Abstract: Background　Percutaneous transforaminal endoscopic spine surgery has gradually become one of the common surgical procedures for the treatment of lumbar disc herniation（LDH）．However，few studies have been conducted to analyze the incidence of adverse psychological state before surgery in patients with LDH and its effects on prognosis.Objective　To investigate the status of anxiety and depression before microinvasive surgery in patients with LDH and analyze its effects on prognosis.Methods　A total of 140 patients with LDH were enrolled in the Department of Orthopedic Surgery of Central Theater Command General Hospital of the Chinese People's Liberation Army from August 2017 to June 2018.The Self-rating Anxiety Scale（SAS） and the Self-rating Depression Scale（SDS） were used to evaluate the anxiety and depression status of patients before surgery.And patients were divided into anxiety group，non-anxiety group，depression group and non-depression according to the scores.All patients underwent percutaneous transforaminal endoscopic spine surgery and were followed up regularly by telephone appointment.The follow-up deadline was January 2019.The scores of SAS，SDS，and Visual Analogue Scale（VAS） and lumbar spine function scores by Japanese Orthopedic Association（JOA） were compared before and after surgery.The effects of preoperative anxiety and depression on postoperative outcomes were analyzed by the modified MacNab evaluation criteria at the last follow-up.Results　A total of 132 patients were included in the final study，including 51（38.6%） patients in the anxiety group，of which patients with mild，moderate and severe anxiety accounted for 15.9%（21/132），17.4%（23/132） and 5.3%（7/132），respectively，31（23.5%） patients in the depression group，of which patients with mild，moderate and severe depression accounted for 12.1%（16/132），9.1%（12/132），and 2.3%（3/132），respectively.Pearson correlation analysis showed that the preoperative JOA scores were negatively correlated with SAS and SDS scores（P<0.001）．The preoperative VAS scores were positively correlated with SAS and SDS scores（P<0.05）．Compared with preoperative scores，the SAS score was significantly lower in the anxiety group at the last follow-up（P<0.001），and the SDS score was significantly lower in the depression group at the last follow-up（P<0.001）．The VAS scores of the anxiety group and non-anxiety group were lower and the JOA scores were higher at the last follow-up than those before surgery（P<0.05）．The improvement of VAS and JOA scores in non-anxiety group and non-depression group was significantly greater than those in anxiety group and depression group（P<0.05）．The VAS scores of the depression group and non-depression group were lower and the JOA scores were higher at the last follow-up than those before surgery than those before surgery（P<0.05）．At the last follow-up，the excellent rate in the non-depression group was significantly higher than that in the depression group〔93.1%（91/101） vs 74.2%（23/31）〕，and the difference was statistically significant（P=0.004）．While there was no significant difference of excellent rate between the non-anxiety group〔90.1%（73/81）〕 and the anxiety group〔86.3%（44/51）〕（P=0.497）．Conclusion　Some patients with LDH have anxiety and depression before surgery and these adverse psychological states can be significantly improved after percutaneous transforaminal endoscopic spine surgery.However，preoperative anxiety and depression may adversely affect the clinical efficacy，especially in combination with depression.Therefore，it is recommended that the abnormal psychological state should be routinely investigated before surgery and psychological intervention should be carried out for such patients.

Key words: Slipped disk, Intervertebral disc displacement, Percutaneous transforaminal endoscopy, Anxiety, Depression, Prognosis

摘要： 背景　经皮椎间孔镜术已逐渐成为国内外腰椎间盘突出症（LDH）阶梯治疗的常用术式之一，但目前鲜有研究分析LDH患者微创手术术前不良心理状态发生情况及其对预后的影响。目的　调查LDH患者微创手术术前焦虑、抑郁等不良心理状态存在情况及对术后疗效的影响。方法　选取2017年8月—2018年6月在中国人民解放军中部战区总医院骨科脊柱病区住院治疗的140例LDH患者为研究对象，术前分别采用焦虑自评量表（SAS）和抑郁自评量表（SDS）对患者进行焦虑和抑郁评估，并根据评分将患者分为焦虑组和非焦虑组、抑郁组和非抑郁组。患者均行经皮椎间孔镜术治疗，术后采取电话预约门诊随诊的方式进行定期随访，随访截止时间为2019年1月。比较各组患者术前、末次随访时SAS、SDS、疼痛视觉模拟评分（VAS）和日本骨科学会（JOA）腰椎功能评分，以及末次随访时采用改良MacNab评价标准评估恢复效果。结果　共纳入132例患者，其中焦虑组51例（38.6%）：轻度焦虑21例（15.9%），中度焦虑23例（17.4%），重度焦虑7例（5.3%）；抑郁组31例（23.5%）：轻度抑郁16例（12.1%），中度抑郁12例（9.1%），重度抑郁3例（2.3%）。Pearson相关分析结果显示，患者术前VAS与SAS、SDS评分均呈正相关（P<0.05）；术前JOA评分与SAS、SDS评分均呈负相关（P<0.001）。焦虑组患者末次随访时SAS评分低于术前（P<0.001）。抑郁组患者末次随访时SDS评分低于术前（P<0.001）。焦虑组和非焦虑组患者末次随访时VAS均较术前降低，JOA评分均较术前升高（P<0.05）。非焦虑组VAS和JOA评分改善程度高于焦虑组（P<0.05）。抑郁组和非抑郁组患者末次随访时VAS均较术前降低，JOA评分均较术前升高（P<0.05）。非抑郁组VAS和JOA评分改善程度高于抑郁组（P<0.05）。末次随访时，焦虑组优良率为86.3%（44/51）；非焦虑组优良率为90.1%（73/81）。两组患者优良率比较，差异无统计学意义（P=0.497）。抑郁组患者优良率为74.2%（23/31），低于非抑郁组的93.1%（91/101）（P=0.004）。结论　部分LDH患者术前存在焦虑及抑郁，经皮椎间孔镜术后患者焦虑、抑郁心理状态可得到明显改善，但术前焦虑和抑郁状态会对患者临床疗效造成不良影响，尤其是合并抑郁状态。建议术前常规进行不良心理状态调查并对此类患者进行心理干预。

关键词: 椎间盘突出, 椎间盘移位, 经皮椎间孔镜, 焦虑, 抑郁, 预后