腰椎间盘突出症患者脊柱内镜术后核心肌群训练护理方案的构建及应用

doi:10.3761/j.issn.0254-1769.2026.17.008

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (17): 2358-2366.DOI: 10.3761/j.issn.0254-1769.2026.17.008

腰椎间盘突出症患者脊柱内镜术后核心肌群训练护理方案的构建及应用

马杰¹(), 张丽¹, 李娜¹, 朱坤¹, 叶雨辰¹, 陈永侠²^,^*()

¹ 蚌埠医科大学第一附属医院骨科蚌埠市 233000
² 蚌埠医科大学第一附属医院护理部蚌埠市 233000

收稿日期:2026-04-11 出版日期:2026-09-10 发布日期:2026-09-03
*通讯作者: 陈永侠，E-mail：1051893695@qq.com
作者简介:马杰：女，本科，副主任护师，护士长，E-mail：majie0552@163.com
第一联系人：
作者贡献声明 马杰：研究设计、方案构建、研究实施、数据收集与整理、统计学分析、论文撰写；张丽、李娜：研究实施、数据收集与整理、患者随访、质量控制；朱坤、叶雨辰：文献检索与证据整合、专家函询资料整理；陈永侠：研究指导、经费支持、论文审阅与修改
基金资助:
安徽省临床医学研究转化专项项目(202527c1002012)

Development and application of a nursing care program for core muscle training for patients with lumbar disc herniation after endoscopic spine surgery

MA Jie¹(), ZHANG Li¹, LI Na¹, ZHU Kun¹, YE Yuchen¹, CHEN Yongxia²^,^*()

¹ Department of Orthopedics， the First Affiliated Hospital of Bengbu Medical University， Bengbu 233000， China
² Department of Nursing， the First Affiliated Hospital of Bengbu Medical University， Bengbu 233000， China

Received:2026-04-11 Online:2026-09-10 Published:2026-09-03
* Corresponding author: CHEN Yongxia，E-mail：1051893695@qq.com
Funding program:
Anhui Province Clinical Medicine Research and Translation Special Project(202527c1002012)

摘要/Abstract

摘要：

目的构建腰椎间盘突出症患者脊柱内镜术后核心肌群训练护理方案，并评价其应用效果，为临床护理实践提供参考。方法通过检索、评价和整合相关证据，并经2轮专家函询，构建核心肌群训练护理方案。采用便利抽样法，选取2024年10月—2025年12月在安徽省某三级甲等医院骨科住院并拟首次接受手术治疗的腰椎间盘突出症患者120例作为研究对象。采用随机数字表法，分为试验组和对照组，每组各60例。试验组在标准化常规术后康复指导基础上实施核心肌群训练护理方案，正式训练自术后24 h开始，持续至术后3个月；对照组接受标准化常规术后康复指导。比较两组术前24 h内及术后3个月的疼痛视觉模拟评分、删减版Oswestry功能障碍指数评分、日本骨科学会评分、36条目简明健康调查量表得分及腰椎多裂肌表面肌电图指标。结果形成包括3个阶段的核心肌群训练护理方案。两组均完成术后随访。术后3个月，试验组疼痛视觉模拟评分低于对照组，日本骨科学会评分、36条目简明健康调查量表得分及腰椎多裂肌表面肌电图最大自主收缩的标准化均方根值和中位频率均高于对照组，差异均有统计学意义（均P<0.05）。结论该研究构建的核心肌群训练护理方案有助于缓解腰椎间盘突出症患者脊柱内镜术后疼痛，促进腰椎功能恢复，改善健康相关生活质量及腰椎多裂肌部分表面肌电指标。

关键词: 腰椎间盘突出症, 椎间孔镜术, 运动疗法, 康复护理, 术后护理, 生活质量

Abstract:

