腰椎间盘突出症患者手部疼痛敏感度与术后结局的关系  

The Association between Hand Pain Sensitivity and Post-surgery Outcomes in Patients with Lumbar Disc Herniation

作　　者：杨明智[1] 韩玉东[1] 宗龙泽[2] YANG Mingzhi;HAN Yudong;ZONG Longze(Department of Orthopedics,Yan＇an People＇s Hospital,Yan＇an 716000,Shaanxi China;Department of Joint Surgery,Affiliated Hospital of Yah＇an University,Yah＇an 716000,Shaanxi China.)

机构地区：[1]陕西延安市人民医院骨科,陕西延安716000 [2]延安大学附属医院关节外科

出　　处：《中国中医骨伤科杂志》2018年第11期32-36,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:探讨腰椎间盘突出症患者术前疼痛敏感性与术后患者自报告的功能、疼痛、健康状况之间的关系。方法:选取2016年1月至2018年5月在本院行椎间盘切除术的腰椎间盘突出症患者96例,采用定量感觉测试(QST)法检测术前手部压力痛阈(PPT)、冷痛阈(CPT)和热痛阈(HPT)。术前和术后3个月通过Oswestry功能障碍指数(ODI)、视觉模拟评分法(VAS)、医院焦虑抑郁量表(HADS)、欧洲五维健康量表(EQ-5D)和自我效能感量表(SES)评估患者功能、疼痛、健康状况,线性回归分析PPT,CPT和HPT与患者术前术后功能、疼痛、健康情况的关系。结果:椎间盘突出患者PPT与术前术后ODI、术后HADS评分呈负相关(P<0.05),与术前术后SES呈正相关(P<0.05);CPT与术前术后ODI、术后腰腿部VAS呈正相关,与SES呈负相关(P<0.05)。椎间盘突出患者手部HPT与术前及术后功能、疼痛、健康相关评分均无相关性(P>0.05)。结论:作为腰椎间盘突出症患者术前广泛性疼痛的标志,术前手部压痛和冷痛与术后较高的疼痛程度及较低的功能和自我效能相关。Objective：To investigate the relationship between preoperative hand pain sensitivity and postoperative self-re ported function, pain and health status in patients with lumbar disc herniation. Methods：A prospective cohort study was conducted in 96 patients with lumbar disc herniation who underwent discectomy in our hospital from January 2016 to May 2018. The preoperative pain threshold （PPT）, cold pain threshold （CPT） and heat pain threshold （HPT）of hand was de- tected by quantitative sensory testing （QST）. Oswestry dysfunction （ODD, visual analogue scale （VAS）, hospital anxie- ty and depression scale （HADS）, europeanfive-dimensional health scale （EQ-5D）, and self-efficacy scale （SES） were used to assess all patients~ function, pain and health conditions before and 3 months after surgery. The association be- tween PPT, CPT, and HPT and preoperative and postoperative function, pain, and health conditions were analyzed by linear regression. Results：PPT in patients with the disc herniation was negatively correlated with preoperative and postop- erative ODI and postoperative HADS （P〈0.05）. It was positively correlated with preoperative and postoperative SES （P 〈0.05）. CPT was positively correlated with preoperative and postoperative ODI, postoperative back and leg pain VAS, and was negatively correlated with postoperative SES （P〈0.05）. There were no correlation between hand HPT with preoperative and postoperative function, pain, and the other health related scores （P〈0.05）. Conclusion： As a marker of preoperative widespread pain in patients with disc herniation, preoperative hand tenderness and cold pain were associated with postoperative higher pain severity, lower limb function and self-efficacy.

关 键 词：椎间盘突出症 脊柱手术 广泛性疼痛 定量感觉测试 

分 类 号：R681.5[医药卫生—骨科学]