پديد آورندگان :
سعيدي بروجني، حميدرضا دانشگاه علوم پزشكي كرمانشاه , مهرافزون، نيلوفر دانشگاه علوم پزشكي كرمانشاه , ماهور، طيبه دانشگاه علوم پزشكي كرمانشاه - دانشكده پزشكي - گروه پرستاري و مامايي , مشعلچي، حميده دانشگاه علوم پزشكي دزفول - دانشكد پرستاري و مامايي
چكيده لاتين :
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.
Methods
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.
Results
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).
Conclusion
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).
