Weinstein J, Spratt K F, Lehmann T, McNeill T, Hejna W
J Bone Joint Surg Am. 1986 Jan;68(1):43-54.
Using data obtained by questionnaire in a retrospective review of patients with low-back and sciatic pain (eighty-five treated by injection of chymopapain and seventy-one, by open discectomy), the results at one and ten years after treatment were analyzed. For this analysis we used six measures of pain relief, six measures of the patients' course during the ten-year period since primary treatment, and four measures of the patients' history of employment or work since initial treatment. Validity studies demonstrated that the pain-outcome measures reflected the patients' condition adequately and that all six measures were significantly related to each other (Pearson's r, p less than 0.003). The chymopapain and discectomy groups were not distinguishable on the basis of the pain-outcome measures. However, body mass was directly related to the presence of pain ten years after discectomy but not after injection of chymopapain. Analysis of the progress measures (indicators of the course of the patients' pain during the ten-year period) showed that the rates of reoperation in the two treatment groups did not differ significantly, but the discectomy patients tended to have had a higher rate of reoperation at both one and ten years after initial treatment. These measures did not show unequivocal superiority of one treatment compared with the other. Using the work measures (assessments of the patients' history of employment since initial treatment), it was found that in both treatment groups the patients who returned to work six to twelve weeks after treatment despite persistent symptoms had significantly more pain at ten years (p less than 0.04). Also, the patients who returned to work less than six weeks after treatment, while still symptomatic, showed a similar trend. On the other hand, among the patients who were still symptomatic at twelve weeks, it made no difference in the final results whether they returned to work at twelve weeks or thereafter. These findings support the notion that after either discectomy or chemonucleolysis, patients should return to work only after complete symptomatic recovery or a minimum convalescence of twelve weeks.
在对下背部疼痛和坐骨神经痛患者进行回顾性研究时，通过问卷调查获取数据（85例接受木瓜凝乳蛋白酶注射治疗，71例接受开放性椎间盘切除术），分析治疗后1年和10年的结果。对于该分析，我们使用了六种疼痛缓解指标、六种自初次治疗以来十年期间患者病程的指标以及四种自初次治疗以来患者就业或工作史的指标。效度研究表明，疼痛结果指标充分反映了患者的状况，且所有六种指标之间均存在显著相关性（皮尔逊相关系数r，p<0.003）。根据疼痛结果指标，木瓜凝乳蛋白酶组和椎间盘切除组并无差异。然而，体重与椎间盘切除术后十年疼痛的存在直接相关，而与木瓜凝乳蛋白酶注射后无关。对病程指标（十年期间患者疼痛病程的指标）的分析表明，两个治疗组的再次手术率无显著差异，但椎间盘切除术患者在初次治疗后1年和10年的再次手术率往往较高。这些指标并未显示一种治疗方法相对于另一种治疗方法具有明确的优越性。使用工作指标（自初次治疗以来患者就业史的评估）发现，在两个治疗组中，尽管仍有症状但在治疗后6至12周恢复工作的患者在十年时疼痛明显更严重（p<0.04）。同样，在治疗后不到6周恢复工作且仍有症状的患者也呈现类似趋势。另一方面，在12周时仍有症状的患者中，他们在12周或之后恢复工作对最终结果并无影响。这些发现支持了这样一种观点，即无论是椎间盘切除术还是化学髓核溶解术后，患者应在症状完全恢复或至少康复12周后再恢复工作。
