腰椎内固定融合术患者手术前/后生活质量的调查与分析

Investigation and analysis of the quality of life in patients before and after lumbar fusion

中文关键词:  腰椎内固定融合术  腰椎僵硬  生活质量  疗效评估  基于患者报告的临床结局

英文关键词:Lumbar internal fixation and fusion  Lumbar stiffness  Quality of life  Evaluation of efficacy  Patient-reported outcome

中文摘要:

  【摘要】 目的：调查与分析腰椎内固定融合术患者手术前/后的生活质量，评价术后腰椎僵硬对患者生活质量改变的影响以及不同因素之间的相关性。方法：选取在我院行腰椎内固定融合术前（48例）、术后半年（42例）、术后1年（38例）、术后2年（41例）、术后3年及以上（40例）的209例患者进行调查。男89例，女120例；年龄27~82岁（62.2±10.1岁）。所有参与调查的患者均完成Oswestry功能障碍指数（Oswestry disability index，ODI）、疼痛数字评定量表（numeric rating scale，NRS）、日本骨科协会（Japanese Orthopaedic Association，JOA）腰痛评分和一项自制调查问卷的填写。自制调查问卷的主要内容包括疼痛/不适、神经功能障碍、心理健康受损、工作能力受限、各项日常活动能力受限对患者生活质量的影响，以及术后患者的满意度和恢复程度。统计影响患者生活质量的主要因素，并分析ODI、NRS、JOA评分改善情况与患者满意度和恢复程度之间的相关性。结果：术前患者ODI、腰痛NRS、臀部或下肢痛NRS评分显著高于术后各时间点的患者，JOA评分显著低于术后各时间点的患者（P<0.001）。96.27%（155/161）的术后患者认为生活质量较术前改善。患者自我报告的恢复优良率为67.70%，对手术治疗的满意率为73.91%，二者之间呈高度相关（r=0.701，P<0.001）。术前及术后不同时间点，对患者生活质量影响较大的因素主要有疼痛/不适、神经功能障碍和日常活动能力受限。在受限制的各项日常活动中，对术前患者生活质量影响较大的主要有：行走受限、外出/户外活动受限和站立受限；对术后患者生活质量影响较大的主要有：行走受限、弯腰/下蹲受限和外出/户外活动受限。ODI、NRS、JOA评分的改善值、JOA评分改善率与患者报告的恢复程度和满意度之间呈低中度相关，相关系数介于0.310～0.627之间。结论：疼痛/不适、神经功能障碍和日常活动能力受限是影响腰椎内固定融合术患者生活质量的主要因素。在受限制的各项日常活动中，除行走和外出/户外活动受限外，站立受限对术前患者生活质量影响相对较大，弯腰/下蹲受限对术后患者生活质量影响较大。ODI、NRS和JOA评分的改善情况与患者自我报告的恢复程度和满意度之间的相关性不高。在综合评估腰椎内固定融合术对患者生活质量的影响时，除腰腿疼痛外，还应考虑腰腿酸胀、麻木，下肢无力以及腰椎僵硬等对患者生活质量的影响。

英文摘要:

  【Abstract】 Objectives: To investigate and analyze the quality of life of patients before and after lumbar internal fixation and fusion, and to evaluate the influence of postoperative lumbar stiffness on the quality of life and the correlations between factors. Methods: 209 patients with lumbar degenerative disease treated in our hospital were selected for investigation, including patients who were about to receive lumbar internal fixation and fusion(48 cases), at half a year after the surgery(42 cases), 1 year after the surgery(38 cases), 2 years after the surgery(41 cases), and 3 years or more after the surgery(40 cases). There were 89 men and 120 women, averaged 62.2±10.1 years old(27-82 years). All participants were required to complete Oswestry disability index(ODI), numeric rating scale(NRS), Japanese Orthopaedic Association(JOA) score, and a new questionnaire designed by the authors. The main contents of the questionnaire included the impact of pain/discomfort, neurological dysfunction, impaired mental health, limited work ability, and functional limitations of activities of daily living(ADL) on patients′ quality of life, and patient satisfaction and recovery after surgery. The main factors affecting the quality of life of patients were counted, and the correlations between the improvements of ODI, NRS, and JOA score and patient satisfaction and recovery were analyzed. Results: The ODI, NRS of low back pain, and NRS of buttock or lower limb of patients before surgery were significantly higher than those of each postoperative groups(P<0.001), while JOA score before was lower than that after surgery(P<0.001). 96.27%(155/161) of the patients after surgery reported that the quality of life was improved. The excellent and good recovery rate was 67.70%, and the satisfaction rate was 73.91%, and there was a strong correlation in between(r=0.701, P<0.001). The main factors reported by patients affecting their quality of life were pain/discomfort, neurological dysfunction, and functional limitations of ADL in all groups. The limited activities of daily living that impacted the quality of life of preoperative patients greatly included walking, outdoor activities, and standing, and those that had great impacts on the quality of life of postoperative patients included walking, bending/squatting, and outdoor activities. The improvement values of ODI, NRS, and JOA score, and JOA improvement rate were low-to-moderately related with the degree of recovery and satisfaction, and the correlation coefficients ranged from 0.310 to 0.627. Conclusions: Pain/discomfort, neurological dysfunction, and functional limitations of activities of daily living are the main factors affecting the quality of life of patients undergoing lumbar internal fixation and fusion. Besides the limitation of walking and going out/outdoor activities, the limitation of standing has a great impact on the quality of life of preoperative patients, and the limitation of bending and squatting has a great impact on the quality of life of postoperative patients. The correlations between the improvements of ODI, NRS, and JOA score and the degree of recovery and satisfaction are not strong. The impacts of low back or limbs soreness, numbness, lower limb weakness, and lumbar stiffness on quality of life should also be considered besides the low back and leg pain when evaluating comprehensively the impact of lumbar fusion surgery on patients` quality of life.