抑郁对脊髓型颈椎病后路减压手术预后的不良影响  

Depression contributed a dissatisfied cervical surgery outcome of the posterior decompression in cervical spondylotic myelopathy

作　　者：宗雅琪 雪原[1] 赵莹[2] 林威[1] 丁怀荣 何冬[1] 李志阳[1] 唐炎铭 王一[1] 

机构地区：[1]天津医科大学总医院骨科,300052 [2]天津医科大学外科手术学教研室

出　　处：《中华骨科杂志》2015年第8期854-858,共5页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81271360）

摘　　要：目的探讨抑郁对脊髓型颈椎病后路减压手术疗效的影响。方法2006年10月至2011年10月接受后路椎板切除或椎板成形减压手术的脊髓型颈椎病患者396例纳入研究，男132例，女264例；年龄39-84岁，平均60．2岁。术前按贝克抑郁量表（Beckdepression inventory，BDI）评分将患者分为抑郁组与非抑郁组，两组患者年龄、性别、吸烟情况、症状持续时间、工作情况（是否从事当前工作）的差异均无统计学意义。术后影像学评价指标包括脊髓膨胀面积、脊髓后移距离、颈椎曲率指数；临床疗效评价指标包括日本骨科协会（Japanese Orthopedic Association，JOA）评分、颈椎失能指数（neck disability index，NDI）、疼痛视觉模拟评分（visual analogue scale，VAS）及BDI。术后1．5个月对两组患者上述指标进行评价，并进行统计学分析。结果全部396例均获得随访，随访时间24-50个月，平均32个月。抑郁组与非抑郁组术后颈椎曲率指数下降分别为7．1％±2．1％和6．8％±1．5％、脊髓膨胀面积分别为（130．9±7．0）mm^2和（150．8±5．2）mm^2、脊髓后移距离分别为（5．7±1．2）mm和（6．2±0．8）mm，差异均无统计学意义。抑郁组与非抑郁组患者术后JOA评分分别提高（1．42±0．56）分和（6．76±3．12）分，差异有统计学意义；NDI分别下降7．31±2．18和21．11±11．36，差异有统计学意义；VAS评分分别下降（16．08±19．76）分和（23．85±20．79）分，差异有统计学意义。抑郁组与非抑郁组患者术后BDI评分均有所改善，但与术前比较差异均无统计学意义。结论术前抑郁状态对脊髓型颈椎病后路减压术后的功能恢复、伤残指数下降及疼痛缓解有不良影响。Objective To investigate the effect of depression symptoms on surgical outcome of posterior decompression among cervical spondylotic myelopathy （CSM） patients. Methods Between October 2006 and October 2011 in our hospital, lami- nectomy or laminoplasty was performed in 396 cases that were enrolled in the study. There were 132 males and 264 females with an average age of 60.2 years（ranged, 39-84 years）. All patients were divided into depression group and non-depressed group by the 21-item Beck Depression Inventory （BDI）. There were no statistically significant differences between groups in age, sex, smoking status, duration of symptoms, and employment status （whether in the current working）. The Japanese Orthopedic Association （JOA） scores, Neck disability index （NDI） and visual analogue scale （VAS） were compared after 1.5 months postoperatively. Resuits All of 396 cases were followed up. The mean follow up duration was 32 months （range, 24-50 months）. There were no statistically significant differences in the CCI decline （7.1%±2.1% versus 6.8%±1.5%）, expansion degree [（130.9±7.0） mm^2 versus （150.8±5.2） mm^2] and the drift-back distance of the spinal cord [（5.7±1.2） mm versus （6.2±0.8） mm]. However, patients with continuous depression showed poorer improvement than non-depressed patients in the surgery outcome： JOA improved （1.42±0.56 versus 6.76±3.12）; NDI declined （7.31±2.18 versus 21.11±11.36）; and VAS lightened （16.08±19.76 versus 23.85±20.79）. Conclusion Depression contributed a dissatisfied surgery outcome after posterior decompression on functional re- covery, disability index and pain scores among patients of the cervical spondylotic myelopathy.

关 键 词：颈椎 脊髓压迫症 减压术 外科 抑郁 

分 类 号：R687.3[医药卫生—骨科学]