Razi Journal of Medical Sciences
مجله علوم پزشکی رازی
RJMS
Medical Sciences
http://rjms.iums.ac.ir
39
journal39
2228-7043
2228-7051
en
jalali
1399
7
1
gregorian
2020
10
1
27
7
online
1
fulltext
fa
بررسی کیفیت سلامت بیماران با هرنی دیسک کمری ، قبل و بعد از جراحی هرنی دیسک کمری
The Health quality assessment patients whit Lumbar disc herniation, before and after Herniated Lumbar Disc surgery
جراحی مغز و اعصاب
Neurosurgery
پژوهشي
Research
<strong><span style="color:#0070c0;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">زمینه و هدف: </span></span></span></strong><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">فتق دیسک کمری یکی از شایعترین علل درد کمر میباشد و پس از بیماریهای ریوی، کمردرد دومین علت مراجعه به پزشک میباشد</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">.</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> در مطالعه حاضر به بررسی کیفیت سلامت بیماران، قبل و بعد از جراحی هرنی دیسک کمری و ضرورت انجام جراحی دیسک پرداخته شده است.</span></span></span><br>
<strong><span style="color:#0070c0;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">روش کار:</span></span></span></strong><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> در این مطالعه توصیفی- تحلیلی که نمونهها بهصورت در دسترس انتخاب شدند 90 بیمار با کمردرد مزمن که کاندید جراحی هرنی دیسک کمر بودند، مورد بررسی قرار گرفتند. جمع آوری دادهها از طریق پرسشنامه کیفیت سلامت 36-</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">SF</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> و همچنین با استفاده از پرسشنامه دموگرافیک، جمع آوری شد. قبل از عمل به منظور ارزیابی کیفیت سلامت بیماران از پرسشنامه 36-</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">SF</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> استفاده شد پس از عمل نیز بیماران در دو مرحله زمانی 6 ماه و سپس 12 ماه، با کمک پرسشنامه مذکور پیگیری شدند و کیفیت زندگی آنها مجدداً مورد ارزیابی قرار گرفت. از آمار توصیفی، آزمون </span></span></span> <span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">T</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">زوجی و آزمون </span></span></span> <span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;"> KS</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> استفاده شد و برای اهداف مقایسهای بر حسب متغیرهای زمینهای از روش لایه سازی استفاده شد سپس نمونهها با نرم افزار20 </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">SPSS-</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> مورد تحلیل قرار گرفت.</span></span></span><br>
<strong><span style="color:#0070c0;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">یافتهها:</span></span></span></strong><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> میانگین و انحراف معیار بهبود نمره در بعد جسمی کیفیت زندگی قبل و 6 ماه پس از درمان از نظر جنس، در مردان 13/9</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">60/38 و در زنان 56/8</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">90/31 به دست آمد که این اختلاف از نظر آماری معنی دار بود (005/0</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">p=</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">). همچنین میانگین و انحراف معیار بهبود نمره در بعد جسمی کیفیت زندگی قبل و 12 ماه پس از درمان، در مردان72/6</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> 58/ 43و در زنان 24/7</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> 37/40بود که این اختلاف از نظر آماری معنی دار نبود (009/0=</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">p</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">). میانگین و انحراف معیار بهبود نمره در بعد روانی کیفیت زندگی قبل و 6 ماه پس از درمان در مردان 72/11</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">41/18 در زنان 37/7</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> 26/14بود که این اختلاف از نظر آماری معنی دار بود (001/0></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">p</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">)، همچنین میانگین و انحراف معیار بهبود نمره در بعد روانی کیفیت زندگی قبل و 12 ماه پس از درمان در مردان 69/9</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> 93/24 و زنان 86/8</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> 26/29 برآورد شد که این اختلاف از نظر آماری معنادار بود بهطوریکه در زنان بهبودی بیشتری نسبت به مردان حاصل شده بود. میانگین و انحراف معیار بهبود نمره در بعد جسمی کیفیت زندگی قبل و 6 ماه پس از درمان در بیماران بر اساس مدت زمان درد کمر و اندام تحتانی، در دو گروه زیر 2ماه و بالاتر از 2 ماه مورد بررسی قرار گرفت. نتایج نشان داد که در گروه زیر 2 ماه ،18/7</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> 06/39 در گروه بالاتر از 2 ماه 36/9</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> 59/32 بوده است که این