Toyone Tomoaki, Tanaka Tadashi, Kato Daisuke, Kaneyama Ryutaku, Otsuka Makoto
Division of Orthopaedic Surgery, Kimitsu Chuo Hospital, Kisarazu-city, Chiba, Japan.
Spine (Phila Pa 1976). 2005 Dec 1;30(23):2689-94. doi: 10.1097/01.brs.0000187876.14304.15.
Prospective consecutive series.
To determine patient expectations in lumbar spine surgery and assess the level of fulfillment of those expectations.
Little has been offered in the literature in specific regards to lumbar spine surgery.
Ninety-eight patients, 49 patients who underwent discectomy for lumbar disc herniation (Group 1) and 49 patients who underwent laminotomy for lumbar spinal stenosis (Group 2), completed the self-report questionnaire. Preoperative expectations, reasons for surgery, and expected postoperative status were inquired before surgery and the satisfaction at 2 years after surgery.
Concerning patients' expectations, half of the patients expected to become completely leg pain free, and more than three fourths of the patients expected to become unlimited in their walking ability in both groups. More than half of the patients expected to have a 90% or greater chance of complete success of surgery. With regard to satisfaction, 42 of the 49 patients (86%) in Group 1 and 35 of the 49 patients (71%) in Group 2 chose "Surgery met my expectations" at the follow-up. The remaining patients selected "I did not improve as much as I had hoped." Positive expectations were associated with better satisfaction in Group 1 only. Of the patients who had achieved the expected postoperative status with respect to their no.1 reason for surgery, 2 of 34 patients in Group 1 (6%) and 5 of the 26 patients in Group 2 (19%) nonetheless reported "unfulfilled expectations." In patients whose no. 1 concern was further progression, 3 (38%) of the 8 patients in Group 1 and 2 (40%) of the 5 patients in Group 2 demonstrated unfulfilled expectations.
Even if the clinical expectations were met, some patients were still dissatisfied. Patients with spinal stenosis (Group 2) seem to have more unrealistic expectations than patients with disc herniation (Group 1).
前瞻性连续系列研究。
确定腰椎手术患者的期望，并评估这些期望的实现程度。
文献中关于腰椎手术的具体内容较少。
98例患者，49例行腰椎间盘突出症椎间盘切除术的患者（第1组）和49例行腰椎管狭窄症椎板切开术的患者（第2组）完成了自我报告问卷。术前询问患者的术前期望、手术原因和术后预期状态，以及术后2年的满意度。
关于患者的期望，两组中一半的患者期望完全消除腿部疼痛，超过四分之三的患者期望行走能力不受限制。超过一半的患者期望手术完全成功的几率达到90%或更高。关于满意度，第1组49例患者中的42例（86%）和第2组49例患者中的35例（71%）在随访时选择了“手术符合我的期望”。其余患者选择“我的改善不如我期望的那么大”。仅在第1组中，积极的期望与更高的满意度相关。在因首要手术原因达到术后预期状态的患者中，第1组34例患者中的2例（6%）和第2组26例患者中的5例（19%）仍报告“期望未实现”。在首要担忧是病情进一步进展的患者中，第1组8例患者中的3例（38%）和第2组5例患者中的2例（40%）表现出期望未实现。
即使临床期望得到满足，一些患者仍然不满意。腰椎管狭窄症患者（第2组）似乎比椎间盘突出症患者（第1组）有更多不切实际的期望。
