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Article(id=1194617495320498494, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1194617490446721194, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.0482.2024.1218, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1712851200000, receivedDateStr=2024-04-12, revisedDate=null, revisedDateStr=null, acceptedDate=1722268800000, acceptedDateStr=2024-07-30, onlineDate=1762748605803, onlineDateStr=2025-11-10, pubDate=1740672000000, pubDateStr=2025-02-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1762748605803, onlineIssueDateStr=2025-11-10, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1762748605803, creator=13701087609, updateTime=1762748605803, updator=13701087609, issue=Issue{id=1194617490446721194, tenantId=1146029695717560320, journalId=1189873630562394117, year='2025', volume='50', issue='2', pageStart='123', pageEnd='244', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1762748604641, creator=13701087609, updateTime=1762749162199, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1194619829073191185, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1194617490446721194, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1194619829073191186, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1194617490446721194, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=238, endPage=244, ext={EN=ArticleExt(id=1194617495584739649, articleId=1194617495320498494, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Application and research progress of prehabilitation in spinal surgery, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Prehabilitation is a novel rehabilitation strategy, mainly including sports intervention, psychological intervention, nutrition support, and other specific measures. It extends the concept of accelerated rehabilitation surgery by enhancing patients' organ function and metabolic reserve through preoperative intervention, thereby accelerating postoperative recovery. This concept has been applied to various surgical procedures, including cancer, orthopedics, thoracic surgery, and cardiac surgery. The majority of spinal surgery patients are elderly, exhibiting significant physiological decline and frailty, necessitating a multi-modal rehabilitation program that addresses body and nutrition, pain, and brain health awareness. As a subspecialty of orthopedics, there have been increasing reports on the application of prehabilitation in spinal surgery in recent years. This review summarizes the application and research progress of prehabilitation in spinal surgery, providing a reference for clinical medical staff to correctly implement prehabilitation.

, correspAuthors=Zhi-Hua Yin, authorNote=null, correspAuthorsNote=
E-mail:
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预康复是一种新的康复策略，主要包括运动干预、心理干预、营养支持等措施。其通过术前提高患者的器官功能和代谢储备可加速术后恢复，加速了康复外科理念的延展，目前已应用于癌症及骨科、胸外科、心脏外科等多种外科手术中。脊柱外科为骨科的一个亚专业方向，行脊柱外科手术者多为老年患者，其生理功能下降，衰弱占比较高，需要实施包括针对身体和营养、疼痛、大脑健康认知的多模式康复计划。近年来已有较多预康复策略应用于脊柱手术的报道，本文就预康复在脊柱手术中的应用研究进展进行综述，以期为临床医护人员实施预康复提供参考。

, correspAuthors=尹芝华, authorNote=null, correspAuthorsNote=
尹芝华，E-mail：
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赵晶，主要从事骨科临床快速康复方面的研究

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赵晶，主要从事骨科临床快速康复方面的研究

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赵晶，主要从事骨科临床快速康复方面的研究

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The effectiveness of prehabilitation (Prehab) in both functional and economic outcomes following spinal surgery: a systematic review[J]. Cureus, 2018, 10(5): e2675., articleTitle=The effectiveness of prehabilitation (Prehab) in both functional and economic outcomes following spinal surgery: a systematic review, refAbstract=null), Reference(id=1194646553085321258, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495320498494, doi=null, pmid=null, pmcid=null, year=2016, volume=41, issue=1, pageStart=18, pageEnd=25, url=null, language=null, rfNumber=[48], rfOrder=47, authorNames=Rolving N, Sogaard R, Nielsen CV, journalName=Spine (Phila Pa 1976), refType=null, unstructuredReference=Rolving N, Sogaard R, Nielsen CV, et al. Preoperative cognitive-behavioral patient education versus standard care for lumbar spinal fusion patients: economic evaluation alongside a randomized controlled trial[J]. 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Composition and usage of perioperative nutrition powder[28]

