退变性腰椎间盘突出术后疗效与术前心理因素的相关性研究

Preoperative psychological factors associated with the postoperative outcome of degenerative lumbar disc herniation

中文关键词:  退变性腰椎间盘突出  抑郁  焦虑  心理评估  术后疗效

英文关键词:Degenerative lumbar disc herniation  Depression  Ａnxiety  Psychological assessment  Postoperative outcome

中文摘要:

  【摘要】 目的：探讨抑郁和焦虑与退变性腰椎间盘突出患者术后疼痛程度的相关性，及其对术后疗效的评估作用。方法：选择2008年3月～2010年3月在昆明医学院附属延安医院骨科行手术治疗的40例腰椎间盘突出患者。术前所有患者完成日本骨科学会（JOA）腰痛评分、视觉疼痛自我评定（VAS）、汉密尔顿抑郁量表17项评分以及汉密尔顿焦虑量表14项评分。按照汉密尔顿抑郁量表评分（7分为界）将患者分为抑郁组与非抑郁组，按照汉密尔顿焦虑量表评分（6分为界）将患者分为焦虑组与非焦虑组。术后3个月随访JOA及VAS评分。比较抑郁组与非抑郁组、焦虑组与非焦虑组的术后疼痛缓解程度的相关性。结果：抑郁组与非抑郁组、焦虑组与非焦虑组的患者术后ＪＯＡ评分分别为3.2±0.3、9.1±1.8、3.3±0.3、9.2±1.9，ＶＡＳ评分分别为1.25±0.53、2.53±0.40、1.23±0.55、2.48±0.38，抑郁组及焦虑组疼痛缓解率差（P<0.01）。结论：术前以抑郁和焦虑为主的负性情绪将加重腰椎间盘突出患者术后疼痛，而术前进行心理因素评分有助于预后评估。

英文摘要:

  【Abstract】 Objective：To investigate the correlation of depression and anxiety and postoperative pain degree for degenerative lumbar disc herniation，and to evaluate these preoperative psychological factors on postoperative outcome.Method：40 cases with degenerative lumbar disc herniation undergoing surgery in our institute from March 2008 to March 2010 were reviewed retrospectively.JOA（Japanese Orthopedic Association） scores，ＶAS（visual analog scale） scores，Hamilton depression scale scores of 17 versions and Hamilton anxiety scale scores of 14 versions were performed on all patients.Based on the Hamilton depression scale score（over or less than 7），all patients were classified into depression group and nondepression group.Again all patients were classified into anxiety group and non anxiety group based on the Hamilton anxiety scale score（over or less than 6）.3 months after operation all patients were followed up for JOA and VAS scores.The pain relief of depression and nondepression group and anxiety and non anxiety group was compared retrospectively.Result：Ｔｈｅ　ＪＯＡ　ｓｃｏｒｅs　ｏｆ　ｄｅｐｒｅｓｓｉｏｎ　ｇｒｏｕｐ，ｎｏｎｄｅｐｒｅｓｓｉｏｎ　ｇｒｏｕｐ，ａｎｘｉｅｔｙ　ｇｒｏｕｐ　ａｎｄ　ｎｏn ａｎｘｉｅｔｙ　ｇｒｏｕｐ　ａｒｅ　3.2±0.3，9.1±1.8，3.3±0.3　ａｎｄ　9.2±1.9．Ｔｈｅ　ＶＡＳ　ｓｃｏｒｅs　ｏｆ　ｔｈｅｍ　ａｒｅ　1.25±0.53，2.53±0.40，1.23±0.55　ａｎｄ　2.48±0.38．The postoperative pain relief of depress group and anxiety group was less than other groups（P<0.01）.Conclusion：The preoperative negative emotion（presenting with depression and anxiety） proves unfavorable to pain relief of lumbar disc herniation, and preoperative psychological evaluation will help to prognostic assessment.