全内镜下突出腰椎间盘摘除术后功能状态的影响因素

doi:10.19723/j.issn.1671-167X.2023.03.021

摘要/Abstract

摘要：

目的: 探索影响全内镜下突出腰椎间盘摘除术后患者功能状态的因素。方法: 采用前瞻性研究，收集符合入选标准并且完成全部随访的96例患者的一般资料、疼痛视觉模拟评分(visual analogue scale，VAS)、Oswestry功能障碍指数(Oswestry disability index，ODI)评分、广泛性焦虑障碍-7(generalised anxiety disorder-7，GAD-7)量表评分和患者健康问卷-9(patient health questionnaire-9，PHQ-9)量表评分。采用重复测量方差分析方法研究患者在术前及术后1、3、6个月的ODI评分变化，采用多元回归分析探索患者术后ODI评分的影响因素，采用Logistic回归分析探索患者术后6个月恢复正常工作状态的危险因素。结果: 患者整体术后功能状态有明显改善，其术后的功能状态与正在经历的疼痛强度呈高度正相关。影响术后功能状态的因素在不同康复时期有所不同，术后1个月和3个月时，影响术后功能状态的因素均为当前的平均疼痛强度；术后6个月时，影响术后功能状态的因素包括当前的平均疼痛强度、术前平均疼痛强度、性别和文化程度；影响患者术后6个月恢复正常工作状态的危险因素包括女性、低龄、术前抑郁状态、术后3个月平均疼痛强度高。结论: 全内镜下突出腰椎间盘摘除手术治疗慢性腰腿痛具有较好的可行性；患者术后功能状态恢复过程中，医务人员除需要采取镇痛措施降低患者经历的疼痛强度外，还需要关注心理社会因素对术后功能状态的影响；女性、低龄、术前抑郁状态、术后3个月平均疼痛强度高的患者可能会延迟术后恢复正常工作状态的时间。

关键词: 椎间盘切除术, 内窥镜检查, 腰椎, 椎间盘移位, 危险因素

Abstract:

Objective: To explore the influential factors associated with functional status of those patients who undertook a full-endoscopic lumbar discectomy operation. Methods: A prospective study was conducted. A total of 96 patients who undertook a full-endoscopic lumbar discectomy operation and met inclusive criteria were enrolled in the study. The postoperative follow-up was held 1 month, 3 months and 6 months after operation. The self-developed record file was used to collect the patient's information and medical history. Visual analogue scale (VAS) score, Oswestry disability index (ODI) score, Gene-ralised anxiety disorder-7 (GAD-7) scale score and patient health questionnaire-9 (PHQ-9) scale score were applied to measure pain intensity, functional status, anxiety status and depression status. Repeated measurement analysis of variance was used to explore the ODI score 1 month, 3 months and 6 months after operation. Multiple linear regression was recruited to illuminate the influential factors associated with functional status after the operation. Logistic regression was employed to explore the independent risk factors related to return to work 6 months after operation. Results: The postoperative functional status of the patients improved gradually. The functional status of the patients 1 month, 3 months and 6 months after operation were highly positively correlated with the current average pain intensity. The factors influencing the postoperative functional status of the patients were different according to the recovery stage. One month and 3 months after operation, the factors influencing the postoperative functional status were the current average pain intensity; 6 months after operation, the factors influencing the postoperative functional status included the current average pain intensity, preoperative average pain intensity, gender and educational level. The risk factors influencing return to work 6 months after operation included women, young age, preoperative depression status and high average pain intensity 3 months after operation. Conclusion: It is feasible to treat chronic low back pain with full-endoscopic lumbar discectomy operation. In the process of postoperative functional status recovery, medical staffs should not only take analgesic mea-sures to reduce the pain intensity experienced by the patients, but also pay attention to the impact of psychosocial factors on the recovery. Women, young age, preoperative depression status, and high average pain intensity 3 months after operation may delay return to work after the operation.

Key words: Discectomy, Endoscopy, Lumbar vertebrae, Intervertebral disc displacement, Risk factors

中图分类号:

R681.53

朱薇,祝斌,刘晓光. 全内镜下突出腰椎间盘摘除术后功能状态的影响因素[J]. 北京大学学报（医学版）, 2023, 55(3): 537-542.

