腰椎滑脱术后患者抑郁、焦虑的改善及对预后的影响  

Preoperative depression associated with prognosis after lumbar fusion for spondylolisthesis: a series of 125 cases observation

作　　者：李金泉[1] 孙则干 徐皓[1] 姚晓东[1] 黄青松[1] 

机构地区：[1]南京军区福州总医院骨科,福州350025

出　　处：《中国矫形外科杂志》2017年第1期15-19,共5页Orthopedic Journal of China

摘　　要：[目的]观察腰椎滑脱患者行腰椎滑脱切开复位融合术后抑郁、焦虑的改善情况,探讨腰椎滑脱患者术前抑郁焦虑对预后的影响。[方法]回顾性分析2010年1月~2015年1月于本院行腰椎滑脱(I度)切开复位融合术的125例患者术前术后抑郁、焦虑心理状况。于术前及术后1周、3个月、6个月、1年及末次随访时采用Zung抑郁自评量表(SDS)和Zung焦虑自评量表(SAS)评估患者负性心理,腰背疼痛视觉模拟评分(BP-VAS)、腿部疼痛(LP-VAS)及日本骨科学会(JOA)评分评估神经功能,术后返回工作时间、SF-36量表评估生活质量,以单因素相关分析对结果进行统计处理。[结果]所有患者临床症状及神经功能都有所改善,18例患者术前出现明显的抑郁,37例患者出现焦虑;术后患者SDS及SAS评分均较术前改善,焦虑改善程度有统计学意义,抑郁改善程度无统计学意义。末次随访时患者抑郁及焦虑评分与VAS、术后返回工作时间和SF-36评分显著相关,但与JOA评分无显著相关。[结论]部分腰椎滑脱患者术前存在抑郁和焦虑,腰椎滑脱切开复位融合术可以部分改善这种负性心理,患者的负性心理对其预后有负性作用,术前抑郁及焦虑程度是一项关于腰椎滑脱切开复位融合术的患者术后返回工作时间的独立预估因素。[Objective] To observe the improvementin depression and anxiety in patients with lumbar spondylolisthesis after surgery,and to analyze the influence of preoperative depression and anxiety on prognosis. [Methods] A retrospective analysis was performed on the clinical data of 125 patients with lumbar spondylolisthesis （grade 1） who underwent transfo- raminal lumbar interbody fusion （TLIF） from January 2010 to January 2015. At preoperation, [week, 3 month, 6 month, and 1 year after surgery, and at last follow-up, depression and anxiety were evaluated using the Zungself-rating depression scale （SDS） and Zung self-rating anxiety scale （SAS） , respectively. The neurological function was evaluated usingt the visual an- alog scale （VAS） and Japan Orthopedic Association （JOA） scale. The quality of life was assessed using 36-hem Short- Form Health Survey （SF-36） and time to return to work （RTW） .The data were subjected to univariate correlation analysis. [Results] All patients showed improvements in clinical symptoms and neurological function. Before surgery, 18 patients had obvious symptoms of depression, along with 37 patients showing symptoms of anxiety. After surgery, the patients showed im- provements in SDS score and SAS score, and there was a significant improvement in SAS score but not SDS score. The SDS score and SAS score at last follow-up were significantly correlated with the VAS score, SF-36 score, and time to RTW, but not the JOA score. [Conclusions] Some patients with lumbar spondylolisthesis have depression and/or anxiety before surgery. TLIF can improve the negative mental status to some degree. Depression and anxiety have some negative influence on the prog- nosis of this disorder.The extent of preoperative depression and anxiety is an independent predictor of time to RTW in patients undergoing TLIF for lumbar spondylolisthesis.

关 键 词：腰椎滑脱 焦虑 抑郁 预后 

分 类 号：R687.3[医药卫生—骨科学] R749[医药卫生—外科学]