颈椎人工椎间盘置换术后患者负性心理的改善及其对预后的影响

目的 观察颈椎病患者行颈椎人工椎间盘置换术后负性心理的改善情况,探讨颈椎病患者抑郁、焦虑等负性心理发生的危险因素及其对预后的影响.方法 回顾性分析2010年1月-2012年1月于本院行颈椎椎间盘置换术的85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（self-rating depression scale,SDS）和Zung焦虑自评量表（self-rating anxiety scale,SAS）评估患者负性心理,颈部及上肢疼痛视觉模拟量表（visual analogue scale,VAS）评分、日本骨科学会（Japan Orthopedic Association,JOA）评分评估神经功能,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 所有患者临床症状和神经功能改善满意.12例（14.12%）患者术前出现明显的抑郁,21例（24.70%）患者出现焦虑;术后1周患者SDS和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和焦虑评分与VAS和SF-36评分显著相关,但与年龄和JOA评分无显著相关.结论 部分颈椎病患者术前存在抑郁及焦虑,颈椎人工椎间盘置换术可以部分改善这2种心理,患者负性心理对其预后具有负性作用.

Depression and anxiety improvement after artificial cervical disc replacement and its influence to prognosis

Objective To observe the improvement of depression and anxiety in patients of cervical spondylosis after cervical total disc replacement, and to discuss the risk factors of depression and anxiety and their influence to the prognosis.Methods From January 2010 to January 2012, 85 patients of cervical spondylosis treated with cervical total disc replacement were included. At 1 week, 1 month, 3 months, 6 months, 1 year postoperatively and final follow-up, depression and anxiety were evaluated by Zung self-rating depression scale(SDS) and Zung self-rating anxiety scale(SAS), neurological function was evaluated by visual analog scale(VAS) and Japan Orthopedic Association (JOA) scoes, quality of life was assessed by 36-item short-form health survey(SF-36). Single factor analysis was used. Results All the patients' clinical symptoms and neurological function improved well. Twelve (14.12%)patients had obvious symptoms of depression, and 21(24.71%) patients had symptoms of anxiety. Depression and anxiety were all improved in different levels postoperation. There was a significant difference between preoperative and postoperative SAS scores, while the SDS score improvement had no statistical significace. For all 85 patients, the VAS score and the SF-36 score were associated with postoperative level of depression and anxiety, but not associated age and JOA. Conclusion Some patients of cervical spondylosis have depression and/or anxiety preoperatively. Cervical total disc replacement could improve these 2 kinds of psychological state to some degree. Depression and anxiety have some negative influence to the prognosis.