Wei ZHU,Bin ZHU,Xiao-guang LIU. Influential factors related to functional status after full-endoscopic lumbar discectomy[J]. Journal of Peking University (Health Sciences), 2023, 55(3): 537-542.

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参考文献 10

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Items	1-month after operation			3-month after operation			6-month after operation
Items	ODI	t/F	P	ODI	t/F	P	ODI	t/F	P
Gender		-2.08	0.041		-2.39	0.021		-2.53	0.014
Male (n=52)	0.50±0.10			0.29±0.16			0.16±0.13
Female (n=44)	0.56±0.15			0.38±0.19			0.23±0.15
Marital status		0.17	0.867		0.30	0.791		0.33	0.722
Married (n=80)	0.53±0.13			0.33±0.18			0.20±0.14
Single or divorced (n=16)	0.52±0.13			0.32±0.21			0.18±0.13
Rescource of medical cost		0.71	0.496		-0.16	0.883		-0.55	0.538
Medical insurance (n=82)	0.52±0.13			0.33±0.18			0.20±0.14
Non medical insurance (n=14)	0.55±0.13			0.32±0.20			0.17±0.11
Medical history		0.64	0.532		-0.04	0.962		1.26	0.228
Yes (n=17)	0.55±0.13			0.33±0.14			0.23±0.14
No (n=79)	0.52±0.13			0.33±0.19			0.19±0.14
Smoking		0.02	0.987		-0.41	0.695		0.47	0.637
Yes (n=26)	0.53±0.13			0.34±0.19			0.18±0.14
No (n=70)	0.53±0.13			0.32±0.18			0.20±0.14
Alcohol		-0.02	0.982		0.50	0.585		0.25	0.780
Yes (n=81)	0.53±0.09			0.31±0.16			0.19±0.11
No (n=15)	0.53±0.14			0.33±0.19			0.20±0.15
Analgesics		0.44	0.662		-0.80	0.422		-0.43	0.670
No (n=40)	0.53±0.13			0.31±0.19			0.19±0.14
Yes (n=56)	0.52±0.13			0.35±0.18			0.20±0.14
Educational level		2.19	0.094		1.02	0.386		5.56	0.002
Middle school and lower (n=32)	0.51±0.14			0.33±0.19			0.14±0.10
High school (n=20)	0.52±0.11			0.30±0.18			0.19±0.13
Diploma (n=27)	0.50±0.11			0.30±0.16			0.19±0.13
Bachelor degree and above (n=17)	0.60±0.14			0.39±0.21			0.30±0.18

Items	Age		PHQ-9 at preoperation		GAD-7 at preoperation		Average VAS at preoperation		Average VAS on current
Items	r	P	r	P	r	P	r	P	r	P
ODI (1-month)	0.13	0.208	0.19	0.08	0.465	0.060	0.16	0.110	0.65	< 0.001
ODI (3-month)	0.12	0.260	0.18	0.04	0.675	0.085	0.16	0.127	0.70	< 0.001
ODI (6-month)	0.25	0.014	0.21	0.18	0.086	0.036	0.18	0.081	0.69	< 0.001

Dependent variable	Independent variable	β	t	P	VIF	R²	D-W
ODI (1-month)	VAS (1-month)	0.65	8.24	< 0.001	1.00	41.9%	2.28
ODI (3-month)	VAS (3-month)	0.70	9.60	< 0.001	1.00	49.5%	2.11
ODI (6-month)	VAS (6-month)	0.64	9.28	< 0.001	1.03	58.2%	1.93
	VAS (preoperation)	0.16	2.33	0.022	1.01
	Gender	0.15	2.17	0.032	1.03
	Educational level	0.22	3.14	0.002	1.04

Variables	B	Wald	P	OR	95%CI for OR
Gender	2.41	7.05	0.008	11.12	1.88-65.81
Age	-0.10	5.79	0.016	0.91	0.84-0.98
PHQ-9 at preoperation	0.16	5.59	0.018	1.18	1.03-1.35
Average VAS at 3-month postoperation	0.47	7.09	0.008	1.60	1.13-2.26