【摘要】 目的 探讨腰椎间盘突出症（LDH）术后患者实施普拉提运动结合认知行为疗法后的疼痛程度及腰椎功能变化。方法 选取2020年1月—2022年1月医院收治的LDH术后患者560例为研究对象，按照组间基本特征具有可比性的原则分为观察组和对照组，各280例。对照组实施常规护理，观察组在对照组基础上实施普拉提运动联合认知行为疗法。两组均干预至术后6个月。比较两组干预后的康复效果、遵医行为评分，干预前后的慢性疼痛自我效能感量表（CPSS）、日本骨科协会评分（JOA）、恐动症评估量表（TSK）、改良Barthel指数（MBI）、出院准备度量表（RHDS）评分及腰椎关节活动度。结果 普拉提运动干预后，观察组的康复效果优于对照组，差异有统计学意义（P<0.05）。普拉提运动干预前，两组CPSS的症状应对、躯体功能、疼痛管理评分比较差异无统计学意义（P>0.05）；干预后，观察组CPSS的症状应对、躯体功能、疼痛管理评分高于对照组，差异有统计学意义（P<0.05）。普拉提运动干预前，两组JOA的膀胱功能、日常活动受限、临床体征、主观症状评分比较差异无统计学意义（P>0.05）；干预后，观察组JOA的膀胱功能、日常活动受限、临床体征、主观症状评分高于对照组，差异有统计学意义（P<0.05），说明观察组腰椎功能优于对照组。普拉提运动干预前，两组TSK、MBI、RHDS评分比较差异无统计学意义（P>0.05）；干预后，观察组TSK评分低于对照组，观察组MBI、RHDS评分高于对照组，差异有统计学意义（P<0.05），说明对照组恐动症较观察组严重，观察组日常活动能力、出院准备度好于对照组。普拉提运动干预后，观察组的遵医嘱佩戴腰围、严格遵医锻炼、无过度弯腰动作、每天开展功能锻炼、出院后遵医行为评分高于对照组，差异有统计学意义（P<0.05），说明观察组康复训练遵医行为优于对照组。普拉提运动干预前，两组腰椎前屈、腰椎后伸的活动度比较差异无统计学意义（P>0.05）；干预后，观察组腰椎前屈、腰椎后伸的活动度大于对照组，差异有统计学意义（P<0.05）。结论 LDH术后患者实施普拉提运动结合认知行为疗法可有效提升康复训练遵医行为，提升自我效能，加速腰椎功能的恢复，减轻恐动症，提升日常活动能力和出院准备度，康复效果满意。更多还原

【Abstract】 Objective To investigate the degree of pain and changes in lumbar function in postoperative patients with lumbar disc herniation(LDH) who underwent Pilates exercise combined with cognitive behavioral therapy.Methods A total of 560 postoperative LDH patients admitted to the hospital from January 2020 to January 2022were selected as the research subjects. They were divided into an observation group and a control group based on the principle of comparability of basic characteristics between groups, with 280 patients in each group. The control group received routine care, while the observation group received Pilates exercise combined with cognitive behavioral therapy on the basis of the control group. Both groups were intervened until 6 months after surgery. The rehabilitation effects, compliance behavior scores, chronic pain self-efficacy scale(CPSS), Japanese Orthopaedic Association score(JOA), Tampa scale for kinesiophobia(TSK), modified Barthel index(MBI), readiness for hospital discharge scale(RHDS) scores, and lumbar joint range of motion before and after intervention were compared between the two groups. Results After the Pilates exercise intervention, the rehabilitation effect in the observation group was better than that in the control group, and the difference was statistically significant(P<0.05). Before the Pilates exercise intervention, there was no statistically significant difference in symptom response, physical function, and pain management scores between the two groups of CPSS(P>0.05). After intervention, the symptom response, physical function, and pain management scores of CPSS in the observation group were higher than those in the control group, and the differences were statistically significant(P<0.05). Before the Pilates exercise intervention, there was no statistically significant difference in bladder function, daily activity limitation, clinical signs, and subjective symptom scores between the two groups of JOA(P>0.05). After intervention, the bladder function, daily activity limitation, clinical signs, and subjective symptom scores of JOA in the observation group were higher than those in the control group, and the differences were statistically significant(P<0.05). Before the Pilates exercise intervention, there was no statistically significant difference in TSK, MBI and RHDS scores between the two groups(P>0.05). After intervention, the TSK score in the observation group was lower than that in the control group, the MBI and RHDS scores in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05). After Pilates exercise intervention, the observation group showed higher compliance with medical advice in wearing waist circumference, strict adherence to medical exercise, no excessive bending movements, daily functional exercise, and higher compliance behavior scores after discharge compared to the control group, and the differences were statistically significant(P<0.05). Before the Pilates exercise intervention, there was no statistically significant difference in activity of lumbar flexion and lumbar extension between the two groups(P>0.05). After intervention, the activity of lumbar flexion and lumbar extension in the observation group was greater than that in the control group, and the differences were statistically significant(P<0.05). Conclusion The implementation of Pilates exercise combined with cognitive behavioral therapy in postoperative patients with LDH can effectively improve rehabilitation training compliance behavior,enhance self-efficacy, accelerate the recovery of lumbar function, reduce fear of movement, improve daily activity ability and discharge readiness, and achieve satisfactory rehabilitation results.更多还原