A study on the role of remote, phased core exercise nursing guidance in postoperative patients with lumbar disc herniation
远程阶段性核心运动护理指导在腰椎间盘突出症术后患者中的作用探讨

摘要

目的 明确基于数字技术的多模态远程干预方案对改善腰椎间盘突出症患者术后功能转归的临床价值。方法 2024年1月至12月期间纳入50例行椎间孔镜下髓核摘除术的单节段L4/L5、L5/S1椎间盘突出患者，随机分为对照组和干预组各25例。对照组行常规出院指导配合门诊复诊，干预组实施云端平台支持的阶段性核心肌群训练计划。结果 术后12周干预组JOA评分提升幅度（18.35±2.21 vs 15.72±1.84）显著高于对照组（t=6.432, P<0.001）；ODI指数下降差值（25.73%±4.18% vs 19.25%±3.76%）具有统计学意义（t=5.893, P<0.001）；VAS评分夜间痛缓解率（82.14% vs 64.29%）及核心肌群最大自主收缩力提升率（34.72% vs 21.05%）更优（χ²=4.267, P=0.039）。随访24周MRI显示干预组椎间隙高度维持率（89.66%±4.33%）高于对照组（83.21%±5.17%）（t=3.812, P=0.001）。结论 智能化远程阶段性核心训练系统可显著优化患者术后脊柱动力学稳定性建立过程，降低功能失代偿风险，其数字化监测路径为脊柱微创手术康复模式提供了循证支持。

Abstract

Objective To clarify the clinical value of a multimodal remote intervention program based on digital technology in improving postoperative functional outcomes for patients with lumbar disc herniation.
Methods From January to December 2024, 50 patients undergoing endoscopic transforaminal discectomy for single-segment L4/L5 or L5/S1 disc herniation were enrolled and randomly divided into a control group and an intervention group, with 25 cases each. The control group received routine discharge guidance and outpatient follow-up, while the intervention group implemented a phased core muscle training program supported by a cloud-based platform.
Results At 12 weeks postoperatively, the JOA score improvement in the intervention group (18.35±2.21 vs. 15.72±1.84) was significantly higher than that in the control group (t=6.432, P<0.001). The ODI index reduction difference (25.73%±4.18% vs. 19.25%±3.76%) was statistically significant (t=5.893, P<0.001). The intervention group also demonstrated better outcomes in nocturnal pain relief rate (82.14% vs. 64.29%) and maximal voluntary contraction force of core muscles (34.72% vs. 21.05%) (χ²=4.267, P=0.039). At 24-week follow-up, MRI showed a higher intervertebral disc height maintenance rate in the intervention group (89.66%±4.33%) compared to the control group (83.21%±5.17%) (t=3.812, P=0.001).
Conclusion   An intelligent remote phased core training system can significantly optimize the postoperative spinal dynamic stability establishment process, reduce the risk of functional decompensation, and its digital monitoring pathway provides evidence-based support for minimally invasive spinal surgery rehabilitation models.