, figureFileSmall=null, figureFileBig=null, tableContent=
营养粉组成服用方法
蛋白粉能量300 kcal，蛋白质12 g，脂肪3 g，葡萄糖56 g，钠558 mg，钾805 mg，钙90 mg1袋，溶于250 ml温开水
碳水化合物粉能量200 kcal，蛋白质0 g，脂肪0 g，葡萄糖50 g，钠393 mg，钾523 mg，钙0 mg2袋，溶于200 ml温开水
膳食营养粉能量315 kcal，蛋白质19 g，脂肪7 g，葡萄糖43 g，钠216 mg，钾352 mg，钙206 mg1袋，溶于250 ml温开水
睡前营养粉能量315 kcal，蛋白质19 g，脂肪7 g，葡萄糖43 g，钠216 mg，钾352 mg，钙206 mg1袋，溶于250 ml温开水
), ArticleFig(id=1194646548593222648, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495320498494, language=CN, label=表1, caption=

围手术期营养粉的组成及服用方法[28]

, figureFileSmall=null, figureFileBig=null, tableContent=
营养粉组成服用方法
蛋白粉能量300 kcal，蛋白质12 g，脂肪3 g，葡萄糖56 g，钠558 mg，钾805 mg，钙90 mg1袋，溶于250 ml温开水
碳水化合物粉能量200 kcal，蛋白质0 g，脂肪0 g，葡萄糖50 g，钠393 mg，钾523 mg，钙0 mg2袋，溶于200 ml温开水
膳食营养粉能量315 kcal，蛋白质19 g，脂肪7 g，葡萄糖43 g，钠216 mg，钾352 mg，钙206 mg1袋，溶于250 ml温开水
睡前营养粉能量315 kcal，蛋白质19 g，脂肪7 g，葡萄糖43 g，钠216 mg，钾352 mg，钙206 mg1袋，溶于250 ml温开水
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预康复在脊柱外科手术中的应用研究进展
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赵晶 1 , 罗洋 2 , 尹芝华 2, *
解放军医学杂志 | 综述 2025,50(2): 238-244
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解放军医学杂志 | 综述 2025, 50(2): 238-244
预康复在脊柱外科手术中的应用研究进展
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赵晶1, 罗洋2, 尹芝华2, *
作者信息
  • 1重庆医科大学附属第三医院门诊部，重庆 401120
  • 2重庆医科大学附属第三医院骨与创伤中心，重庆 401120

    • 赵晶，主要从事骨科临床快速康复方面的研究

通讯作者:

尹芝华，E-mail：
Application and research progress of prehabilitation in spinal surgery
Jing Zhao1, Yang Luo2, Zhi-Hua Yin2, *
Affiliations
  • 1Outpatient Department, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
  • 2Bone and Trauma Center, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
出版时间: 2025-02-28 doi: 10.11855/j.issn.0577-7402.0482.2024.1218
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摘要
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预康复是一种新的康复策略，主要包括运动干预、心理干预、营养支持等措施。其通过术前提高患者的器官功能和代谢储备可加速术后恢复，加速了康复外科理念的延展，目前已应用于癌症及骨科、胸外科、心脏外科等多种外科手术中。脊柱外科为骨科的一个亚专业方向，行脊柱外科手术者多为老年患者，其生理功能下降，衰弱占比较高，需要实施包括针对身体和营养、疼痛、大脑健康认知的多模式康复计划。近年来已有较多预康复策略应用于脊柱手术的报道，本文就预康复在脊柱手术中的应用研究进展进行综述，以期为临床医护人员实施预康复提供参考。

预康复  /  脊柱外科手术  /  骨科  /  腰椎

Prehabilitation is a novel rehabilitation strategy, mainly including sports intervention, psychological intervention, nutrition support, and other specific measures. It extends the concept of accelerated rehabilitation surgery by enhancing patients' organ function and metabolic reserve through preoperative intervention, thereby accelerating postoperative recovery. This concept has been applied to various surgical procedures, including cancer, orthopedics, thoracic surgery, and cardiac surgery. The majority of spinal surgery patients are elderly, exhibiting significant physiological decline and frailty, necessitating a multi-modal rehabilitation program that addresses body and nutrition, pain, and brain health awareness. As a subspecialty of orthopedics, there have been increasing reports on the application of prehabilitation in spinal surgery in recent years. This review summarizes the application and research progress of prehabilitation in spinal surgery, providing a reference for clinical medical staff to correctly implement prehabilitation.

