腰椎间盘突出症社区和居家康复中国专家共识

中国康复医学会科学普及专业委员会

doi:10.16766/j.cnki.issn.1674-4152.004278

腰椎间盘突出症社区和居家康复中国专家共识

doi: 10.16766/j.cnki.issn.1674-4152.004278

中国康复医学会科学普及专业委员会

广西医科大学第一附属医院康复医学科，广西南宁 530021

基金项目:

国家自然科学基金项目 81260544

国家自然科学基金项目 81060300

广西科学研究与技术开发计划课题桂科攻1598012-48

详细信息

中图分类号: R681.53
计量
- 文章访问数: 19
- HTML全文浏览量: 12
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2025-10-13
- 网络出版日期: 2026-03-13

Chinese expert consensus on community and home-based rehabilitation for lumbar intervertebral disc protrusion

Professional Committee of Science Popularization of Chinese Association of Rehabilitation Medicine

Department of Rehabilitation Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China

摘要

摘要: 腰椎间盘突出症的连续性康复对患者长期预后具有关键意义，仅依靠急性期医院治疗往往难以满足其长期康复需求，因此社区与居家康复亟需规范化指导，本共识针对这一问题展开系统阐述。在社区康复方面，重点围绕协作网络与服务体系建设，明确转诊指征，建立多维度评估体系，并提出相应的疼痛管理策略与分阶段运动方案，以推动社区康复工作有序、高效开展。在居家康复方面，明确了从社区转介至居家的过渡标准及协作管理模式，提出复发预防措施与适宜运动类型，建立监测与反馈机制，界定紧急就医指征及应对方法，同时提供家庭环境改造建议，以保障居家康复过程的安全性与有效性。本共识旨在为基层医疗人员提供实践指导，规范腰椎间盘突出症的社区与居家康复管理，从而提升康复质量，降低疾病复发率，进一步改善患者生活质量。
- 腰椎间盘突出症 /
- 社区康复 /
- 居家康复 /
- 专家共识
Abstract: The continuous rehabilitation of lumbar intervertebral disc protrusion is of crucial significance to patients' long-term prognosis. Relying solely on hospital treatment during the acute phase is often insufficient to meet their long-term rehabilitation needs; therefore, standardized guidance for community and home-based rehabilitation is urgently required. This consensus provides a systematic elaboration on this issue. In terms of community rehabilitation, this consensus focuses on the construction of collaborative networks and service systems, clarifies the indicators for patient referral, establishes a multi-dimensional assessment system, and proposes corresponding pain management strategies and phased exercise programs-all aimed at promoting the orderly and efficient implementation of community rehabilitation work. For home-based rehabilitation, the consensus specifies the transition standards and collaborative management models for transferring patients from the community to home settings, puts forward recurrence prevention measures and suitable types of exercises, establishes monitoring and feedback mechanisms, defines indicators for emergency medical treatment and corresponding response methods, and provides recommendations for home environment modification. These measures are designed to ensure the safety and effectiveness of the home-based rehabilitation process. This consensus is intended to provide practical guidance for primary healthcare providers, standardize the management of community and home-based rehabilitation for lumbar intervertebral disc protrusion, thereby improving rehabilitation quality, reducing disease recurrence rates, and further enhancing patients' quality of life.
- Lumbar intervertebral disc protrusion /
- Community rehabilitation /
- Home-based rehabilitation /
- Expert consensus

HTML全文

图 1 多学科协作流程

Figure 1. Multidisciplinary collaboration process

下载: 全尺寸图片幻灯片

图 2 双向转诊流程

Figure 2. Two-way referral process

下载: 全尺寸图片幻灯片

表 1 GRADE证据质量分级

Table 1. Grading of GRADE evidence quality

证据质量	定义	标注符号
高	非常有把握：观察值接近真实值	A
中	对观察值有中等把握：观察值有可能接近真实值，也有可能差别很大	B
低	对观察值的把握有限：观察值可能与真实值有很大差别	C
极低	对观察值几乎没有把握：观察值与真实值可能有极大差别	D

