退化性腰椎病變手術後病人之疼痛性質與日常生活活動功能之變化

Abstract

研究背景 疼痛是退化性脊椎病人最常見的症狀之一，最常見的有腰部、臀下肢疼痛，甚至有腰、臀下肢麻、酸、緊繃感及肢體無力等不適感，雖然可藉由服藥或其他保守療法來嘗試改善症狀，但在長期困擾下，不但產生心理問題也漸影響社交的擴展。 研究目的 本研究目的在了解退化性脊椎病變病人(1)手術前與手術後一個月之疼痛強度、疼痛持續時間、疼痛性質及其變化；(2)手術前與手術後一個月之日常生活活動功能及其變化；(3)手術前與手術後一個月之焦慮及憂鬱得分及其變化；(4)手術前與手術後一個月之日本骨科學會背部疼痛評估問卷及其次量表得分及其變化；(5) 日本骨科學會背部疼痛評估問卷分數與疼痛強度、日常生活活動功能、焦慮及憂鬱之關係。 研究方法 本研究為描述性、相關性之研究，以立意取樣針對退化性脊椎病人在手術前及手術後一個月，以結構式問卷進行疼痛強度及相關因素之探討。收集資料期間自民國107年5月30日至108年4月5日，研究工具有疼痛數字評分表、日常生活活動功能量表、醫院焦慮憂鬱量表、日本骨科學會背部疼痛評估問卷，所收集的資料以SPSS16.0套裝軟體做描述性及推論性統計分析。 研究結果 本研究共收集85個案，個案平均年齡66.44歲，男性占49.4%，女性占50.6%。研究結果如下: (1)手術後一個月，病人疼痛強度、疼痛持續時間及不適症狀程度皆顯著下降，肢體麻感之不適症狀其完全消失的人數在手術後一個月有顯著差異；(2)手術後一個月日常生活活動功能得分顯著上升；(3)手術後一個月焦慮量表得分顯著下降，而手術後一個月憂鬱量表得分顯著上升；(4)手術後一個月日本骨科學會背部疼痛評估問卷總分及背痛評估、腰椎功能評估、行走功能評估、社會生活功能評估、心理健康功能評估等五個次量表，除了腰椎功能評估次量表無顯著差異外，總分其他四個次量表得分皆顯著上升；(5)日本骨科學會背部疼痛評估問卷總分與疼痛強度呈顯著負相關，與日常生活活動功能、憂鬱之關係呈顯著正相關。 結論與建議 根據本研究結果，退化性脊椎病人接受手術後其疼痛感及麻感是最具顯著差異性的，但其他不適症狀如酸、無力感、緊繃感完全消除的人數在手術後無顯著差異，再加上憂鬱的程度在手術後增加，特別是手術後需穿戴背架而限制社交活動等影響，易造成心理上的負擔，因此除了減輕疼痛外更需要提供心理支持，對準備接受手術病人導入穿戴背架活動訓練的介入措施，讓病人提早適應及因應日常生活需求，可以減輕心理負擔。

Background. Pain is the most common symptom for patients with degenerative spinal disorders requiring surgery. These pains usually locate in the lower back, lower hips and even lower legs. Other than pain, patients usually complain numbness, sourness, tightness, and even weakness. Not only could these discomforts cause physical and mental uneasiness to the patients, but also affect patients’ daily activities and social life in many degrees. Purposes. The aim of this study is to understand the short-term outcome and perioperative changes after lumbar spine surgery for degenerative lumbar patients. Specifically, this study aimed to understand. (1) The pain intensity, pain duration, pain characteristics and its changes before and one month after surgery. (2) Daily living activities and their changes before and one month after surgery. (3) The score of anxiety and depression and their changes before and one month after surgery. (4) The score of Japanese of Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and its five subscales and their changes before and one month after surgery. (5) The associations between JOABPEQ and patients’ pain intensity, daily living activities, anxiety and depression. Methods. This is a descriptive, correlational research. Participants were selected based on purposive sampling from hospitalized patients scheduled to undergo degenerative spinal surgery in a medical center in northern Taiwan during May 2018 to April 2019. Patients completed structured questionnaires, consisting of demographic information, Pain Numeric Rating Scale, Barthel Index, Hospital Anxiety and Depression Scale and the Japanese Orthopedics Association Back Pain Assessment Questionnaire (JOABPEQ) before and one month after surgery. The collected data were analyzed using SPSS16.0 software package. Results. A total of 85 patients completed the questionnaire. The mean age of participants was 66.4 years-old with males accounted for 49.4% and females accounted for 50.6%. Our data were as follows: (1) One month after surgery, the patient's pain intensity, pain duration and level of discomfort decreased significantly. Other discomforts such as soreness, weakness and tightness did not show significantly complete improvement after the surgery. (2) The score of daily living activities also improved significantly one month after surgery. (3) The score of the anxiety scale decreased significantly, yet depression scale increased significantly one month after surgery. (4) The score of JOABPEQ and its four subscales: back pain, walking function, social life, and mental health all showed significant improvement one month after surgery. (5) There is a significantly negative correlation between JOABPEQ and pain intensity and significantly positive correlation, between JOABPEQ and depression and daily living activities. Conclusions and Suggestions. In summary, pain intensity, pain duration, the level of numbness, and activities of daily living were improved significantly one month after lumbar spinal surgery for patients with degenerative spinal disorders. However, other discomforts like soreness, weakness and tightness did not show significantly complete improvement. The level of depression also increased significantly after surgery. Therefore, we should design an intervention program to assist patient overcoming their residual discomfort, adapting early inconvenience and also easing the psychological stress.