Objective To develop a structured early core muscle training program for patients with lumbar disc herniation after transforaminal endoscopic spine surgery and to evaluate its effectiveness，thereby providing a reference for nursing practice. Methods Relevant evidence was systematically retrieved，appraised，and synthesized，and a structured early core muscle training program was developed through 2 rounds of Delphi expert consultation. The convenience sampling was used to recruit 120 patients with lumbar disc herniation who were admitted to the Department of Orthopedics of a tertiary grade A hospital in Anhui Province and underwent surgery between October， 2024 and December，2025 as study participants. Participants were randomly assigned to an intervention group or a control group using a random-number table，with 60 patients in each group. In addition to standardized routine postoperative rehabilitation guidance，the intervention group received the structured early core muscle training program. Formal training commenced 24 h after surgery and continued until 3 months postoperatively. The control group received standardized routine postoperative rehabilitation guidance. The visual analogue scale score for pain，modified Oswestry Disability Index score，Japanese Orthopaedic Association score，36-Item Short Form Health Survey composite score，and surface electromyographic parameters of the lumbar multifidus muscles were compared between the 2 groups within 24 h before surgery and at 3 months after surgery. Results The final structured early core muscle training program comprised 3 first-level indicators，9 second-level indicators，and 26 third-level indicators. All participants completed the 3-month follow-up. At 3 months after surgery，the intervention group had a lower visual analogue scale score and higher Japanese Orthopaedic Association score，36-Item Short Form Health Survey composite score，root mean square value normalized to maximum voluntary contraction[RMS（%MVC）]，and median frequency than the control group，with all between-group differences being statistically significant（all P<0.05）. Conclusion The structured early core muscle training program developed in this study may help reduce pain，promote lumbar functional recovery，improve health-related quality of life，and improve selected surface electromyographic parameters of the lumbar multifidus muscles in patients with lumbar disc herniation after transforaminal endoscopic spine surgery.

Key words: Lumbar Disc Herniation, Transforaminal Endoscopic Spine Surgery, Exercise Therapy, Rehabilitation Nursing, Postoperative Care, Quality of Life

马杰, 张丽, 李娜, 朱坤, 叶雨辰, 陈永侠. 腰椎间盘突出症患者脊柱内镜术后核心肌群训练护理方案的构建及应用[J]. 中华护理杂志, 2026, 61(17): 2358-2366.

MA Jie, ZHANG Li, LI Na, ZHU Kun, YE Yuchen, CHEN Yongxia. Development and application of a nursing care program for core muscle training for patients with lumbar disc herniation after endoscopic spine surgery[J]. Chinese Journal of Nursing, 2026, 61(17): 2358-2366.

图/表 5

表1 核心肌群训练护理方案内容

Table 1 Contents of the nursing care program for core muscle training

表2 两组一般资料的比较

Table 2 Comparison of baseline characteristics between the 2 groups

表3 两组术前24 h内及术后3个月疼痛视觉模拟评分比较[分，M（P25，P75）]

Table 3 Comparison of visual analogue scale scores between the 2 groups within 24 h before surgery and at 3 months after surgery[scores，M（P25，P75）]

表4 两组术前24 h内及术后3个月删减版Oswestry功能障碍指数评分、日本骨科学会评分及36条目简明健康调查量表得分比较（分，$\overline{x}\pm s$）

Table 4 Comparison of modified Oswestry Disability Index scores，Japanese Orthopaedic Association scores，and 36-item Short-Form Health Survey composite scores between the 2 groups within 24 h before surgery and at 3 months after surgery（scores，$\overline{x}\pm s$）

表5 两组术前24 h内及术后3个月核心肌群表面肌电图指标比较（$\overline{x}\pm s$）

Table 5 Comparison of surface electromyography indicators of the core muscles between the 2 groups within 24 h before surgery and at 3 months after surgery（$\overline{x}\pm s$）

