術後頸部椎間盤突出病人醫療品質之研究

目的：頸部椎間盤突出症(Cervical disc herniation,CDH )是臨床上常見的脊椎疾病，也是一種常見的退化性慢性疾病，疾病常伴隨者持續性的神經病變疼痛，因疾病嚴重度而造成病人日常生活的困擾。在台灣頸部椎間盤突出症為民眾姿勢不良導致頸部退化主要原因，本研究目的為探討接受頸部手術病人人口學、手術方式對其醫療品質之影響。方法：本研究採回溯性研究設計，以病歷回顧法收集資料，資料來源於南部某醫學中心病人住院資料。研究收案期間為2017年1月1日至2018年12月31日初次接受手術後持續追蹤半年，總共列入研究個案共有248頸部椎間盤突出症手術的病人，並於病人術後症狀減輕，統計方法以敘述性統計，卡方檢定及多元羅吉斯迴歸分析方式找出影響術後醫療品質之相關因素。統計結果：頸部椎間盤突出症病人，男性119人（佔48％），女性129人（佔52％），年齡51歲至70歲143人 (佔57.7%)，無職業已退休及家管137人（佔55.2％），BMI≧24~<27 kg/m2 與≧27 kg/m2 (佔57.2%)，慢性病結果：患糖尿病78人（佔31.5％）、患高血壓107人 (佔43.1%)，頸椎融合手術178人 (佔71.8%)，術後有使用頸圈情形243人 (佔98.0%)，X光檢查結果異常31人 (佔12.5%)，術後追蹤一年再住院32人(佔12.9%)，頸椎手術住院天數1-6天143人 (佔57.7%)，經由多元羅吉斯迴歸統計發現在術後X光檢查異常方面為身體質量指數異常 (p=0.0189, 95%CI=1.233~10.263)、糖尿病 (p=0.0166, 95%CI=1.247~9.146)及住院天數 (p=0.0005, 95%CI=1.999~12.26)具有統計顯著差異;再住院方面則有身體質量指數異常 (p=0.0187, 95%CI=1.238~10.499)、糖尿病 (p=0.0137, 95%CI=1.288~9.224)、頸椎手術住院天數(p=0.0004, 95% CI=1.028~1.102)具有統計顯著差異。結論與建議：由以上研究結果得知，病人的身體質量指數異常、糖尿病、以及頸椎手術住院天數分別會對頸部椎間盤突出病人術後醫療品質有影響，尤其是預防糖尿病，注意體重控制，保持正確姿勢使椎間盤與脊髓神經不再受壓，可降低術後再住院率，研究結果可提供醫院管理者及醫療人員參考，以提升病人術後醫療品質。

關鍵字

頸部椎間盤突出術後；醫療品質

並列摘要

Objective: Cervical disc herniation (Cervical disc herniation, CDH) is a common clinical spine disease and degenerative chronic disease. The disease is often accompanied by persistent neuropathic pain, which leads to patient's daily trouble due to disease severity. cervical disc herniation in Taiwan is the main cause of cervical degeneration caused by poor posture. The purpose of this study is to explore the impact of demography and surgical methods of patients undergoing cervical surgery on their medical quality. Methods: The retrospective study design was adopted in this study, and the data were collected by the medical record review method. The data was derived from the hospitalization data of a patient in a medical center in the south. The study cases were collected from January 1, 2017 to December 31, 2018. After the initial operation, and the follow-up was continued for half a year. A total of 248 patients with cervical disc herniation surgery were included in the study case. Using descriptive statistics, Chi-square test and multiple logistic regression analysis to find the relevant factors that affect the quality of postoperative medical treatment. Statistical results: Patients with cervical disc herniation, 119 males (48%), 129 females (52%), 143 patients (age 57.7%) aged from 51 to 70 years old, 137 patients retired without occupation and housekeeping (accounting for 55.2%), body mass index (BMI) ≧24~<27 kg/m2 與≧27 kg/m2 (accounting for 57.2%), chronic disease results: 78 patients with diabetes (31.5%), 107 patients with hypertension (43.1%), 178 patients (71.8%) in cervical fusion surgery, 243 patients (98.0%) used neck protection after operation, 31 patients (12.5%) had abnormal X-ray examination results, and 32 patients (12.9%) were rehospitalized one year after surgery. The days of hospital stay for cervical spine surgery was 1-6 days (accounting for 57.7%), and through multiple logistic regression statistics, it was found that the postoperative X-ray abnormalities were BMI abnormality (p=0.0189, 95%CI=1.233~10.263), diabetes (p=0.0166, 95%CI=1.247~9.146), and the days of hospital stay (p=0.0005, 95%CI=1.999~12.26). In terms of rehospitalization, there are statistically significant differences in BMI abnormality (p=0.0187, 95% CI=1.238~10.499), diabetes (p=0.0137, 95% CI=1.288~9.224), and the days of hospital stay for cervical surgery (p=0.0004, 95% CI=1.028~1.102). Conclusions and recommendations: According to the above research results, the patient’s BMI abnormality, diabetes, and the days of hospital stay for cervical spine surgery will have an impact on the postoperative medical quality of patients with cervical disc herniation, especially diabetes prevention, body weight control and the correct posture. Thus, the intervertebral disc no longer compresses the spinal nerve to reduce the rate of postoperative rehospitalization. The results of the study can provide references for hospital managers and medical staff to improve the medical care quality of postoperative patients.