Berthelot J M, Rodet D, Guillot P, Laborie Y, Maugars Y, Prost A
Rheumatology Department, Nantes Teaching Hospital, France.
Rev Rhum Engl Ed. 1999 Apr;66(4):207-13.
To identify criteria for predicting the outcome at discharge in patients scheduled for inhospital treatment of disk-related sciatica.
We studied 150 rheumatology department patients admitted for disk-related sciatica with a mean duration of 88 +/- 127 days to determine the impact on treatment outcomes of 50 parameters.
After complete bed and 2.2 +/- 1.1 epidural glucocorticoid injections during a mean hospital stay of 9.9 +/- 4.3 days, 80% of patients reported either complete or partial pain relief (19% and 61%, respectively). The remaining 20% reported little (9%) or no (11%) change. Surgery was performed in 13% of cases. A tighter straight-leg raising test angle was correlated with treatment failure (P = 0.01). Complete bed rest duration prior to admission was shorter in the 80% of responders (P = 0.036) than in the 20% of nonresponders; in the overall population, patients spent on average 64% +/- 33% of daytime hours in bed. Patient predictions about their own outcomes were unreliable (P = 0.926). Patients who believed strongly that sciatica requires surgical treatment were more likely to be nonresponders (P = 0.06), as were patients with a family history of surgically-treated sciatica (P = 0.055). Outcomes were not correlated with any of the other parameters studied, including sciatica duration (P = 0.13), bedrest duration prior to admission (P = 0.52; mean duration, 18 +/- 29 days), the specialty of the physicians seen, investigations done prior to admission, or a history of sciatica (noted in 65% of cases and treated surgically in 16%).
Eighty percent of patients benefited from their hospital stay. Patient opinions on the merits of nonsurgical and surgical treatments in their own case were not correlated with their own outcomes. A tight straight leg-raising test angle was correlated with a poorer outcome. Neither sciatica duration nor rest duration prior to admission had an influence on outcome. Absence of complete bed rest prior to admission was correlated with a greater likelihood of a therapeutic benefit from the hospital stay.
确定预测计划住院治疗椎间盘源性坐骨神经痛患者出院时预后的标准。
我们研究了150例因椎间盘源性坐骨神经痛入院的风湿科患者，平均病程为88±127天，以确定50个参数对治疗结果的影响。
在平均住院9.9±4.3天期间，经过完全卧床休息并接受2.2±1.1次硬膜外糖皮质激素注射后，80%的患者报告疼痛完全或部分缓解（分别为19%和61%）。其余20%的患者报告疼痛几乎没有（9%）或没有（11%）变化。13%的病例接受了手术治疗。直腿抬高试验角度越紧与治疗失败相关（P = 0.01）。80%有反应的患者入院前的完全卧床休息时间比20%无反应的患者短（P = 0.036）；在总体人群中，患者白天平均卧床时间为64%±33%。患者对自身预后的预测不可靠（P = 0.926）。坚信坐骨神经痛需要手术治疗的患者更有可能无反应（P = 0.06），有手术治疗坐骨神经痛家族史的患者也是如此（P = 0.055）。预后与所研究的任何其他参数均无相关性，包括坐骨神经痛病程（P = 0.13）、入院前卧床时间（P = 0.52；平均病程，18±29天）、看过的医生专业、入院前进行的检查或坐骨神经痛病史（65%的病例有记录，16%接受过手术治疗）。
80%的患者从住院治疗中受益。患者对自身病例中非手术和手术治疗优点的看法与自身预后无关。直腿抬高试验角度紧与较差的预后相关。坐骨神经痛病程和入院前休息时间均对预后无影响。入院前未完全卧床休息与住院治疗获得治疗益处的可能性更大相关。
