Herno A, Airaksinen O, Saari T, Svomalainen O
Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Finland.
Am J Ind Med. 1996 Oct;30(4):473-8. doi: 10.1002/(SICI)1097-0274(199610)30:4<473::AID-AJIM13>3.0.CO;2-1.
Low back disorders are an increasingly common and costly health problem in Western countries. It has been recommended that the return to work of patients should be the most important outcome measure of medical care. The aim of this study was to compare women's and men's working capacity after lumbar spinal stenosis (LSS) operations and to identify the factors related to it. The subjects of this study were 185 women (mean age 54 years, mean follow-up time 4.2 years) and 254 men (mean age 52 years, mean follow-up time 4.3 years). After the operation, 37% of the women and 41% of the men returned to work. None of the patients who had retired before the operation returned to work afterward. The variables that predicted postoperative ability to work for women were: being fit to work at the time of operation, age < 50 years at the time of operation, and duration of LSS symptoms < 2 years. For men, these variables were: being fit to work at the time of operation, age < 50 years at the time of operation, no prior surgery, and the extent of the surgical procedure equal to or less than 1 laminectomy. Women's and men's working capacity do not differ after LSS operation. If the aim is to maximize working capacity, then, when an LSS operation is indicated, it should be performed without delay. In LSS patients who are > 50 years old and on sick leave, it is unrealistic to expect that they will return to work. Therefore, after such an extensive surgical procedure, re-education of patients for lighter jobs could improve the chances of these patients returning to work.
在西方国家，下背部疾病是一个日益常见且代价高昂的健康问题。有人建议，患者重返工作岗位应是医疗护理最重要的疗效衡量指标。本研究的目的是比较腰椎管狭窄症（LSS）手术后女性和男性的工作能力，并确定与之相关的因素。本研究的对象为185名女性（平均年龄54岁，平均随访时间4.2年）和254名男性（平均年龄52岁，平均随访时间4.3年）。手术后，37%的女性和41%的男性重返工作岗位。术前已退休的患者术后均未重返工作岗位。预测女性术后工作能力的变量为：手术时适合工作、手术时年龄<50岁、LSS症状持续时间<2年。对于男性，这些变量为：手术时适合工作、手术时年龄<50岁、无既往手术史、手术范围等于或小于1次椎板切除术。LSS手术后女性和男性的工作能力没有差异。如果目标是最大限度地提高工作能力，那么，当需要进行LSS手术时，应立即进行。对于年龄>50岁且休病假的LSS患者，期望他们重返工作岗位是不现实的。因此，在进行如此广泛的手术后，对患者进行轻体力工作的再培训可以提高这些患者重返工作岗位的机会。