اختلاف از نظر آماری معنی دار بود (012/0=</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">p</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">) بهطوریکه بیماران با مدت درد کمر و اندام تحتانی کمتر (گروه زیر 2 ماه) بهبودی بیشتری را نشان دادند. همچنین میانگین و انحراف معیار بهبود نمره در بعد جسمی کیفیت زندگی قبل و 12ماه پس از درمان در گروه زیر 2 ماه، 86/7</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> 37/45 در گروه بالاتر از 2 ماه 31/10</span></span></span><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">±</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> 68/38 بوده است که این اختلاف از نظر آماری معنی دار بود (08/0=</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">p</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">) بهطوریکه بیماران با مدت درد کمر و اندام تحتانی کمتر (گروه زیر 2 ماه) بهبودی بیشتری را نشان دادند همچنین بهطور کلی میانگین نمره بهبود سلامت جسمی و روانی اختلاف معنی داری را با توجه به شاخص توده بدنی، تعداد دیسک درگیر و مصرف دخانیات در قبل، 6 و 12 ماه بعد را نشان داد به این معنی که با توجه به نتایج آزمون </span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">T</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> مستقل، نمره بهبود کیفیت زندگی در بعد جسمی و روانی؛ در مقایسه قبل، 6 ماه و 12 ماه پس از جراحی در بین مردان و زنان از نظر آماری معنادار بود و نشان دهنده بالا رفتن کیفیت زندگی در دو بعد جسمی و روانی شده بود (001/0></span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:Times New Roman,serif;"><span style="font-size:9.0pt;">p</span></span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">). </span></span></span><br>
<strong><span style="color:#0070c0;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> نتیجهگیری:</span></span></span></strong><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;"> نتایج مطالعه حاضر نشان داد کیفیت زندگی که در مطالعه حاضر در دوره های زمانی قبل از درمان، 6 و 12ماه پس از درمان صورت گرفت باعث بهبود قابل توجهی در وضعیت جسمی و روانی بیماران با عارضه هرنی دیسک کمری شد</span></span></span><span style="color:black;"><span style="font-family:B Mitra;"><span style="font-size:9.0pt;">.</span></span></span>
<strong>Background:</strong> Lumbar disc herniation is one of the most common causes of low back pain and after pulmonary disease, low back pain is the second most common reason to see a doctor. Diagnosis of lumbar disc herniation in a patient presenting with sciatica is based on history, clinical signs, physical examination, and MRI or CT imaging techniques. Pain Most patients who present with sciatica due to lumbar disc herniation respond to conservative and rest treatments, but patients who do not respond to medical treatment and rest undergo lumbar MRI imaging without contrast and if indicated Clinically, the presence of a disc herniation undergoes surgery with a pressure effect on the spinal sac or nerve root. Clinical indication for lumbar disc herniation surgery occurs when, despite rest, the pain persists for more than 4 weeks, due to high pressure, the person develops paresthesia in the lower extremities, the patient's pain recurs frequently and the patient's life Disrupt. Chronic diseases such as back pain have important consequences, including changes in people's quality of life. Quality of life is a multidimensional structure that is characterized by social, mental and physical vitality and causes a feeling of vitality and satisfaction with life, and certainly spinal surgery affects the quality of life in all dimensions. In the present study, the quality of patients' health before and after lumbar disc herniation surgery and the necessity of disc surgery were investigated.<br>
<strong>Methods: </strong>In this descriptive-analytical study in which samples were selected by convenience, 90 patients with chronic low back pain who were candidates for lumbar disc herniation surgery were studied. Data were collected through the 36-SF Health Quality Questionnaire and also using a demographic questionnaire, patient demographic information including age, sex, height, weight, smoking, occupation and level of education was collected. Before the operation, the 36-SF questionnaire was used to assess the quality of patients' health. After the operation, patients were followed up in two stages of 6 months and then 12 months with the help of the questionnaire and their quality of life was re-evaluated. Exclusion criteria included patients who had complications from surgery during the follow-up period, including wound infection, nerve root damage and neurological defects, incomplete recovery of lower back and lower extremity pain, and recurrence of disc herniation. They were lumbar or found a new history of other diseases such as stroke, rheumatoid arthritis, autoimmune disease, in which case they were excluded from the study. Descriptive statistics including calculation of numerical indices (mean and standard deviation) for quantitative traits and percentage for qualitative traits were used for summarization. Also, paired t-test was used to analyze quantitative data and Wilcoxon test was used if necessary and KS test was used for data normality. The stratification method was used for comparative purposes in terms of contextual variables. Then the samples were analyzed with SPSS-20 software.<br>