下载: 导出CSV

表 2 GRADE推荐强度分级

Table 2. GRADE recommended intensity grading

推荐强度	定义	标注符号
强	明确显示干预措施利大于弊或弊大于利	1
弱	利弊不确定或无论质量高低的证据均显示利弊相当	2

下载: 导出CSV

参考文献(59)

[1]	POJSKIC M, BISSON E, OERTEL J, et al. Lumbar disc herniation: epidemiology, clinical and radiologic diagnosis WFNS spine committee recommendations[J]. World Neurosurg X, 2024, 22: 100279. DOI: 10.1016/j.wnsx.2024.100279.
[2]	ARSLAN S, ÜLGER Ö. The effect of exercise in the treatment of lumbar disc herniation: a systematic review[J]. Acta Neurol Belg, 2025, 125(5): 1209-1224. doi: 10.1007/s13760-025-02767-2
[3]	于亚洁, 陆燕群, 祝熠晨, 等. "互联网+"康复锻炼运动模型对提升腰椎间盘突出症患者自我效能的影响[J]. 浙江临床医学, 2024, 26(2): 280-282.
[4]	陈敏, 周冰华, 吴正艳. 互联网+延伸性护理对腰椎间盘突出症患者康复锻炼依从性及功能改善的影响[J]. 国际护理学杂志, 2024, 43(16): 3056-3060.
[5]	杨丹, 王胜, 陆燕群, 等. 依从"互联网+"主动康复锻炼运动模型的腰椎间盘突出症患者临床应用分析[J]. 浙江临床医学, 2023, 25(10): 1505-1507.
[6]	蔡玉静, 李伦兰, 丁晓云, 等. "互联网+"延续护理对腰椎间盘突出症患者术后疗效的Meta分析[J]. 护理管理杂志, 2023, 23(7): 532-538.
[7]	HE Q X, ZHAO J H, FAN M P, et al. Effect of continuous nursing based on wechat platform on postoperative rehabilitation of patients with lumbar disc herniation[J]. Jpn J Nurs Sci, 2021, 18(2): e12382. DOI: 10.1111/jjns.12382.
[8]	KNEZEVIC N N, CANDIDO K D, VLAEYEN J W S, et al. Low back pain[J]. Lancet, 2021, 398(10294): 78-92. doi: 10.1016/S0140-6736(21)00733-9
[9]	CHRISTOPHERS L, TOROK Z, TRAYER A, et al. Interdisciplinary teamworking in rehabilitation: experiences of change initiators in a national rehabilitation hospital[J]. BMC Health Serv Res, 2025, 25(1): 651. DOI: 10.1186/s12913-025-12795-6.
[10]	DESAI R H, HAMLIN E, EYLER A, et al. The role of the built environment in the community participation of adults aging with long-term physical disabilities: a scoping review[J]. J Aging Environ, 2024, 38(3): 232-256. doi: 10.1080/26892618.2023.2175099
[11]	PERANSON J, WEIS C A, SLATER M, et al. An interprofessional approach to collaborative management of low-back pain in primary care: a scholarly analysis of a successful educational module for prelicensure learners[J]. J Chiropr Educ, 2024, 38(1): 30-37. doi: 10.7899/JCE-22-24
[12]	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.
[13]	牟鈃雨, 张林, 安康, 等. 三甲医院全程健康管理模式下的家庭医生签约服务实践[J]. 中华全科医学, 2023, 21(7): 1085-1088.
[14]	秦晓宽, 孙凯, 徐卫国, 等. 腰椎间盘突出症中医循证实践指南[J]. 西部中医药, 2024, 37(5): 1-15.
[15]	FARDON D F, WILLIAMS A L, DOHRING E J, et al. Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology[J]. Spine J, 2014, 14(11): 2525-2545. doi: 10.1016/j.spinee.2014.04.022
[16]	ZHANG A S, XU A, ANSARI K, et al. Lumbar disc herniation: diagnosis and management[J]. Am J Med, 2023, 136(7): 645-651. doi: 10.1016/j.amjmed.2023.03.024
[17]	BEALL D P, KIM K D, MACADAEG K, et al. Treatment gaps and emerging therapies in lumbar disc herniation[J]. Pain Physician, 2024, 27(7): 401-413. doi: 10.36076/ppj.2024.27.401
[18]	中华医学会骨科学分会骨科康复学组, 中国康复医学会脊柱脊髓专业委员会腰椎研究学组. 老年腰椎间盘突出症诊疗指南[J]. 中华老年骨科与康复电子杂志, 2021, 7(3): 132-139.
[19]	GE L, HUANG H J, YU Q H, et al. Effects of core stability training on older women with low back pain: a randomized controlled trial[J]. Eur Rev Aging Phys Act, 2022, 19(1): 10. DOI: 10.1186/s11556-022-00289-x.
[20]	SHARIF S, JAZAIB ALI M Y, KIRAZLI Y, et al. Acute back pain: the role of medication, physical medicine and rehabilitation: WFNS spine committee recommendations[J]. World Neurosurg X, 2024, 23: 100273. DOI: 10.1016/j.wnsx.2024.100273.
[21]	龚剑秋, 张芳, 司马振奋, 等. 基于平均频率变化的腰椎间盘突出症患者核心稳定性训练的康复价值探讨[J]. 中华全科医学, 2019, 17(3): 475-478. doi: 10.16766/j.cnki.issn.1674-4152.000712
[22]	WANG X Q, WANG Y L, WITCHALLS J, et al. Physical therapy for acute and sub-acute low back pain: a systematic review and expert consensus[J]. Clin Rehabil, 2024, 38(6): 715-731. doi: 10.1177/02692155241229398
[23]	FERNÁNDEZ-RODRÍGUEZ R, ÁLVAREZ-BUENO C, CAVERO-REDONDO I, et al. Best exercise options for reducing pain and disability in adults with chronic low back pain: pilates, strength, core-based, and mind-body. A network meta-analysis[J]. J Orthop Sports Phys Ther, 2022, 52(8): 505-521. doi: 10.2519/jospt.2022.10671
[24]	HAYDEN J A, ELLIS J, OGILVIE R, et al. Exercise therapy for chronic low back pain[J]. Cochrane Database Syst Rev, 2021, 9(9): CD009790. DOI: 10.1002/14651858.CD009790.pub2.
[25]	HAYDEN J A, ELLIS J, OGILVIE R, et al. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis[J]. J Physiother, 2021, 67(4): 252-262. doi: 10.1016/j.jphys.2021.09.004
[26]	VANTI C, ANDREATTA S, BORGHI S, et al. The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials[J]. Disabil Rehabil, 2019, 41(6): 622-632. doi: 10.1080/09638288.2017.1410730
[27]	ELIKS M, ZGORZALEWICZ-STACHOWIAK M, ZEÑCZAK-PRAGA K. Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: state of the art[J]. Postgrad Med J, 2019, 95(1119): 41-45. doi: 10.1136/postgradmedj-2018-135920
[28]	FRIZZIERO A, PELLIZZON G, VITTADINI F, et al. Efficacy of core stability in non-specific chronic low back pain[J]. J Funct Morphol Kinesiol, 2021, 6(2): 37. DOI: 10.3390/jfmk6020037.
[29]	WIELAND L S, SKOETZ N, PILKINGTON K, et al. Yoga for chronic non-specific low back pain[J]. Cochrane Database Syst Rev, 2022, 11(11): CD010671. DOI: 10.1002/14651858.CD010671.
[30]	TATARYN N, SIMAS V, CATTERALL T, et al. Posterior-chain resistance training compared to general exercise and walking programmes for the treatment of chronic low back pain in the general population: a systematic review and meta-analysis[J]. Sports Med Open, 2021, 7(1): 17. DOI: 10.1186/s40798-021-00306-w.
[31]	LEE J S, YANG S H, KOOG Y H, et al. Effectiveness of sling exercise for chronic low back pain: a systematic review[J]. J Phys Ther Sci, 2014, 26(8): 1301-1306. doi: 10.1589/jpts.26.1301
