脊柱结核患者的康复管理(回顾)

Jaouher Dhouibi, A. Kalai, A. Chaabeni, Ahlem Aissa, Z. Ben Salah Frih, A. Jellad
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摘要

脊柱结核(ST)是一种严重的疾病,也是全球关注的健康问题,在肌肉骨骼结核病例中占很大比例。它可导致严重的脊柱和神经系统并发症。ST 的治疗涉及多学科方法,包括内科治疗、外科手术和康复治疗。康复治疗在整个病程中至关重要,并根据患者的主诉、临床和功能并发症为每个阶段量身定制。在脊柱受压导致神经系统问题的情况下,康复治疗的目的是克服卧床并发症,包括活动技巧、加强锻炼和相关的膀胱括约肌疾病(尿动力学、导尿)。康复治疗在治疗 ST 患者疼痛方面的作用主要体现在支撑(限制活动并减轻对受损结构的压力)和物理镇痛手段(电刺激和按摩技术)上。针对肌肉骨骼并发症,可采用多种康复方案。通常包括运动范围练习、肌肉强化、使用感知和本体感觉技术纠正姿势和平衡。还需要进行心肺功能调节,以改善呼吸功能、行走能力和心血管耐力。最终,康复治疗可以最大限度地减少残疾和防止丧失自理能力,尤其是对老年患者而言。康复方法的优势在于其多选择性,包括物理治疗、职业治疗、人体工程学建议和辅助设备。尽管康复治疗起着至关重要的作用,但在 ST 的治疗中仍未得到充分研究。因此,本微型综述旨在根据 ST 的临床特征和并发症,按照疾病的发展过程探讨康复治疗方案。
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Rehabilitation management of patients with spinal tuberculosis (Review)
Spinal tuberculosis (ST) is a serious condition and a global health concern, accounting for a significant portion of musculoskeletal tuberculosis cases. It can lead to sever spinal and neurological complications. The management of ST involves a multidisciplinary approach, including medical treatment, surgery and rehabilitation. Rehabilitation is crucial through the course of the disease's and is tailored for each stage according to the patients' complaints, and clinical and functional complications. In the case of neurological issues due to spinal compression, rehabilitation aims at overcoming bed confinement complications, involving mobilization techniques, strengthening exercises and related vesico-sphincter disorders (urodynamics, catheterizing). The role of rehabilitation for the management of pain in patients with ST is based on bracing (restricting movements and relieving the pressure on harmed structures), and analgesic physical means (electrical stimulation and massage techniques). Several rehabilitation options may be used to address musculoskeletal complications. Range of motion exercises, muscle strengthening, and posture and balance correction using sensory perception and proprioception techniques, are commonly involved. Cardiorespiratory reconditioning is required to improve respiratory function, walking ability and cardiovascular endurance. Ultimately, rehabilitation allows for the minimization of disability and the prevention of the loss of autonomy, particularly in elderly patients. The advantage of the rehabilitation approach is its multi-optional characteristics including physical therapy, occupational therapy, ergonomic advices and assistive equipment. Despite its crucial role, rehabilitation remains understudied in the management of ST. Thus, the present mini-review aimed to address the rehabilitation options for the clinical features and complications of ST, according to the course of the disease.
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