椎体后凸成形术护理中康复治疗及心理干预对生活质量的影响

Quality of life affected by physical therapy and psychological intervention for patients who underwent vertebral kyphoplasty during the perioperative care

目的评价椎体后凸成形术后护理中康复治疗和心理干预对病人生活质量的影响。材料和方法本组共20例患者，其中男性4例，女性16例，平均年龄73．3岁（62～79岁），均为骨质疏松性脊柱压缩骨折，伴有持续性疼痛，经保守治疗后效果差，症状平均持续8．6个月（18天～26个月）。术前行骨密度测量，CT检查确诊；均无脊髓和神经根受损的症状和体征。护理干预包括术前心理干预、术前一般护理、术后病情护理、骨水泥外漏引起并发症的观察、穿刺部位感染预防以及健康指导等。本组病人随访至少6个月，使用SF-36健康调查评分表评价其手术前后生活质量变化情况，将结果全部百分化处理后进行统计学分析，进行配对t检验。结果20例患者平均随访16．9个月（6～23个月），术后腰疼情况均明显改善，基本上停用止痛药。术后均无神经根和脊髓损伤、肺栓塞出现。参考SF-36健康调查评分表评分标准计算得分，结果显示总分及总体健康、活力、精神健康、躯体疼痛、社会机能、生理机能6个维度的积分术后较术前的提高有显著统计学意义（P〈0．01）；生理职能、情感职能2个维度的积分术后较术前的提高无统计学意义（P〉0．05）。结论椎体后凸成形术围手术期护理中的心理干预和康复治疗是必要而有效的。良好的护理有助于提高SF-36的评分。同时良好的护理对患者的康复起到了非常重要促进作用。

Objective To evaluate the value of quality of life affected by physical therapy and psychological intervention for patients who underwent vertebral kyphoplasty during the perioperative care. Methods Twenty cases were involved in this study including 4 male and 16 female with the average age of 73.3 （62- 79 years old） and all were diagnosed as vertebral compression fracture due to severe osteoporosis with consistent back pain which was not relived after conservative treatment. The symptoms lasted about 8.6 months （18 days- 26 months） averagely. The BMD and CT scan were applied to confirm the diagnosis. No symptoms or signs of impairment of spinal cord and nerve root were noted. The nursing intervention involved preoperative psychological intervention, preoperative general duty nursing, postoperative nosographical nursing, the observation of complication due to cement leaking, the prevention of infection at the puncture site and health guidance. All patients were followed up for at least 6 months. SF-36 score was used to evaluate the changes of quality of life before and after the operation. All data were converted to the form of percentage and analyzed by paired t-test. Results The back pain was significantly relieved and the antalgesic was ceased. No impairment of spinal cord and nerve root and pulmonary embolism were reported. According to the SF-36 score, significant difference was found between before and after the operation in the aspects of overall score, overall health status, vigour, emotional health status, body pain, social function and physiological function （ P 〈 0.01 ）, while no significant difference was detected in the aspects of physiological functional authority and sentiment functional authority perioperatively （ P 〉 0.05）. Conclusion The psychological intervention and physical therapy during perioperative nursing are essential and effective for the patients who underwent vertebral kyphoplasty. The felicitous nursing helps to improve the score of SF-36, and meanwhile plays an important role in the rehabilitation of patient.