prehabilitation  /  spine surgery  /  orthopedics  /  lumbar
赵晶, 罗洋, 尹芝华. 预康复在脊柱外科手术中的应用研究进展. 解放军医学杂志, 2025 , 50 (2) : 238 -244 . DOI: 10.11855/j.issn.0577-7402.0482.2024.1218
Jing Zhao, Yang Luo, Zhi-Hua Yin. Application and research progress of prehabilitation in spinal surgery[J]. Medical Journal of Chinese People’s Liberation Army, 2025 , 50 (2) : 238 -244 . DOI: 10.11855/j.issn.0577-7402.0482.2024.1218
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脊柱外科住院患者中>65岁者占56.8%~70.2%，>80岁者占10.0%~17.5%。腰椎退行性疾病(lumber degenerative diseases，LDD)是老年人的常见病，患病率为5%~10%，并呈逐年升高且年轻化的趋势[1-2]。老年患者多合并高血压、糖尿病、冠心病、慢性阻塞性肺疾病等慢性病，身体功能低下，手术耐受性差，疼痛感明显，术后并发症发生率较高。常规康复侧重于术后快速康复，包括早期进食、早期下地活动、预防深静脉血栓、术后镇痛及各种管道管理等[3]。预康复(prehabilitation)理念于2002年由Topp等[4]提出，亦称术前康复，是基于加速康复外科(enhanced recovery after surgery，ERAS)理念衍生的术前管理新策略，指在术前阶段采取康复措施以提升患者身体功能和术后康复质量[5-6]。预康复多用于癌症及胸外科、骨科、心脏外科等外科手术中，2011－2020年Web of Science数据库检索出889篇相关文献，且文献量逐年增加。Punnoose等[7]荟萃分析了预康复对骨科术后患者的影响，纳入48项研究共3570例患者，发现预康复的效果优于常规康复，可减轻腰椎术后背部疼痛(高等级证据)，改善腰椎术后健康相关生活质量和术后6个月腰椎功能康复(中等级证据)。本文综述预康复在脊柱外科手术中的应用研究进展，以期为预康复在脊柱外科患者中的进一步应用提供参考。
1 脊柱手术实施预康复的必要性
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老年脊柱手术患者因行动不便而长期卧床，并可能伴有失眠、焦虑或抑郁等，其康复及预后往往存在诸多问题。一项回顾性研究纳入52 671例老年退行性脊柱疾病患者，其中衰弱患者占4%，65岁以上患者中衰弱的发生率为8%[8]；此类患者往往需要实施针对身体和营养、疼痛、大脑健康认知的多模式预康复计划[9]。Gillis等[10]指出，任何影响患者手术耐受性的术前状况均为术后康复不佳的危险因素，包括生理压力(如心肺储备差、肌少症)、损害应激反应的因素(如营养不良、衰弱)和增强对压力的分解代谢反应(如胰岛素抵抗)等。Eubanks等[11]系统综述了脊柱手术前预康复的效果，共纳入23项研究，采取的干预措施包括健康教育(n=6，26%)、运动(n=6，26%)、认知行为治疗(n=3，13%)、疼痛教育(n=3，13%)、健康行为咨询(n=3，13%)和警示教育(n=2，9%)，结果显示，预康复可减少医疗支出，改善患者术后疼痛、功能障碍指数、心理状态并提高患者对手术结果的满意度。成人脊柱畸形伴衰弱患者矫形手术后并发症发生率较高，预康复可帮助其更大程度地缓解疼痛、改善腰背部功能[12-13]。Wada等[14]指出，术前低肌肉量状态是腰椎管狭窄患者术后12个月内发生跌倒的预测因素，因此预康复应加强以提高肌肉质量和力量为主的运动锻炼。
2 预康复的主要干预措施
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2.1 运动干预
术前体质不佳可影响术后治疗效果，而运动干预可增强患者体质，减轻衰弱状态，减少术后并发症，加快患者康复速度[15-16]。进行预康复的时间取决于患者自身状况，一般术前2~12周进行运动干预即可改善术后康复效果。Marchand等[17-18]观察了为期6周的术前运动干预对腰椎管狭窄症患者术后康复的影响，运动干预的频率为3次/周，30 min/次，5 min的热身运动选择骑自行车或跑步机，肌肉锻炼包括躯干部稳定性、腰背肌锻炼及下肢肌肉训练(图1)[18]，运动强度根据患者的能力制定；结果表明，预康复组患者的术前疼痛程度、Oswestry功能障碍指数(Oswestry disability index，ODI)评分、腰背肌力量明显优于常规康复组，而以上优势在术后3个月逐渐消失。Dos Santos Alves等[19]观察了4个月的术前物理康复对青少年特发性脊柱侧凸矫正术后心肺功能和身体耐力的影响，物理康复措施包括10 min的热身(拉伸和低水平的有氧运动，如缓慢和渐进的散步)、40 min的有氧运动(在跑步机或固定自行车上进行)和10 min的放松(拉伸和低能量有氧运动)，频率为3次/周(每隔1 d一次)，60 min/次；结果表明，预康复组患者的心率和呼吸频率、外周血氧饱和度、步行距离、术后6 min步行试验(6-minute walking test，6MWT)距离均得到明显改善，术后恢复较佳。Fors等[20]对LDD拟行手术者进行为期9周的术前物理治疗，比较实验组与对照组的体力活动水平、行走能力、股四头肌肌力、定时10 m步行测试结果；结果显示，实验组干预后及随访时各项指标均明显改善(P<0.05)，且优于对照组(P<0.028)；其中锻炼≥12次的患者所有指标均明显改善(P<0.032)，而锻炼0~11次的患者仅步行速度改善(P=0.035)，表明术前物理治疗可提高LDD患者的行走能力和下肢力量。Lindbäck等[21]观察了术前物理治疗能否改善LDD手术患者的腰椎功能障碍、疼痛和健康状况，共纳入197例患者，随机分为术前物理治疗组与对照组，随访至术后12个月；结果显示，术前物理治疗组患者的术后ODI评分、背部疼痛视觉模拟量表(visual analogue scale，VAS)评分、欧洲五维健康量表(EuroQol five-dimensional questionaire，EQ-5D)评分、EQ-VAS评分、恐惧回避信念问卷-身体活动评分、自我效率量表评分、医院焦虑抑郁量表评分及活动水平均优于对照组。郭卿等[22]评价了基于运动疗法的预康复(包括有氧运动、抗阻运动、四肢大关节主动活动、四肢小关节主动活动、股四头肌功能锻炼、腰背肌功能锻炼、呼吸功能训练)在腰椎间盘突出症术后康复中的应用效果，结果显示，干预组术后3 d和出院时的VAS评分均低于对照组(P<0.05)，术后3 d、出院时的Barthel指数评分，术前1 d、术后3 d、出院时的腰椎日本骨科协会(Japanese Orthopaedic Association，JOA)评分，以及出院时术后功能锻炼依从性评分均高于对照组(P<0.05)，提示基于运动疗法的预康复可有效减轻腰椎间盘突出症患者的术后疼痛，改善腰椎功能，提高术后功能锻炼的依从性。
2.2 营养支持
营养支持可提高患者的运动能力和力量，增加生理储备能力和身体蛋白质，降低并发症发生率和死亡率，缩短住院时间，改善手术预后[23]。围手术期患者易发生营养不良，提前进行营养支持十分必要。Zhong等[24]的Meta分析纳入15项随机对照试验，包括3831例营养不良的患者，发现围手术期进行营养支持可有效降低并发症发生率，缩短住院时间。有研究表明，对虚弱群体在术前进行营养支持，通过补充蛋白质和抗阻运动，其体能和力量均有明显提高，而净体重在24周内仅减轻了1.3 kg[25]。Debono等[26]认为，低血清白蛋白水平(<35 g/L，低于正常范围)、低转铁蛋白水平、低淋巴细胞计数，与手术部位感染、术后并发症发生风险增加、住院时间延长及30 d内再入院率、脊柱手术后死亡率增高相关。
围手术期增加营养和摄入蛋白质对脊柱手术患者十分有益。在一项随机双盲临床试验中，对照组后路脊柱融合术患者术前48 h至术后1个月给予安慰剂+饮食(蛋白质含量为1.2 g/kg)，蛋白质补充组给予蛋白质36 g/d(分装成3袋，每袋含有12 g蛋白质、1 g碳水化合物、0.4 g脂肪和58 kcal能量)+饮食(蛋白质含量为1.2 g/kg)，结果显示，蛋白质补充组患者两侧多裂肌和腰肌横截面积较对照组明显增加(P<0.001)，蛋白质补充与后路脊柱融合术患者疼痛程度(P<0.001)和残疾发生率(P<0.001)呈明显负相关关系[27]。Xu等[28]评估了一种新型多模式营养管理(multimodal nutritional management，MNM)方案在原发性腰椎手术患者中的应用效果，将187例患者随机分为MNM组与对照组；对照组患者接受常规围手术期营养管理，术前8 h开始禁食，术后6 h开始进食；MNM组患者实施MNM方案[29]，包括术前1 d睡前给予营养粉，麻醉前6 h给予蛋白粉，麻醉诱导前2 h给予碳水化合物粉，术后第一顿晚餐给予膳食营养粉，手术当日睡前给予睡前营养粉；术后2~4 h开始早期进食；围手术期营养粉的组成及服用方法如表1；结果显示，MNM组白蛋白输注率和总输注量均低于对照组，术后1、3 d白蛋白水平均高于对照组，术后低钾血症、低钠血症和低钙血症发生率低于对照组；两组术后1 d血红蛋白水平差异无统计学意义，术后3 d MNM组血红蛋白水平高于对照组；此外，MNM组住院天数少于对照组，创面引流量低于对照组。该研究表明MNM方案可有效降低白蛋白输注量、输注白蛋白的患者比例、电解质紊乱发生率和住院天数，且术后患者的白蛋白、钠、钾和钙下降幅度较小。
2.3 心理干预
有研究表明，术前心理健康水平是腰椎融合术后患者腰背疼痛评分和下腰痛功能评分的预测因素[30]。脊柱手术通常涉及神经，与患者的肢体感觉、运动、大小便及性功能密切相关。近年来脊柱手术已向微创化发展，但患者仍存在一定的心理压力，常伴有失眠、焦虑或抑郁等。Tong等[31]对术前心理干预效果进行了Meta分析，共纳入19项研究(1893例择期骨科手术患者)，心理干预措施包括放松、认知行为疗法、催眠、情感咨询和混合心理疗法，不包括一般宣教；发现心理干预可改善患者术后焦虑和精神状态，但未能证实其可减轻术后疼痛。Mansell等[32]主张对腰椎融合术患者予以认知行为的预康复计划，对有运动恐惧、灾难感明显和自我效能低下者进行心理干预。Lotzke等[33]将认知行为疗法用于腰椎融合术患者，术后随访8周，发现患者的症状、焦虑状态和EQ-5D评分均得到明显改善，具体认知行为疗法概要见图2。Fors等[34]指出，改善抑郁状态有助于ODI恢复，恐惧回避信念的减轻有助于降低VAS评分，良好的活动能力和恐惧回避信念有助于降低EQ-5D-VAS评分。Rolving等[35]探讨了术前认知行为干预(cognitive behavioural therapies，CBT)对腰椎融合术患者的影响，将90例退行性椎间盘疾病或椎体滑脱患者随机分为常规治疗组与CBT组；结果显示，术后3个月时CBT组ODI评分较常规治疗组降低15分(P=0.003)且维持1年，1年后两组ODI评分差异无统计学意义(P=0.082)；而两组患者的灾难感、恐惧回避信念差异均无统计学意义，因此建议采用针对性更强的康复干预措施来降低灾难感和恐惧回避信念水平。
2.4 其他术前干预措施
Lam等[36]术前访谈腰椎管狭窄症患者，发现所有患者均希望进行术前教育以便于其做出手术决策；但部分患者因症状不同或工作、生活、旅行等时间冲突不愿参加预康复，对预康复的效果存疑。因此，骨科医师和物理治疗师应采取多种方式(如宣传册、视频或讲座)进行术前教育，探讨远程预康复措施落实的可行性[36]。吸烟患者脊柱融合术后假关节形成的风险明显增加，建议术前进行至少4周的戒烟治疗[37]。贫血患者行复杂脊柱手术前应口服补铁、输铁或使用促红细胞生成素使血红蛋白达到130 g/L后再进行手术[38]。心肺疾病、糖尿病、慢性肝肾疾病、长期抗凝治疗者术前应改善心肺功能，监测血压、肝肾功能、血糖、凝血等指标，及时调整或停用抗凝药物[39-41]。
3 预康复的实施
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3.1 预康复的实施应因地制宜
术前预康复尚存在患者知晓率、实施率低等问题。梁艳彩等[42]的报告中仅61.9%(65/105)的患者了解术前预康复，且仅31.4%(33/105)的患者实施了以居家康复为主的术前预康复。对于择期手术的患者，术前居家预康复为较好的方法。但居家预康复需医护与患者进行实时有效的沟通，及时解决预康复中出现的问题，督促患者按时有效地完成每日的预康复任务。Paloncy等[43]借助院外康复机构指导患者进行预康复，节约了医院的人力成本，整合并节省了资源。
3.2 预康复措施的制定需要多学科有效合作
研究指出，临床医师需重视多学科协作，联合营养、康复、疼痛等专科实施个体化的营养支持、康复锻炼、疼痛管理，以最大限度地缩短康复时间，避免病情加重[44]。Durrand等[45]认为，应组建多学科预康复团队为患者提供全方位的预康复措施。预康复团队由患者、医护人员和相关服务人员组成，其中医护人员主要包括骨科医师、康复医师、营养科医师及多名临床护理人员，负责预康复干预策略的制定、定期审查并解决预康复措施落实中遇到的各种问题等，督促各项预康复措施的正确实施。研究发现，多模式预康复可缩短术前预康复时间，提高患者依从性和康复效果[46]。
