中青年腰椎间盘突出症保守治疗病人腰背功能障碍的影响因素分析

陈玮; 侯倩雯; 陈清军; 龚传艳; 朱俊琛

doi:10.13898/j.cnki.issn.1000-2200.2023.09.028

中青年腰椎间盘突出症保守治疗病人腰背功能障碍的影响因素分析

Analysis of influencing factors of low back dysfunction in young and middle-aged patients with lumbar disc herniation undergoing conservative management

摘要

摘要:
目的了解中青年腰椎间盘突出症(LDH)保守治疗病人的腰背功能障碍程度，分析疾病自我管理行为、恐惧-回避信念与功能障碍的关系，探讨引起腰背功能障碍的影响因素。
方法采用便利抽样法选取248例中青年LDH保守治疗病人作为研究对象。收集病人的一般人口学及病例资料，采用视觉模拟评分(VAS)、慢性病自我管理量表(CDSMS)、恐惧-回避信念量表(FABQ)和Oswestry功能障碍指数问卷(ODI)对病人进行调查。分析中青年LDH病人CDSMS、FABQ和ODI的相关性及腰背功能障碍的影响因素。
结果中青年LDH病人ODI总分为(23.26±6.39)分，中度、重度及极重度功能障碍者分别占比为36.29%、48.39%和15.32%，无轻度功能障碍和限制卧床病人。不同性别、年龄段、锻炼频率、体质量指数、自评健康程度、是否使用止痛药、疼痛部位和疼痛程度的病人ODI评分差异均有统计学意义(P<0.01)。中青年LDH病人CDSMS各维度得分与ODI总分呈明显负相关关系(P<0.01)，FABQ各维度得分与ODI总分呈明显正相关关系(P<0.01)。性别、年龄段、体质量指数、使用止痛药、疾病自我管理行为和恐惧-回避信念是功能障碍的主要影响因素(P<0.01)，共解释LDH病人ODI的76.10%。
结论中青年LDH病人腰背功能障碍程度偏重，疼痛明显。疾病自我管理行为、恐惧-回避信念与功能障碍有一定关联。护理人员应积极开展健康教育及针对性干预，提高病人的疾病自我管理能力及疼痛应对信念，从而降低腰背功能障碍程度。

Abstract:
ObjectiveTo understand the degree of low back dysfunction in young and middle-aged patients with lumbar disc herniation (LDH) undergoing conservative management, analyze the relationship between disease self-management behavior, fear avoidance belief and dysfunction, and explore the influencing factors of low back dysfunction.
MethodsA total of 248 young and middle-aged patients with LDH undergoing conservative management were selected as the study subjects by convenient sampling method.The general demography and case data of the patients were collected, and the patients were investigated by visual analogue scale (VAS), chronic disease self-management scale (CDSMS), fear avoidance belief questionnaire (FABQ) and Oswestry dysfunction index (ODI).The correlation between CDSMS, FABQ, and ODI in young and middle-aged LDH patients, as well as the influencing factors of lower back dysfunction were analyzed.
ResultsThe total ODI score of young and middle-aged LDH patients was (23.26±6.39) points, patients with moderate, severe, and extremely severe dysfunction accounted for 36.29%, 48.39% and 15.32%, respectively, and there were no patients with mild dysfunction and bed-restricted rest.There were statistically significant differences in ODI scores among patients with different genders, age, exercise frequency, body mass index, health status of self-assessment, use of analgesics, pain site, and pain severity (P<0.01).The scores of CDSMS in all dimensions of young and middle-aged LDH patients were significantly negatively correlated with the total score of ODI (P<0.01), and the scores of FABQ in all dimensions were significantly positively correlated with the total score of ODI (P<0.01).Gender, age, body mass index, use of analgesics, disease self-management behavior and fear avoidance belief were the main influencing factors of dysfunction (P<0.01), which could explain 76.10% of the total variation of ODI.
ConclusionsYoung and middle-aged patients with LDH undergoing conservative management have more severe low back dysfunction and obvious pain.Disease self-management behavior and fear avoidance belief are associated with dysfunction.Nursing staff should actively carry out health education and targeted intervention to improve patients' disease self-management ability and pain coping belief, so as to reduce the degree of low back dysfunction.

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