<strong>Results:</strong> Mean and standard deviation of score improvement in physical dimension of quality of life before and 6 months after treatment in terms of sex were 38.60 9 9.13 in men and 31.90 56 8.56 in women, which was statistically different. Was significant (p = 0.005). Also, the mean and standard deviation of the score improvement in physical dimension of quality of life before and 12 months after treatment was 43.58 6 6.72 in men and 40.37 24 7.24 in women, which was not statistically significant (p=0.009). The mean and standard deviation of the score improvement in the psychological dimension of quality of life before and 6 months after treatment was 18.41 ± 11.72 in men and 14.26 37 7.37 in women, which was statistically significant (p<0.001)), also the mean and standard deviation of the score improvement in the psychological dimension of quality of life before and 12 months after treatment was estimated to be 24.93 9 9.69 in men and 29.26 86 8.86 in women, which was statistically significant. In women, there was more improvement than men. Mean and standard deviation of score improvement in physical dimension Quality of life before and 6 months after treatment in patients based on the duration of low back and lower limb pain, in two groups under 2 months and above 2 months were studied. The results showed that in the group under 2 months, 39.06 18 7.18 in the group above 2 months was 32.59 36 9.36 which was statistically significant (p=0.012) so that Patients with less back and lower limb pain (less than 2 months) showed more improvement. Also, the mean and standard deviation of the score improvement in the physical dimension of quality of life before and 12 months after treatment in the group under 2 months was 45.37 86 7.86 in the group over 2 months was 38.68 10 10.31, which was different from Statistically significant (p=0.08) that patients with less back and lower extremity pain (less than 2 months) showed more improvement. In general, the mean score of physical and mental health improvement was significantly different from Paying attention to body mass index, number of involved discs and smoking before, 6 and 12 months later showed that according to the results of independent t-test, the score of improving the quality of life in physical and mental dimensions; Compared to before, 6 months and 12 months after surgery were statistically significant among men and women and showed an increase in quality of life in both physical and psychological dimensions (p<0.001).<br>
<strong>Conclusion: </strong>The results of the present study showed that the quality of life in the present study in the time periods before treatment, 6 and 12 months after treatment caused a significant improvement in the physical and mental condition of patients with lumbar disc herniation so that the mean score of quality of life Before the intervention, it was increased to 5.94 29 29.5, 6 months after the intervention to 60.17 4 4.55 and in 12 months after the intervention to 65.26 6 6.18, which statistical test also showed a significant increase (p<0.001).
کمردرد, کیفیت سلامت, دیسککتومی, لامینکتومی, سلامت روانی, سلامت جسمی
Low back pain, Quality of health, Discectomy, Laminectomy, Mental health, Physical health
176
185
http://rjms.iums.ac.ir/browse.php?a_code=A-10-5067-1&slc_lang=fa&sid=1
Hamid Rez
Saeidi Boroojeni
حمیدرضا
سعیدی بروجنی
dr.saeidi@yahoo.com
3900319475328460056872
3900319475328460056872
No
Kermanshah University of Medical Sciences, Kermanshah, Iran
دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران
Niloofar
Mehrafzoon
نیلوفر
مهرافزون
mehrafzoon@yahoo.com
3900319475328460056873
3900319475328460056873
No
kermanshah
کرمانشاه
Hamideh
Mashalchi
حمیده
مشعلچی
hamidehmashalchi@gmail.com
3900319475328460056874
3900319475328460056874
No
dezfol
دزفول
Tayebeh
Mahvar
طیبه
ماه ور
mandanamahvar@yahoo.com
3900319475328460056875
3900319475328460056875
Yes
Kermanshah University of Medical Sciences, Kermanshah, Iran
دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران