术前抑郁对腰椎管狭窄症手术疗效的影响

Impact of preoperative depression on surgical outcomes for lumbar spinal stenosis

摘要:

[目的]探讨术前抑郁对腰椎管狭窄症(lumbar spinal stenosis, LSS)术后满意度与临床疗效的影响。[方法]2016 年 1 月—2018 年 12 月接受经椎间孔椎体间融合术 (transforaminal lumbar interbody fusion, TLIF) 的单节段 LSS 患者 126 例纳入本研究。根据抑郁自评量表(self-rating depression scale, SDS)评分，将患者分为两组，其中抑郁组 36 例，非抑郁组 90 例。比较两组间 VAS、ODI、JOA 评分以及术后患者满意等级，并将术前 SDS 评分与术后临床评分行相关分析。[结果] 所有患者均顺利完成手术。两组患者手术时间、出血量、住院时间及并发症发生情况的差异均无统计学意义(P＞0.05)。所有患者均获随访 2 年以上，术后 2 年两组患者 VAS-back、VAS-leg 和 ODI 评分较术前均显著减少，而 JOA 评分较术前显著增加，差异均有统计学意义 (P＜0.05)。抑郁组术后 2 年的 ODI、VAS-back、VAS-leg 评分均高于非抑郁组，而 JOA 评分低于非抑郁组，差异均有统计学意义 (P＜0.05)。术后 2 年患者满意率抑郁组为 72.22% (26/36)，非抑郁组 88.89% (80/90)，抑郁组满意率低于非抑郁组，差异有统计学意义(P＜0.05)。相关分析表明，术前 SDS 与术后不满意等级呈显著正相关(P＜0.05)；术前 SDS 与术后 ODI 评分、VAS-back 评分、VAS-leg 评分呈显著正相关(P＜0.05)；术前 SDS 与术后 JOA 评分呈显著负相关(P＜0.05)。[结论]术前抑郁对 LSS 患者术后满意度及临床疗效存在不良影响。

Abstract:

[Objective] To explore the impact of preoperative depression on patients’ satisfaction and clinical outcome after surgical treatment for lumbar spinal stenosis (LSS) . [Methods] A total of 126 patients who underwent transforaminal lumbar interbody fusion (TLIF) for single-segment LSS from January 2016 to December 2018 were enrolled in this study. According to self-rating depression scale (SDS) preoperatively, 36 patients were fall in the depression group, while the remaining 90 patients were termed as the non-depression group. The VAS-back, VAS-leng, ODI and JOA scores, as well as postoperative satisfaction level of patient were compared between the two groups, and the correlations between preoperative SDS score and postoperative clinical items was analyzed. [Results] All patients in both groups had operation completed successfully with no significant differences in operation time, blood loss, hospital stay and complications between 2 groups (P＞0.05) . All patients were followed up for more than 2 years. The VAS-back, VAS-leg and ODI scores significantly decreased (P＜0.05) , while JOA scores significantly increased in both groups at 2 years postoperatively compared with those before operation (P＜ 0.05) . The depression group had significantly higher VAS-back, VAS-leg and ODI scores (P＜0.05) , whereas significantly lower JOA score than the non-depression group at 2 years after surgery (P＜0.05) . The patients’ satisfaction rate was of 72.22% (26/36) in the depression group, whereas 88.89% (80/90) in the non-depression group, which was statistically significant (P＜0.05) . As results of correlation analysis, the preoperative SDS was significantly positively correlated with postoperative dissatisfaction level (P＜0.05) , significantly positively corre- lated with postoperative ODI score, VAS-back score and VAS-leg score (P＜0.05) , whereas negatively correlated with postoperative JOA score (P＜0.05) . [Conclusion] Preoperative depression has considerably adverse impacts on postoperative satisfaction and surgical efficacy for LSS.