Starkweather Angela R, Witek-Janusek Linda, Nockels Russ P, Peterson Jonna, Mathews Herb L
Intercollegiate College of Nursing, Washington State University, Spokane, WA, USA.
J Neurosci Nurs. 2008 Feb;40(1):32-9.
Minimally invasive transforaminal lumbar interbody fusion (TLIF) offers equivalent postoperative fusion rates compared to posterior lumbar fusion (PLF) and minimizes the amount of iatrogenic injury to the spinal muscles. The objective of this study was to examine the difference in pain perception, stress, mood disturbance, quality of life, and immunological indices throughout the perioperative course among patients undergoing TLIF and PLF. A prospective, nonrandomized descriptive design was used to evaluate these measures among patients undergoing TLIF (n = 17) or PLF (n = 18) at 1 week prior to surgery (T1), the day of surgery (T2), 24 hours postoperatively (T3), and 6 weeks postoperatively (T4). Among TLIF patients, pain, stress, fatigue, and mood disturbance were significantly decreased at the 6-week followup visit (T4) compared to patients who underwent PLF. The TLIF group also demonstrated significantly higher levels (near baseline) of CD8 cells at T4 than the PLF group. Interleukin-6 levels were significantly higher in the TLIF group as well, which may be an indicator of ongoing nerve regeneration and healing. Knowledge concerning the effect of pain and the psychological experience on immunity among individuals undergoing spinal fusion can help nurses tailor interventions to improve outcomes, regardless of the approach used.
与后路腰椎融合术（PLF）相比，微创经椎间孔腰椎椎体间融合术（TLIF）术后融合率相当，且能将对脊柱肌肉的医源性损伤降至最低。本研究的目的是探讨接受TLIF和PLF的患者在围手术期疼痛感知、压力、情绪障碍、生活质量和免疫指标的差异。采用前瞻性、非随机描述性设计，在手术前1周（T1）、手术当天（T2）、术后24小时（T3）和术后6周（T4）对接受TLIF（n = 17）或PLF（n = 18）的患者进行这些指标的评估。与接受PLF的患者相比，TLIF患者在6周随访（T4）时疼痛、压力、疲劳和情绪障碍显著减轻。TLIF组在T4时的CD8细胞水平也显著高于PLF组（接近基线水平）。TLIF组的白细胞介素-6水平也显著更高，这可能是神经持续再生和愈合的一个指标。了解脊柱融合患者疼痛和心理体验对免疫的影响，有助于护士制定干预措施以改善预后，无论采用何种手术方式。
