Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial.
Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial.
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DOI：
10.1136/bmjopen-2012-002534
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发表时间：
2013-05-28
期刊：
影响因子：
2.9
通讯作者：
Ronald Brand
中科院分区：
文献类型：
--
作者：
Lequin MB;Verbaan D;Jacobs WC;Brand R;Bouma GJ;Vandertop WP;Peul WC;Leiden-The Hague Spine Intervention Prognostic Study Group;Wilco C Peul;Bart W Koes;Ralph T W M Thomeer;Wilbert B van den Hout;Ronald Brand
这项研究描述了坐骨神经痛试验的 5 年结果，重点关注疼痛、残疾、恢复（不）令人满意以及恢复不令人满意的预测因素。一项随机对照试验。九家荷兰医院。收集了 283 名患者中的 231 名 (82%) 的五年随访数据。早期手术或计划 6 个月的保守治疗。分析了罗兰残疾问卷、腿部和背部疼痛视觉模拟量表（VAS）以及总体感知恢复的李克特自评量表的得分。各组之间 5 年主要结局评分没有显着差异。尽管进行了至少 6 个月的保守治疗，但仍有 46% 的保守分配患者因严重的腿部疼痛和残疾而接受了手术治疗。 49 名 (21%) 患者在 5 年时恢复不理想，恢复模式显示，有一个由 66 名患者 (31%) 组成的可变组在 1 年、2 年或 5 年随访时至少有一项结果不满意。多变量逻辑回归显示，年龄（> 40；OR 2.42（95% CI 1.16 - 5.02））、腿痛严重程度（VAS > 70；OR 3.32（95% CI 1.69 - 6.54））和Mc Gill情感评分（评分> 3；OR 6.23（95% CI 2.23 - 17.38））是唯一显着的因素。 5年后结果不令人满意的预测因素。从长远来看，8% 的坐骨神经痛患者从未表现出任何康复，至少 23% 的坐骨神经痛患者似乎会导致持续的主诉，无论是否接受治疗，这种主诉都会随着时间的推移而波动。长期的保守治疗可能会给患者带来公平的机会，让他们在不进行手术的情况下缓解疼痛和残疾，但在长期遭受坐骨神经痛后，也有接受延迟手术的风险。年龄超过 40 岁、基线时严重腿部疼痛和较高的情感麦吉尔疼痛评分是恢复不理想的预测因素。试验注册 ISRCT 编号 26872154。
This study describes the 5 years’ results of the Sciatica trial focused on pain, disability, (un)satisfactory recovery and predictors for unsatisfactory recovery. A randomised controlled trial. Nine Dutch hospitals. Five years’ follow-up data from 231 of 283 patients (82%) were collected. Early surgery or an intended 6 months of conservative treatment. Scores from Roland disability questionnaire, visual analogue scale (VAS) for leg and back pain and a Likert self-rating scale of global perceived recovery were analysed. There were no significant differences between groups on the 5 years’ primary outcome scores. Despite at least 6 months of conservative treatment 46% of the conservatively allocated patients were treated surgically because of severe leg pain and disability. Forty-nine (21%) patients had an unsatisfactory recovery at 5 years and the recovery pattern showed that there was a variable group of 66 patients (31%) with at least one unsatisfactory outcome at 1, 2 or 5 years of follow-up. Multivariate logistic regression showed that age (>40; OR 2.42 (95% CI 1.16 to 5.02)), severity of leg pain (VAS >70; OR 3.32 (95% CI 1.69 to 6.54)) and the Mc Gill affective score (score >3; OR 6.23 (95% CI 2.23 to 17.38)) were the only significant predictors for an unsatisfactory outcome at 5 years. In the long term, 8% of the patients with sciatica never showed any recovery and in at least 23%, sciatica appears to result in ongoing complaints, which fluctuate over time, irrespective of treatment. Prolonged conservative care might give patients a fair chance for pain and disability to resolve without surgery, but with the risk to receive delayed surgery after prolonged suffering of sciatica. Age above 40 years, severe leg pain at baseline and a higher affective Mc Gill pain score were predictors for unsatisfactory recovery. Trial Registry ISRCT No 26872154.
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