[32]	GARCIA L M, BIRCKHEAD B J, KRISHNAMURTHY P, et al. An 8-week self-administered at-home behavioral skills-based virtual reality program for chronic low back pain: double-blind, randomized, placebo-controlled trial conducted during COVID-19[J]. J Med Internet Res, 2021, 23(2): e26292. DOI: 10.2196/26292.
[33]	ZHENG F M, LI Z C, HUANG H J, et al. Home-based rehabilitation training with human key point detection for chronic low back pain patients: a randomized controlled trial protocol[J]. Trials, 2023, 24(1): 760. DOI: 10.1186/s13063-023-07805-z.
[34]	李媛, 黄孝玲, 牛衍芝, 等. 基于时机理论构建腰椎间盘突出症非手术病人出院准备度干预方案[J]. 护理研究, 2025, 39(1): 103-108.
[35]	YAMAN M E, KAZANCI A, YAMAN N D, et al. Factors that influence recurrent lumbar disc herniation[J]. Hong Kong Med J, 2017, 23(3): 258-263.
[36]	安建鹏, 王飞, 王雅蓉, 等. 综合生物信息学分析肥胖和腰椎间盘突出症的共享基因特征和生物学机制[J]. 空军航空医学, 2024, 41(2): 143-149.
[37]	LENER S, WIPPLINGER C, HARTMANN S, et al. The impact of obesity and smoking on young individuals suffering from lumbar disc herniation: a retrospective analysis of 97 cases[J]. Neurosurg Rev, 2020, 43(5): 1297-1303. doi: 10.1007/s10143-019-01151-y
[38]	SHIMONY N, LOUIE C, BARROW D, et al. Adolescent disc disease: risk factors and treatment success-related factors[J]. World Neurosurg, 2021, 148: e314-e320. doi: 10.1016/j.wneu.2020.12.126
[39]	SAYIN GÜLENSOY E, GÜLENSOY B. A 9-year retrospective cohort of patients with lumbar disc herniation: comparison of patient characteristics and recurrence frequency by smoking status[J]. Medicine, 2022, 101(51): e32462. DOI: 10.1097/MD.0000000000032462.
[40]	YORIMITSU E, CHIBA K, TOYAMA Y, et al. Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years[J]. Spine, 2001, 26(6): 652-657. doi: 10.1097/00007632-200103150-00019
[41]	ORAKIFAR N, SALEHI R, SHATERZADEH YAZDI M J, et al. Comparison of proprioceptive postural control strategies between prolonged standing induced low back pain developers and non-low back pain developers[J]. Physiother Theory Pract, 2023, 39(2): 300-309. doi: 10.1080/09593985.2021.2021571
[42]	ANNASWAMY T M, CUNNIFF K J, KROLL M, et al. Lumbar bracing for chronic low back pain: a randomized controlled trial[J]. Am J Phys Med Rehabil, 2021, 100(8): 742-749. doi: 10.1097/PHM.0000000000001743
[43]	MIN Y Q, XU P. Curative effects of remote home management combined with Feng's spinal manipulation on the treatment of elderly patients with lumbar disc herniation[J]. J Healthc Eng, 2022, 2022: 1420392. DOI: 10.1155/2022/1420392.
[44]	CHOO Y J, CHANG M C. The effect of exercise on stabilizing and strengthening core muscles for patients with symptomatic herniated lumbar disc: a systematic review and meta-analysis[J]. Asian J Surg, 2024, 47(3): 1703-1704. doi: 10.1016/j.asjsur.2023.12.045
