新的持续护理计划对综合骨科手术后患者短期和长期腰背痛的影响：基于 282 名患者的回顾性研究

IF 1.6 4区医学 Q2 SURGERY

Frontiers in Surgery Pub Date : 2024-08-29 DOI:10.3389/fsurg.2024.1443231

Jucai Li, Yanli Song, Lumei Wu, Dan Su, Lin-Feng Wang

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引用次数: 0

摘要

背景单侧双ortal内镜椎间盘切除术（UBED）是一种被广泛接受的治疗腰椎退行性疾病的微创手术。然而，部分患者在术后短期和长期仍有持续的腰背痛（LBP）症状，这可能与患者术后护理和康复不当有关。本研究回顾性入选了 2019 年 1 月至 2022 年 1 月在我院接受椎间盘突出症手术治疗的 282 例腰椎间盘突出症（LDH）患者。根据患者是否接受持续护理项目将其分为两组：传统护理组 147 例，持续护理组 135 例。收集患者的人口统计学特征、放射学参数和随访数据。结果连续护理组患者术后 3 个月和 12 个月的枸橼酸盐视觉模拟量表（VAS）评分分别为（0.97±1.159）分和（0.61±0.954）分，术后 12 个月的腿痛视觉模拟量表（VAS）评分分别为（0.23±0.421）分，均优于传统护理组（1.51±1.313、1.10±1.076、0.68±0.788，p&;lt;0.001），持续护理组术后12个月Oswestry残疾指数（ODI）评分低于传统护理组（7.36±6.526 vs. 12.43±6.942，p&;lt;0.001）。持续护理组的康复完成度（7.98±1.857）分、疗效满意度（9.13±1.101）分、担心再疝（1.97±1.217）分均优于传统护理组（分别为（4.14±3.066）分、（8.28±1.240）分、（2.79±1.973）分，P&;lt; 0.001）。两组在一年内的再疝率相似（3/135 vs. 2/147，P = 0.673）。没有发生切口感染。多变量回归分析显示，3个月随访时出现持续性腰痛的风险因素是椎间盘退行性变[几率比（OR）：2.144，CI：1.306-3.519，p = 0.03]、Pfirrmann分级（OR：3.073，CI：1.427-6.614，p = 0.04）和手术时间（OR：0.969，CI：0.937-1.003，p = 0.74）。在 12 个月的随访中，术前腿部 VAS（OR：1.261，CI：1.000-1.591，p = 0.05）和 Pfirrmann 分级（OR：3.309，CI：1.460-7.496，p = 0.04）是导致持续性腰背痛的风险因素。结论持续性护理方案可改善UTBED术后患者短期和长期持续性腰背痛的症状，提高UTBED术后康复训练的完成度，减轻患者对复发的担忧，提高患者的满意度。

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Effects of a new continuous nursing program on the short-term and long-term low back pain in patients after UBED: a retrospective study based on 282 patients

BackgroundUnilateral biportal endoscopic discectomy (UBED) is a widely accepted minimally invasive surgery for the treatment of lumbar degenerative diseases. However, some patients continue to have persistent low back pain (LBP) symptoms in the short and long term after surgery, which may be related to improper postoperative nursing and rehabilitation of patients. Further research is needed to determine whether continuous nursing can improve the symptoms of patients after UBED.MethodsThis study retrospectively enrolled 282 lumbar disc herniation (LDH) patients who underwent UBED in our hospital from January 2019 to January 2022. The patients were divided into two groups according to whether they accepted the continuous nursing program: 147 patients in the traditional nursing group and 135 patients in the continuous nursing group. Demographic characteristics, radiological parameters, and follow-up data of the patients were collected. Finally, the risk factors of LBP after UBED were analyzed.ResultsThe visual analog scale (VAS) score of LBP in the continuous nursing group was 0.97 ± 1.159 at 3 months and 0.61 ± 0.954 at 12 months after operation, and VAS of leg pain was 0.23 ± 0.421 at 12 months after operation, which were better than those in the traditional nursing group (1.51 ± 1.313, 1.10 ± 1.076, 0.68 ± 0.788, respectively, p < 0.001) The Oswestry disability index (ODI) score of the continuous nursing group was lower than that of the traditional nursing group at 12 months after operation (7.36 ± 6.526 vs. 12.43 ± 6.942, p < 0.001). The rehabilitation completion (7.98 ± 1.857), efficacy satisfaction (9.13 ± 1.101), and re-herniation worry scores (1.97 ± 1.217) in the continuous nursing group were better than those in the traditional nursing group (4.14 ± 3.066, 8.28 ± 1.240, 2.79 ± 1.973, respectively, P < 0.001). The re-herniation rate within 1 year was similar between the two groups (3/135 vs. 2/147, p = 0.673). No incision infection occurred. Multivariate regression analysis showed that risk factors for persistent LBP at 3-month follow-up were degenerative disc [odds ratio (OR): 2.144, CI: 1.306–3.519, p = 0.03], Pfirrmann grade (OR: 3.073, CI: 1.427–6.614, p = 0.04), and surgical time (OR: 0.969, CI: 0.937–1.003, p = 0.74). At the 12-month follow-up, the risk factors for persistent LBP were preoperative VAS of the legs (OR: 1.261, CI: 1.000–1.591, p = 0.05) and Pfirrmann grade (OR: 3.309, CI: 1.460–7.496, p = 0.04).ConclusionContinuous nursing programs can improve the symptoms of short-term and long-term persistent LBP in patients after UBED, enhance the completion of rehabilitation training after UBED, alleviate patients' concerns about recurrence, and improve patients' satisfaction.

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.