疼痛敏感度用于预测经皮脊柱内镜髓核摘除术治疗腰椎间盘突出症的早期效果

PREDICTION OF SHORT-TERM OUTCOMES AFTER PERCUTANEOUS TRANSFORAMINAL ENDOSCOPIC DISCECTOMY USING PAIN SENSITIVITY IN PATIENTS WITH LUMBAR DISC HERNIATION

目的:观察疼痛敏感度对经皮脊柱内镜髓核摘除术(percutaneous transforaminal endoscopic discectomy,PTED)治疗腰椎间盘突出症早期效果的影响。方法:101例诊断为腰椎间盘突出症病人行脊柱内镜髓核摘除术。术前完成以下量表:疼痛敏感度量表(pain sensitivity questionnaire,PSQ)、医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)、疼痛灾难化量表(pain catastrophizing scale,PCS)和Oswestry功能障碍指数问卷表(oswestry disability index,ODI)。术后6月进行随访,内容包括腰腿痛评分(numerical rating scales,NRS)、ODI和Mac Nab评估。结果:98例病人完成随访。PTED术后症状显著缓解,根据Mac Nab评估结果将病人分为两组:优良组(83.7%)和中差组(16.3%)。优良组的PSQ评分显著低于中差组;PSQ评分与手术前后的ODI差值之间显著相关,但与手术前后NRS差值之间无明显相关。HADS和PCS评分在两组间无明显差异,且与手术前后的ODI、NRS差值之间无明显相关。结论:PSQ或许可用于预测PTED术后早期的整体功能恢复,但无法预测手术后的疼痛缓解程度。

Obiective: To assess the in?uence of pain sensitivity on short-term outcomes after percutaneous transforaminal endoscopic discectomy(PTED) in patients with lumbar disc herniation. Methods: The study included 101 patients who were scheduled to undergo PTED for lumbar disc herniation. The following questionnaires were completed before surgery: Pain Sensitivity Questionnaire(PSQ), Hospital Anxiety and Depression Scale(HADS), Pain Catastrophizing Scale(PCS) and Oswestry Disability Index(ODI). The clinical outcomes of PTED were evaluated by numerical rating scales(NRS), ODI and MacNab at 6 months after surgery. Results: 98 patients were followed-up successfully. Symptoms were signi?cantly relieved after PTED. Patients were divided into two groups according to MacNab:good outcome group(83.7%) and poor outcome group(16.3%). The PSQ in the good outcome group was signi?cantly lower than the poor outcome group. The PSQ was signi?cantly correlated with the difference of ODI before and after surgery, but not NRS. There was no signi?cant difference in HADS, PCS scores between the two groups. HADS, PCS scores were not correlated with the difference of ODI, NRS before and after surgery. Conclusions: The PSQ may be used to predict short-term functional recovery after PTED, but not pain relief.