3.3 预康复措施的实施需借助现代社会智能设备
目前我国缺乏专业的预康复机构，可充分利用互联网、智能手机等优势，推出更多可视化的科普资料，便于患者在家庭、工作等场所运动。Lam等[36]认为患者更易接受基于网络的预康复：可将个性化预康复方案上传至微信公众号和微信群等平台，通过视频向患者播放预康复方法及注意事项；向患者发放康复运动手册、运动记录表及血压、血糖监测记录表；要求患者用手机设置备忘提醒等。采用以上措施，可充分畅通医患沟通的路径及发挥患者的自我管理作用，通过网络、微信和自媒体等促进预康复措施的正确实施。
4 预康复的局限性
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预康复应用于脊柱手术中仍存在一定的局限性。Gometz等[47]系统综述了预康复在脊柱手术中的应用效果，发现物理治疗在脊柱手术前的作用尚缺乏重要证据。Rolving等[48]认为，与标准治疗相比，CBT并未被证实可节省医疗花费。Janssen等[49]综述了以CBT为主的预康复对LDD手术的有效性，共纳入15项研究，描述了12种干预措施，结果显示对于腰椎手术，无明确的证据表明CBT较常规治疗有效。该研究涉及了不同类型的脊柱手术，对于脊柱融合术、脊柱矫形术、涉及两个及以上椎间隙的处理，以及需要辅助内固定的手术，预康复优势明显，但对于简单减压手术、微创手术、无需椎间融合，以及无须辅助内固定的手术，预康复的效果并不显著。
5 总结与展望
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以运动干预、心理干预、营养支持为主的预康复应用于脊柱外科手术患者已取得了确切的临床效果，主要用于腰椎间盘突出症、腰椎滑脱、腰椎管狭窄症等LDD的腰椎融合术，其次为脊柱畸形(青少年特发性脊柱侧凸、退变性侧凸、强直性脊柱炎后凸)矫形术。目前预康复尚未用于腰椎动态内固定术、颈椎内镜、颈椎融合、颈椎管扩大成形术等，此类手术患者群体较大，是未来研究的主要方向。在脊柱结核、脊柱感染术前用药期间实施预康复可获得较好的效果。未来应开展大样本、多中心、高等级证据的临床研究，有力地推动预康复在脊柱外科中科学、规范、高效地应用。
基金
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  • 重庆医科大学附属第三医院院内孵化项目(KY22050)
文献
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2025年第50卷第2期
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doi: 10.11855/j.issn.0577-7402.0482.2024.1218
  • 接收时间：2024-04-12
  • 首发时间：2025-11-10
  • 出版时间：2025-02-28
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  • 收稿日期：2024-04-12
  • 录用日期：2024-07-30
基金
Incubation Project of the Third Affiliated Hospital of Chongqing Medical University(KY22050)
重庆医科大学附属第三医院院内孵化项目(KY22050)
作者信息
    1重庆医科大学附属第三医院门诊部，重庆 401120
    2重庆医科大学附属第三医院骨与创伤中心，重庆 401120

通讯作者:

尹芝华，E-mail：
参考文献
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https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/10.11855/j.issn.0577-7402.0482.2024.1218
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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