[45]	YILDIRIM P, GULTEKIN A. The effect of a stretch and strength-based yoga exercise program on patients with neuropathic pain due to lumbar disc herniation[J]. Spine, 2022, 47(10): 711-719. doi: 10.1097/BRS.0000000000004316
[46]	TAŞPINAR G, ANGIN E, OKSÜZ S. The effects of Pilates on pain, functionality, quality of life, flexibility and endurance in lumbar disc herniation[J]. J Comp Eff Res, 2023, 12(1): e220144. DOI: 10.2217/cer-2022-0144.
[47]	SHI Z J, ZHOU H X, LU L, et al. Aquatic exercises in the treatment of low back pain: a systematic review of the literature and meta-analysis of eight studies[J]. Am J Phys Med Rehabil, 2018, 97(2): 116-122. doi: 10.1097/PHM.0000000000000801
[48]	QIN X K, SUN K, XU W G, et al. An evidence-based guideline on treating lumbar disc herniation with traditional Chinese medicine[J]. J Evid Based Med, 2024, 17(1): 187-206. doi: 10.1111/jebm.12598
[49]	PUSCHMANN A K, LIN C I, WIPPERT P M. Sustainability of a motor control exercise intervention: analysis of long-term effects in a low back pain study[J]. Front Sports Act Living, 2021, 3: 659982. DOI: 10.3389/fspor.2021.659982.
[50]	NECHVÁTAL P, HITRÍK T, KENDROVÁ L D, et al. Comparison of the effect of the McKenzie method and spiral stabilization in patients with low back pain: a prospective, randomized clinical trial[J]. J Back Musculoskelet Rehabil, 2022, 35(3): 641-647. doi: 10.3233/BMR-210055
[51]	周谋望, 岳寿伟, 何成奇, 等. "腰椎间盘突出症的康复治疗"中国专家共识[J]. 中国康复医学杂志, 2017, 32(2): 129-135.
[52]	中国康复医学会脊柱脊髓专业委员会基础研究与转化学组, 冯世庆, 曹富江, 等. 腰椎间盘突出症诊治与康复管理指南[J]. 2022, 60(5): 401-408.
[53]	宋佳苧, 娄晓乐, 刘换, 等. 核心训练联合呼吸训练对腰椎间盘突出症患者多裂肌和腹横肌的形态学及功能效果[J]. 中国康复理论与实践, 2025, 31(1): 107-116.
[54]	VAN TILBURG M, KLOEK C, STAAL J B, et al. Feasibility of a stratified blended physiotherapy intervention for patients with non-specific low back pain: a mixed methods study[J]. Physiother Theory Pract, 2022, 38(2): 286-298. doi: 10.1080/09593985.2020.1756015
[55]	KÖGL N, PETR O, LÖSCHER W, et al. Lumbar disc herniation: the significance of symptom duration for the indication for surgery[J]. Dtsch Arztebl Int, 2024, 121(13): 440-448.
[56]	GIANOLA S, BARGERI S, DEL CASTILLO G, et al. Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis[J]. Br J Sports Med, 2022, 56(1): 41-50. doi: 10.1136/bjsports-2020-103596
[57]	SONG S Y, NAM D C, MOON D K, et al. Surgical decompression timing for patients with foot drop from lumbar degenerative diseases: a meta-analysis[J]. Eur Spine J, 2022, 31(3): 551-560. doi: 10.1007/s00586-021-07045-2
[58]	COLLINET A, NTILIKINA Y, ROMANI A, et al. Psychopathological profile and sagittal alignment in low-back pain[J]. Orthop Traumatol Surg Res, 2023, 109(2): 103474. DOI: 10.1016/j.otsr.2022.103474.
[59]	施炘婕. 基于FBS模型的下背痛人群的办公座椅设计研究[J]. 玩具世界, 2024(7): 160-162.