参考文献 26

[1]	中华医学会骨科学分会脊柱外科学组, 中华医学会骨科学分会骨科康复学组. 腰椎间盘突出症诊疗指南[J]. 中华骨科杂志, 2020, 40(8):477-487.
	Chinese Orthopaedic Association Spine Surgery Group, Chinese Orthopaedic Association Orthopaedic Rehabilitation Group. Clinical practice guideline for diagnosis and treatment of lumbar disc herniation[J]. Chin J Orthop, 2020, 40(8):477-487.
[2]	Pan MM, Li QF, Li SC, et al. Percutaneous endoscopic lumbar discectomy:indications and complications[J]. Pain Physician, 2020, 23(1):49-56.
[3]	Brotis AG, Kalogeras A, Spiliotopoulos T, et al. Physical therapies after surgery for lumbar disc herniation-evidence synthesis from 55 randomized controlled trials(RCTs) and a total of 4,311 patients[J]. Brain Spine, 2025, 5:104238. DOI URL
[4]	Yu HN, Cancelliere C, Mior S, et al. Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery:a systematic review[J]. Brain Spine, 2024, 4:102806. DOI URL
[5]	Lyu Z, Bai JZ, Chen SZ, et al. Efficacy of lumbar kinetic chain training for staged rehabilitation after percutaneous endoscopic lumbar discectomy[J]. BMC Musculoskelet Disord, 2021, 22(1):793. DOI
[6]	Zhang R, Zhang SJ, Wang XJ. Postoperative functional exercise for patients who underwent percutaneous transforaminal endoscopic discectomy for lumbar disc herniation[J]. Eur Rev Med Pharmacol Sci, 2018, 22(1 Suppl):15-22.
[7]	汪四花, 王华芬, 马姚静, 等. 运动疗法在腰椎退行性疾病患者脊柱融合术后康复中的作用[J]. 中华护理杂志, 2012, 47(11):984-986.
	Wang SH, Wang HF, Ma YJ, et al. Effects of exercise therapy on rehabilitation after spinal fusion in patients with lumbar degenerative diseases[J]. Chin J Nurs, 2012, 47(11):984-986.
[8]	Chang MC, Park D, Kim JH, et al. Effect of exercise on stabilizing and strengthening core muscles for patients with herniated lumbar disc:a systematic review and meta-analysis[J]. Asian J Surg, 2024, 47(1):731-733. DOI URL
[9]	郑海伦, 王珊, 郭金花, 等. 核心肌群训练对腰椎间盘突出患者术后康复的影响[J]. 国际护理学杂志, 2021, 40(15):2782-2786.
	Zheng HL, Wang S, Guo JH, et al. Effect of core muscle group training on postoperative rehabilitation of patients with lumbar disc herniation[J]. Int J Nurs, 2021, 40(15):2782-2786.
[10]	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ:advancing guideline development,reporting and evaluation in health care[J]. Can Med Assoc J, 2010, 182(18):E839-E842.
[11]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research:the quality evaluation of diagnostic and economic evaluation[J]. J Nurses Train, 2018, 33(8):701-703.
[12]	McArthur A, Klugárová J, Yan H, et al. Innovations in the systematic review of text and opinion[J]. Int J Evid Based Healthc, 2015, 13(3):188-195. DOI URL
[13]	Fairbank JC, Couper J, Davies JB, et al. The Oswestry Low Back Pain Disability Questionnaire[J]. Physiotherapy, 1980, 66(8):271-273. PMID
[14]	Liu H, Tao HR, Luo ZJ. Validation of the simplified Chinese version of the Oswestry Disability Index[J]. Spine, 2009, 34(11):1211-1216. DOI PMID
[15]	Azimi P, Mohammadi HR, Montazeri A. An outcome measure of functionality and pain in patients with lumbar disc herniation:a validation study of the Japanese Orthopedic Association(JOA) score[J]. J Orthop Sci, 2012, 17(4):341-345. DOI URL
[16]	Ware JE Jr, Sherbourne CD. The MOS 36-item Short-Form Health Survey(SF-36). I. Conceptual framework and item selection[J]. Med Care, 1992, 30(6):473-483. PMID
[17]	李鲁, 王红妹, 沈毅. SF-36健康调查量表中文版的研制及其性能测试[J]. 中华预防医学杂志, 2002, 36(2):109-113.
	Li L, Wang HM, Shen Y. Development and psychometric tests of a Chinese version of the SF-36 Health Survey Scales[J]. Chin J Prev Med, 2002, 36(2):109-113. PMID
[18]	Manni T, Ferri N, Vanti C, et al. Rehabilitation after lumbar spine surgery in adults:a systematic review with meta-analysis[J]. Arch Physiother, 2023, 13(1):21. DOI
[19]	Sakaguchi T, Gunjotikar S, Tanaka M, et al. Evaluation and rehabilitation after adult lumbar spine surgery[J]. J Clin Med, 2024, 13(10):2915. DOI URL
[20]	徐慧萍, 赵辉, 李东哲, 等. 腰椎术后患者疼痛管理智能化方案的制订及应用[J]. 中华护理杂志, 2020, 55(10):1465-1470. DOI
	Xu HP, Zhao H, Li DZ, et al. Formulation and application study on intelligent pain management program of patients after lumbar spine surgery[J]. Chin J Nurs, 2020, 55(10):1465-1470. DOI
[21]	Fairbank JC, Pynsent PB. The Oswestry Disability Index[J]. Spine, 2000, 25(22):2940-2952. DOI PMID
[22]	柴学红. 量化肌力训练对腰椎间盘突出症患者术后康复的影响[J]. 中华现代护理杂志, 2021, 27(18):2488-2491.
	Chai XH. Effect of quantitative muscle strength training on postoperative rehabilitation of patients with lumbar disc herniation[J]. Chin J Mod Nurs, 2021, 27(18):2488-2491.
[23]	Hides J, Wilson S, Stanton W, et al. An MRI investigation into the function of the transversus abdominis muscle during “drawing-in” of the abdominal wall[J]. Spine, 2006, 31(6):E175-E178.
[24]	Hou JY, Yang R, Yang YP, et al. The effectiveness and safety of utilizing mobile phone-based programs for rehabilitation after lumbar spinal surgery:multicenter,prospective randomized controlled trial[J]. JMIR Mhealth Uhealth, 2019, 7(2):e10201. DOI URL
[25]	Suo MR, Zhou LN, Wang JZ, et al. The application of surface electromyography technology in evaluating paraspinal muscle function[J]. Diagnostics(Basel), 2024, 14(11):1086.
[26]	Ducas J, Marineau E, Abboud J. Task-dependent neuromuscular adaptations in low back pain:a controlled experimental study[J]. Front Hum Neurosci, 2024, 18:1459711. DOI URL

