系統性回顧：退化性頸椎脊髓病變病患的非手術及術後之運動訓練策略

Exercise Training for Non-operative and Post-operative Patient with Cervical Spondylotic Myelopathy: Systematic Review

鄭智修(Chih-Hsiu Cheng) ； 蘇皓琮(Hao-Tsung Su) ； 劉文瑜(Wen-Yu Liu) ； 王淑芬(Shwu-Fen Wang) ； 徐瑋勵(Wei-Li Hsu) ； 莊育芬(Yu-Fen Chuan)

《物理治療》 38卷4期 (2013/12) Pp. 279-285

https://doi.org/10.6215/JFPT.PTS1378742891

摘要

背景與目的：運動訓練為一種針對退化性頸椎脊髓病變（cervical spondylotic myelopathy）患者的介入方式。本研究目的是利用系統性回顧，統整對於非手術或術後的退化性頸椎脊髓病變患者，其運動介入後的效果和介入策略。方法：收集華藝線上圖書館、PubMed、MEDLINE和ScienceDirect等四個線上資料庫從2000年1月至2013年5月間出版的文獻，對於有詳細記錄運動治療內容、成效之研究進行探討。結果：本篇文獻只納入五篇文章，分別有三篇非手術運動治療文章及兩篇術後運動治療文章。其中文獻品質分數使用皮卓量表（PEDro）評分，兩篇為兩分、三篇為三分，品質皆較差，主要原因為缺乏隨機控制測驗、雙盲研究設計等。而各篇實證證據等級依據牛津大學實證醫學中心醫學文獻證據等級分類，文獻皆為實證等級較差的第四等級。本研究結果顯示，非手術的運動介入策略主要為頸部屈曲肌力訓練和行走訓練，可增進動作與感覺功能、生活功能獨立性和行走能力，減少頸部失能情形和疾病嚴重程度。術後運動介入則包括下肢肌力訓練、功能性訓練、行走訓練和術後早期頸部活動度運動，可以增進肌力、功能性和行走能力，並維持正中姿勢下的頸椎前凸角度。結論：本篇系統性回顧搜集到的文獻數量不多、實證等級及品質亦較差；然而根據本篇歸納發現運動介入可改善非手術、或是術後退化性頸椎脊髓病變患者的身體結構及功能、活動與生活參與。

關鍵字

退化性頸椎脊髓病變 ； 運動訓練 ； 術後 ； 非手術

並列摘要

Background and Purpose: Patients with cervical spondylotic myelopathy suffer from physical disorders and functional deterioration, and are commonly suggested with the exercise training. The aim of this study was to investigate the effect of exercise on the non-operative or post-operative patients with cervical spondylotic myelopathy. Methods: The database from the Airiti Library, PubMed, MEDLINE, and ScienceDirect were used, and the articles published from January 2000 to May 2013 and explicitly presented with the exercise program were identified. Results: Only five articles were included in this review (three were non-operative studies, and two were post-operative studies). Among these five studies, two were scored by 2 points with PEDro scale, and three were scored by 3 points. Level of evidence was grade IV for all five studies according to the Oxford Centre for Evidence-based Medicine-Level of Evidence. Low quality and level of evidence were due to poor study design without randomized control trial and double-blind procedure. Results of the non-operative studies showed that the craniocervical flexion and walking exercise can improve the motor & sensory function, functional independence and walking ability of the patients. Such exercises also reduced neck dysfunction and severity of disease. Results of post-operative studies showed that the lower limb strengthening, functional training, walking exercise and early cervical range of motion exercise can improve strength, function and walking ability, as well as maintained cervical lordotic curve in neutral position. Conclusion: According to these low-quality studies, our review suggests that exercise training can benefit both non-operative and post-operative patients with cervical spondylotic myelopathy by the body function & structure, activity and participation.

並列關鍵字

Cervical spondylotic myelopathy ； Exercise training ； Post-operation ； Non-operation

參考文獻

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Oxford Centre for Evidence-based Medicine - Levels of Evidence. Available at: http://www.cebm.net/?O=1025. Updated March 2009. Accessed 2013.5.1.

Kumar NSS, Lal N, Rajalakshmi D. Effect of exercise program on the rehabilitation of patients with cervical spondylotic myelopathy. Neurosci Med 2012;3:54-9.