3D 疼痛绘图在腰椎微创手术中评估疼痛程度的应用价值

崔成文; 刘建恒; 张明博; 曹洪海; 陶宇洪; 苏晓静; 李德昊; 黄鹏

doi:10.3969/j.issn.2095-5227.2021.01.014

3D 疼痛绘图在腰椎微创手术中评估疼痛程度的应用价值

3D Pain Drawing System in evaluating pain degree in percutaneous endoscopic lumbar discectomy

摘要

摘要:
背景疼痛绘图(pain drawing，PD)是评估患者疼痛的重要工具。近年来，电子化的疼痛绘图取得迅速发展，但尚无在腰椎微创术中应用价值的研究。
目的探讨3D 疼痛绘图评估行腰椎间孔镜治疗的腰椎间盘突出症导致腰痛患者疼痛程度变化的价值。
方法选取2019年10月- 2020年4月解放军总医院第一医学中心60例有下腰痛症状的腰椎间盘突出症并行单侧经皮腰椎间孔镜下腰椎间盘切除术治疗的患者。所有手术均在局麻下进行。为此研究设计3D疼痛绘图系统，以疼痛绘图记录疼痛分布范围及程度。术前、术中及术后3个月描绘疼痛绘图并记录PD评分值(即三维人体图中着色的像素点数量)、视觉模拟评分(visual analogue scale，VAS)及Oswestry功能障碍指数(Oswestry disabilityindex，ODI)，以评估疼痛程度及变化。验证3D疼痛绘图能否准确评估腰痛患者腰痛程度及变化。
结果术前腰痛PD评分值与术前腰痛ODI、VAS评分均呈正相关(r=0.537，r=0.370；P均＜0.01)；术中接触、处理髓核、纤维环、黄韧带、后纵韧带四个解剖部位腰痛PD评分值与VAS评分均呈正相关，相关系数(r)分别为0.667、0.740、0.825、0.684(P均＜0.01)；三种评价术后腰痛改善效果的指标中，PD评分值改善率与ODI改善率、VAS评分改善率的组内相关系数(r)分别为0.781(95% CI：0.644～0.870)和0.732(95% CI：0.571～0.839)，具有很高的一致性。术后3个月腰痛PD评分值与ODI、VAS评分均呈显著正相关(r=0.771，r=0.745；P均＜0.01)。
结论腰痛PD评分与其他疼痛评测指标间显示了较好的相关性和一致性，3D疼痛绘图是行腰椎间孔镜治疗的腰椎间盘突出症患者腰痛程度及变化的良好评价工具。

Abstract:
Background Pain drawing (PD) is an important tool to assess patient’s pain. In the past few years, electronic PD has achieved rapid development. However, there is no research on the value of applying electronic PD in percutaneous endoscopic lumbar discectomy.
Objective To explore the value of 3D Pain Drawing System in evaluating the changes of pain degree in patients with low back pain caused by lumbar disc herniation treated by percutaneous endoscopic lumbar discectomy (PELD).
Methods From October 2019 to April 2020, 66 patients with lumbar disc herniation and low back pain symptoms were selected for unilateral percutaneous endoscopic lumbar discectomy in the First Medical Center of Chinese PLA General Hospital. All operations were performed under local anesthesia. For this research, the 3D Pain Drawing System were designed and developed to record pain distribution range and degree. The PD scores at preoperation, intraoperation and postoperative 3 months were described by pain mapping, pain visual analog scale (VAS) score and Oswestry disability index (ODI) score were recorded to observe the degree of pain and changes, so as to verify whether 3D pain drawing could accurately evaluate the degree and changes of low back pain in these patients.
Results The preoperative PD score was positively correlated with the preoperative ODI and VAS score (r=0.537, r=0.370; P＜0.01, respectively). During the operation, there were positive correlations between the pain PD scores and VAS scores in the four different anatomical sites (nucleus pulposus, annulus fibrosus, ligamentum flavum and posterior longitudinal ligament), and the correlation coefficients were 0.667, 0.740, 0.825, 0.684, respectively, with significant differences (all P＜0.01). The intraclass correlation coefficients of PD score improvement rate with ODI improvement rate (ICC=0.781, 95% CI: 0.644-0.870) and VAS score improvement rate (ICC=0.732, 95% CI: 0.571-0.839) in evaluating the treatment effect of low back pain showed high consistency. The PD score of low back pain was positively correlated with ODI and VAS scores at 3 months after operation (r=0.771, r=0.745; P＜0.01, respectively).
Conclusion The PD score shows highly consistency with other pain evaluation methods, and 3D pain drawing system is a good evaluation tool for the degree and change of low back pain in patients with lumbar disc herniation treated by PELD.

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