伴发抑郁情绪对经皮腰椎间盘切吸术后疗效的影响

背景经皮腰椎间盘切吸术(percutaneous lumber discectomy,PLD)已成为治疗多数腰椎间盘突出症的主要治疗手段.临床诊治腰椎间盘突出症过程中,部分患者表现出抑郁情绪的特点.但伴发抑郁情绪是否对PLD疗效及术后康复产生影响尚无报道.目的探讨腰椎间盘突出症患者伴发抑郁情绪对PLD疗效的影响,以及PLD术后有效的康复干预手段.设计病例对照研究.单位新乡医学院第二附属医院放射介入科、精神科.对象2001-07/2002-12新乡医学院第二附属医院放射介入科行PLD治疗的74例腰椎间盘突出症患者中选取符合腰椎间盘突出症诊断、采用PLD治疗、抑郁自评量表SDS得分＞50、既往无精神病史及精神病家族史标准的腰椎间盘突出症伴发抑郁情绪患者26例为抑郁组.每一病例选配本院自1997-06/2002-03经PLD治疗的腰椎间盘突出症患者一例加以对照,即对照组.干预采用Zung编制的抑郁自评量表(SDS)于术前、术后在病房安静环境下,被调查者独立完成;随访6个月,评定SDS和疗效.主要观察指标①术前、术后SDS评分.②随访6个月时的SDS评分和疗效.结果腰椎间盘突出症患者的抑郁发生率为35%(26/74);抑郁组显效率46%(14/26)与对照组显效率81%(21/26)比较,差异有显著性意义(x2=4.282,P=0.039);抑郁组总有效率85%(22/26)与对照组总有效率92%(23/26)比较,差异无显著性意义(x2=0.754,P=0.385).两组患者的疗效的构成比差异无显著性意义(x2=4.339,P=0.114).同期74例患者PLD疗效总有效率92%.术后6个月腰椎间盘突出症伴发抑郁情绪患者SDS评分(56.29±10.27)与术前(61.37±9.68)比较,差异有显著性意义(t=5.701,P＜0.001),抑郁情绪的缓解比例为35%.结论腰椎间盘突出症患者抑郁情绪发生率高于正常人群,并且其PLD的疗效显效率低于无伴发抑郁情绪人群,但提高对抑郁情绪的认识能够提高PLD的总体疗效.

Impact of depression on the curative effect of percutaneous lumbar discectomy for lumbar disc herniation

BACKGROUND: Percutaneous lumbar discectomy(PLD) has become the major surgical approach for treatment of lumbar disc herniation(LDH). Some clinical patients with LDH are found to develop depression symptoms, but whose impact on the therapeutic effect of the surgery and postoperative rehabilitation has not been well documented.OBJECTIVE: To define sthe impact of depression on the effect of PLD in patients with LDH, and explore effective postoperative rehabilitative interventions.DESIGN: A case-controlled study.SETTING: Department of Radiology and Department of Psychiatry, the Second Affiliated Hospital of Xinxiang Medical College.PARTICIPANTS: From 74 patients with LDH who had undergone PLD in the Department of Radiology, the Second Affiliated Hospital of Xinxiang Medical College from July 2001 to December 2002, 26 were identified to have depression that complicated the diagnostically defined condition of LDH. The selected patients had the score of self-rating depression scale (SDS) ＞ 50 and were free of psychosis or such a family history. Each LDH case with depression was paired with another LDH case treated by PLD during June 1997 to March 2002, and the latter case group constituted the control group.INTERVENTIONS: Each patient was investigated separately with the SDS designed by Zung that was completed independently by the patient in a quite ward both before and after PLD. The curative effect was assessed and SDS score measured after the 6-month follow-up.SDS scores and curative effect after a 6-month follow-up.RESULTS: The incidence of depression was 35% (26/74) in the LDH patients, who had an effective rate of the treatment of 46% (14/26), significantly lower than that in the control group(81% , 21/26) (x2 =4. 282, P =0. 039). The total effective rate was 85% (22/26)in the depression group, which was not significantly different from that in the control group(92%, 23/26) (x2 =0. 754, P =0. 385) . No significant difference was noted in the constituent ratio of the curative effects between the two groups(x2 =4. 339, P = 0. 114) . The total effective rate of PLD was 92% in the 74 LDH patients. The SDS score in the depression group 6 months after PLD was remarkably different from that before PLD (56.29 ± 10.27 vs 61.37 ±9.68, t =5.701, P ＜ 0.001), and the remission rate of depression was 35%.CONCLUSION: The incidence of depression is higher in LDH patients than in normal people, a condition that compromises the effectiveness of PLD. Recognition of the role of depression may help improve the curative effect of PLD in LDH patients.