持续抑郁对腰椎间盘突出症患者经皮内窥镜腰椎间盘摘除术预后的影响

Effect of persistent depression on the prognosis of patients undergoing percutaneous endoscopic lumbar discectomy for lumbar disc herniation

目的探讨持续抑郁对腰椎间盘突出症(LDH)患者经皮内窥镜腰椎间盘摘除术(PELD)预后的影响。方法 168例LDH患者接受PELD治疗并随访2年,根据贝克抑郁量表(BDI)评分将患者分为情绪正常组(98例,BDI评分≤9分)和持续抑郁组(70例,BDI评分≥10分)。采用VAS疼痛评分、Oswestry功能障碍指数(ODI)评分和日本骨科协会(JOA)评分系统评估两组术前及术后3、6个月和1、2年患者的腰腿痛、功能障碍和神经功能,比较椎间盘高度比及椎间不稳定发生率。结果与术前比较,两组术后3、6个月和1、2年腰腿痛VAS疼痛评分和ODI评分降低(P<0.05),JOA评分增高(P<0.05),情绪正常组优于持续抑郁组(P<0.05)。两组术后不同时间点腰椎间盘高度比及椎间不稳定发生率比较差异无统计学意义(P>0.05)。结论持续抑郁会对LDH患者PELD术后疼痛及身体功能造成不利影响,应注意对LDH患者PELD术前及术后抑郁的筛查和治疗。

Objective To observe the effect of persistent depression on the prognosis of the patients undergoing percutaneous endoscopic lumbar discectomy(PELD) for lumbar disc herniation(LDH).Methods PELD was performed in 168 patients with LDH,who were followed up for 2 years.According to Beck depression inventory(BDI),the patients were assigned into two groups of A(BDI≤9 points,98 cases) and B(BDI≥10 points,70 cases).The VAS pain score,Oswestry dysfunction index(ODI) score and Japanese Orthopedic Association(JOA) scoring system were used to evaluate the pain on the low back and leg,dysfunction and nerve function in both groups before and 3 months, 6 months, one year and 2 years after operation.The disc height ratio and the incidence of intervertebral instability were compared between the two groups.Results Compared to before,the VAS pain score and ODI score of low back and leg were lower,and JOA score was higher during follow-up in both groups(P<0.05),which were better in group A than those in group B(P<0.05).After operation,there were no significant differences in lumbar disc height ratio and the incidence of intervertebral instability between two groups during follow-up(P>0.05).Conclusion Persistent depression has adverse effects on postoperative pain and physical function in LDH patients undergoing PELD.Attention should be paid to screening and treating the perioperative depression in LDH patients.