌群的肌肉活動型態與核磁共振影像間的關聯目的 2. 探討在微創腰椎融合手術後接受以核心肌群訓練為主的早期復健運動之療效目的 3. 探究接受微創腰椎融合手術後，核心肌群其術後短期與長期之影響，與再次手術發生之情形方法：第一年 (目的1)：收集50 名即將接受微創腰椎融合手術之病人，觀察其執行功能性伸取動作、平靜站立與行走之動作學、力學與肌肉活動型態的表現，再根據核磁共振影像將脊椎相鄰肌肉之脂肪含量分級。最後使用皮爾森相關係數測試，檢驗功能性活動表現與肌肉內脂肪含量之相關性。第二年 (目的2)：將50 名接受微創腰椎融合術後2 個星期的病人，隨機分配到實驗組(n=25)與控制組(n=25)，實驗組將接受為期6 週、每週3 次之核心肌群訓練，控制組則不接受任何運動訓練介入。成果評估將採用與目的1 相同的方式，惟核磁共振影像將於術後6 個月才進行追蹤。組間與組內之差異將利用重複多項次變數分析法進行檢驗。第三年 (目的3)：將長期追蹤目的2 中接受微創腰椎融合手術之病人。評估的時間點定於術後6個月與1 年。成果評估採用與目的1 相同的方式。組間與組內之差異將利用重複多項次變數分析法進行檢驗。另外，將長期記錄病患再接受脊椎手術的次數。預期結果與貢獻：本研究結果將提供微創腰椎融合手術後的實證復健指引，進而減低腰椎疾患病人再次手術的機率。本土接受微創腰椎融合術之病人資料庫將會被建立並長期追蹤病人術後脊椎退化的情形。藉由生物力學與影像醫學的分析，將對患者手術前後動作控制系統與脊椎穩定度也將有全面的瞭解，有助於日後更有效的治療腰椎疾病的患者，改善及增進其生活品質。<br> Abstract: Background:Lumbar fusion has been widely used for spinal disorders when conservative treatment has failed.However, a number of studies have reported that the rate of re-operation is high for lumbar fusion surgery.Swelling, atrophy or fat infiltration of the paraspinal muscles at the surgery site can cause weakness and pain.After fusion, the range of motion is constrained at the fused spine and might facilitate compensativemovement of the adjacent levels and increase degeneration rate of the spine.Evidence has shown that core muscles play an important role to stabilize and support the spine. Whethercore stability exercise can enhance spinal stability after lumbar fusion surgery remains unclear. Therefore, theoverall goal of this proposed research is to investigate how core muscles affect outcomes after lumbar spinalfusion. We will explore this issue hierarchically and systematically in 3-year duration. The specific aims ofthe proposed study are as follows:Specific Aims:In this 3-year study, we propose to achieve the following specific aims:Aim 1. To establish an assessment model using biomechanical changes during functional activitiesand magnetic resonance imaging (MRI) to identify the causal relationship between coremuscles activation pattern and pathological changes in patients with lumbar fusion.Aim 2. To investigate the effectiveness of early rehabilitation by core stability exercise afterminimally invasive lumbar spinal fusion surgery.Aim 3. To determine short and long-term outcomes of core muscles and re-operation status afterminimally invasive lumbar spinal fusion surgery.Methods:Year 1(Aim 1): Kinematic, kinetic, and muscle activation pattern in functional reach, quiet stanceand gait will be recorded in 50 patients before minimally invasive lumbar spinal fusionsurgery. Fat infiltration of the cross-sectional area of paraspinal muscles will be graded byMRI. The correlation between performance of function activities and fat infiltration of theparaspinal muscle will be determined using Person’s correlation coefficient test.Year 2(Aim 2): Fifty patients who underwent minimally invasive lumbar spinal fusion surgery in 2weeks will be allocated to experimental (n=25) and control (n=25) groups using a randomnumbers table. The experimental group will receive core stability exercise training 3 times perweek for 6 weeks. The control group will not receive any exercise. Outcome measures will bethe same as those in Aim 1, except the MRI will be taken 6 months after surgery. Thedifference between and within groups in outcome measures will be examined by repeatedMeasures Multivariate Analysis of Variance (MANOVA).Year 3(Aim 3): Follow-up assessments for the patients recruited in Aim 2 will be conducted at 6months and 1 year after minimally invasive lumbar spinal fusion surgery. Outcome measureswill be the same as those in Aim 1. The difference between and within groups in outcomemeasures will be examined by repeated MANCOVA. The re-operation status will be recordedfrom the first surgery.Expected Outcome and Significance:The results of this proposed research will provide an evidence-based guideline for postsurgicalrehabilitation in minimally invasive lumbar fusion surgery and decrease the re-operation rate for patients withlumbar spine disorder. A local Taiwanese database for long-term effects on spine degeneration afterminimally invasive lumbar spinal fusion surgery will also be established. Knowledge of the observedbiomechanical and clinical changes after minimally invasive lumbar fusion will help腰椎融合核心肌群術後復健生物力學lumbar fusioncore musclespostsurgical rehabilitationbiomechanics