摘要
目的:在临床实践中应用自制腰椎间盘突出症评估系统对患者进行病情程度评估以及预测术后的功能效应。方法:选择2000-02/2002-11在中国医科大学附属第二医院骨科因患腰椎间盘突出症而首次行腰椎手术的患者177例,在术前、术后应用自制评估系统进行评分。①术前评分:包括症状功能、体征及影像3部分,共100分,按得分情况分为3组:≤40分组的轻度患者15例,41～60分组的中度患者44例,≥61分组的中度患者46例。术后随访项目:症状功能和体征、术后对治疗的满意程度、术后生活能力、术后对生活的态度、术后工作、家务活动及术后影像检查(X射线,CT,MR),也是100分。评估标准为得分越高,说明病情越严重。②术后疗效根据中华骨科学会脊柱学组腰背痛手术评定标准判断术后疗效,优:术前症状缓解,腰椎活动度、直腿抬高试验、神经功能均恢复,并能恢复原来的工作和生活;良:术前症状部分缓解,腰椎活动度、直腿抬高试验、神经功能部分改善,不能恢复原来的工作和生活;差:治疗无效或症状加重,有关体征无改善。然后将各组数据输入并用SPSS10.0进行统计分析。结果:完成随访的105例患者进入结果分析。①腰椎间盘突出症评估系统手术前后总评分比较:治疗前明显高于治疗后犤(28～80,0～66)分,(t=23.086,P<0.01)犦,说明治疗后症状、体征得到改善。②按腰背痛手术评定标准判定术后疗效:术前评分>40分组中疗效差的比例明显低于≤40分组犤(15.3,40)%,(χ2=12.31,P<0.01)犦。41～60分组术后疗效最优,优良率可达97.7%。术前评分60分上下时和40～60分组与61分以上组经统计学分分析比较在疗效方面无明显差异犤(χ2=0.03,χ2=2.29),(P<0.05)犦。结论:自制腰椎间盘突出症评估系统在病情评估方面同时适用于术前和术后,而且其术前评分对术后疗效具有良好的预测作用。
AIM： To prove the effects of self-made objective rating system for lumbar discectomy in evaluating the disease severity and predicting postoperative function of all the patients in clinical practice. METHODS： Between January 2000 and November 2002,177 patients, who received lumbar diseectomy for the first time because of lumbar disc protrusion in the Department of Orthopaedics, the Second Affiliated Hospital of China Medical University, were assessed with the self-made objective rating system before and after discectomy.①Preoperative scores：There were 3 parts of symptomatic function, physical sign and imaging, the total score was 100 points,the patients were divided into 3 groups：≤40 points group （mild group, n=15）, 41-60 points group （moderate group, n-44） and ≥61 points group （moderate group, n=46）.Postoperative follow-up items：symptomatic function and physical signs, postoperative satisfactory degree to the treatment, postoperative living ability, postoperative attitude to life, postoperative work and housework and postoperative imaging examination （Xray, CT, MR）, the score was 100 point.s, the higher the score, the severer the disease.②Postoperative effect：h was evaluated with the standard for low back pain operation set by the spinal group of China Association of Orthopaedics： Excellent： preoperative symptoms were relieved, the lumbar activity,straight-leg raising test and neurological function were all recovered, and they could recover to original work and life; Good： preoperative symptoms were relieved partly, the lumbar activity, straight-leg raising test and neurological function were ameliorated partly, and they could not recover to original work and life; Bad： the treatment was invalid or symptoms were aggravated,related physical signs were not improved.The data of each group were input and statistically analyzed with the SPSS 10.0 software. RESULTS： Totally 105 patients,who finished the follow-up,were involved in the analysis of results.①Comparison of preoperative and postoperative scores of the self-made objective rating system for lumbar discectomy：The preoperative score was obviously higher than the postoperative one[（28-80, 0-66） points, t=23.086, P 〈 0.01], indicating, that the symptoms and physical signs after operation were ameliorated. ②Postoperative effect evaluated with the standard for low back pain operation： The proportion of bad effect was obviously lower in thee preoperative score 〉 40 points group than in the ≤40 points group [15.3%, 40%,x^2=12.31, P 〈 0.01]. The effect was the best in the 41-60 points group, and the rate of excellent to good reached 97.7%. The effect when the score was around 60 points was not significantly different from that in the 41-60 points group and above 61 points group [x^2=-0.03,x^2=2.29, P 〈 0.05]. CONCLUSION： The self-made objective rating system for lumbar discectomy can evaluate both the preoperative and postoperative disease conditions, and the preoperative score plays a better role in predicting the postoperative effect.
出处
《中国临床康复》
CSCD
北大核心
2005年第30期1-3,共3页
Chinese Journal of Clinical Rehabilitation
