摘要
目的:评估SF-36量表用于国人脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者健康相关生活质量(quality of life,QOL)的信度,并验证术后疗效评价中,生活质量评价与神经功能评估的一致性。方法:本研究前瞻性收集了接受手术治疗的脊髓型颈椎病患者142例,男84例,女58例,年龄60.0±10.9岁。所有患者均接受手术治疗。分别于术前、术后3个月、术后1年和术后2年以上末次随访时分别使用改良日本骨科协会评分法(modified Japanese Orthopaedic Association,mJOA)评分和健康状况调查简表(SF-36量表)进行神经功能和生活质量评估,并与正常人群的常模进行对比。使用克隆巴赫系数(Cronbachα)分析SF-36量表八个维度的信度,并进一步分析在术后不同随访时间节点SF-36各维度与神经功能评价的相关性。根据患者各项评分的变化趋势,分析患者的康复峰值时间。结果:术前CSM患者SF-36量表8个维度中,除“精神健康”维度外,其余7各维度较健康成年人常模均存在显著功能缺陷。SF-36量表各维度的Cronbachα介于0.73~0.85之间(Cronbachα:生理功能=0.85、生理职能=0.83、躯体疼痛=0.80、整体健康=0.81、活力=0.81、社会功能=0.79、情感职能=0.73、精神健康=0.75)。术后3个月时,mJOA评分的改善仅与患者SF-36量表中生理功能和躯体疼痛两个维度得分有显著相关性(相关系数R:生理功能=0.32,躯体疼痛=0.20;P<0.05);术后1年时,mJOA评分的改善与SF-36量表中生理功能、整体健康、社会功能和情感职能四个维度有显著相关性(相关系数R:生理功能=0.39,整体健康=0.24,社会功能=0.22,情感职能=0.19;P<0.05);在术后2年以上末次随访时,mJOA评分的改善与SF-36量表中生理功能、活力和情感职能三个维度显著相关(相关系数R:生理功能=0.38,活力=0.20,情感职能=0.20;P<0.05)。SF-36量表的生理总评分和心理总评分分别在17.7个月和18.9个月达到峰值。结论:SF-36量表各维度的信度较高,是一项可靠的评估CSM患者健康相关生活质量的方法。在术后不同随访期的疗效评估中,SF-36量表各维度与神经功能改善评估的一致性不尽相同:在术后恢复早期,mJOA评分的改善与SF-36量表中的生理相关维度显著相关;随着术后恢复期延长,mJOA评分的改善则与生理、心理相关维度均显著相关。
Objectives:To calculate the reliability of SF-36 and to verify its consistency with neurological function assessment after surgery for Chinese cervical spondylotic myelopathy(CSM)patients.Methods:The data of 142 CSM patients(male=84,female=58,average age was 60.0 years old,SD=10.9)who underwent surgical treatment were prospectively collected.Both neurological measurement(modified Japanese Orthopaedic Association,mJOA score)and quality of life(QOL)measurement(SF-36)were used to evaluate patients in this study preoperatively and at the follow-up of 3-month,1-year and over 2-year postoperatively.The re sults of SF-36 evaluation in CSM patients were compared with that of healthy adults.Cronbachαwas used to assess the reliability of 8 domains of SF-36.We also analyzed the consistency of domains of SF-36 with mJOA score at different follow-up time points.Based on the changing trends of each scale,we calculated the peak recovery time of CSM patients during the follow-up period.Results:The scores for all SF-36 domains except for mental health domain indicated that patients with CSM were significantly impaired compared with healthy adults.Cronbachαranged from 0.73(for role-emotional)to 0.85(for physical functioning).(Cronbachα:physical functioning=0.85,role-physical=0.83,bodily pain=0.80,general health=0.81,vitality=0.81,social functioning=0.79,role-emotional=0.73,mental health=0.75).At the 3-month follow-up,improvements in mJOA scores were only significantly correlated with the patient′s scores of physical functioning and bodily pain.[Correlation coefficient(CC)(R):physical functioning=0.32,bodily pain=0.20;P<0.05].At 1 year after surgery,improvements in mJOA scores were significantly correlated with physical functioning,general health,social functioning and role-emotional[CC(R):physical functioning=0.39,general health=0.24,social functioning=0.22,role-emotional=0.19;P<0.05].While at final follow-up,improvements in mJOA scores were significantly correlated with physical functioning,vitality and role-emotional[CC(R):physical functioning=0.38,vitality=0.20,role-emotional=0.20;P<0.05].The physical component score(PCS)peaked at 17.7 months and the mental component score(MCS)at 18.9 months,respectively.Conclusions:SF-36 is a reliable method to evaluate patients with CSM.The evaluation of quality of life was inconsistent with the neurological function improvement in different stages of the postoperative follow-up.At the early stage of recovery,the improvements in mJOA scores essentially correlated with domains from the physical components of the SF-36,while at later stages the improvements were associated with domains from both physical and mental components.
作者
周非非
张一龙
李舒扬
孙宇
张凤山
潘胜发
刘忠军
ZHOU Feifei;ZHANG Yilong;LI Shuyang(Department of Orthopeadics,Peking University Third Hospital,Beijing,100191,China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2020年第3期256-262,共7页
Chinese Journal of Spine and Spinal Cord