腰椎间盘突出症患者脊柱内镜术后核心肌群训练护理方案的构建及应用

Development and application of a nursing care program for core muscle training for patients with lumbar disc herniation after endoscopic spine surgery

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 26

相关文章 15

编辑推荐

Metrics

[1]	王芸姣, 杨玉金, 郑春艳, 彭菲津, 王淑贞, 蒋喜露, 周为民, 王薇, 张娜. 糖尿病下肢动脉硬化闭塞症患者介入术后康复护理方案的构建及应用研究[J]. 中华护理杂志, 2026, 61(9): 1221-1229.
[2]	冯丽, 郭沛然, 程蓉, 熊楚琴, 张志霞. 基于时机理论的运动康复方案在慢性阻塞性肺疾病患者中的应用效果评价[J]. 中华护理杂志, 2026, 61(8): 1013-1020.
[3]	谢海燕, 曹淼, 闫睿, 刘思第, 薛荣娜, 谢丹. 白塞病患者生活质量影响因素的混合研究[J]. 中华护理杂志, 2026, 61(8): 1066-1073.
[4]	杜倩, 胡恒瑜, 李珍, 曹静文, 刘星歌, 刘林莉. 作业疗法联合职业康复对结直肠癌患者术后重返工作岗位的效果研究[J]. 中华护理杂志, 2026, 61(8): 1080-1087.
[5]	刘素玲, 蒋伟红, 李晓艳, 唐晓敏. 1例完全型Shone综合征合并重度肺动脉高压患儿的康复护理[J]. 中华护理杂志, 2026, 61(8): 1107-1111.
[6]	王伟娜, 乔晓斐, 吴立胜, 王倩倩, 蒋燕. 减重代谢术后患者体重管理方案的构建及应用[J]. 中华护理杂志, 2026, 61(7): 947-955.
[7]	赵浩, 赵颖, 杨艳珍. 慢性心力衰竭患者家庭照顾者照护技能干预方案的构建及应用研究[J]. 中华护理杂志, 2026, 61(6): 775-782.
[8]	付海炜, 朱晓菊, 毕建静, 黎美娴, 张小迪, 王宗华. 肺癌患者癌症相关认知障碍核心症状与生活质量的相关性研究[J]. 中华护理杂志, 2026, 61(6): 783-789.
[9]	刘晓, 李丽, 施忠英. 青少年神经性厌食患者及其父母出院准备体验及需求的质性研究[J]. 中华护理杂志, 2026, 61(6): 814-821.
[10]	陈静, 王君君, 魏晓琼, 何欢, 孙秋怡, 唐莹, 韩莹, 何华云. 运动干预在幼年特发性关节炎患儿中应用的范围综述[J]. 中华护理杂志, 2026, 61(6): 858-864.
[11]	中国抗癌协会肿瘤康复整合护理专业委员会, （执笔：钟就娣, 王影新, 刘飞, 潜艳, 康璐, 颜红艳, 杨明雪, 廖洋洋, 刘群红. 老年肺癌患者术后分级运动的专家共识[J]. 中华护理杂志, 2026, 61(5): 616-621.
[12]	黄静文, 叶桂连, 杨红, 钟美华, 周华青. 1例保留自主呼吸非气管插管麻醉下行心肺联合移植术患儿的早期康复护理[J]. 中华护理杂志, 2026, 61(5): 697-701.
[13]	陈丹露, 陈茹, 单亚维, 施春香, 沈中鸣. 远程医疗技术在全膝关节置换患者术后运动康复中应用的范围综述[J]. 中华护理杂志, 2026, 61(4): 467-474.
[14]	潘圆圆, 王董慧, 傅慧琳. 基于信息框架效应的垂体瘤患者自我管理行为干预方案的应用研究[J]. 中华护理杂志, 2026, 61(4): 475-482.
[15]	周鑫滢, 徐亦虹, 周丽萍, 宫晓艳, 叶欢, 刘晓娜, 庄一渝. 脑卒中患者性别差异与健康相关生活质量关系的范围综述[J]. 中华护理杂志, 2026, 61(4): 571-577.