摘要
目的分析膝关节置换术(TKA)患者恐动症发生与其康复效果以及社会支持情况的相关性。方法选取2020年12月至2021年12月期间于保定市第一中心医院接受TKA治疗且符合纳入排除标准的膝关节骨关节炎患者372例。纳入标准:符合膝骨关节炎诊断标准,首次接受TKA治疗,年龄50~75岁等。排除标准:膝关节以外骨关节炎,精神类疾病,合并神经及骨骼肌肉疾病,严重机体功能障碍患者,术后出现假体感染、松动、骨折等不良反应。术后均采用恐动症Tampa评分表(TSK)进行评估,将其分为恐动症组(TSK评分>37分)和非恐动症组(TSK评分≤37分)。采用卡方检验、t检验比较两组的一般资料、康复效果指标,包括疼痛视觉模拟量表(VAS)、美国膝关节协会评分表(AKSS)、膝关节活动度(ROM)、Berg平衡量表、社会支持评定量表(SSRS);二元logistic回归分析恐动症发生与康复效果、社会支持情况的相关性。结果372例TKA术患者中,发生恐动症的人数为108例,未发生恐动症的人数为264例,恐动症发生率为29.03%。恐动组的TSK量表平均分数(42±3)高于非恐动组的平均分数(21±6)(t=36.061,P<0.001)。恐动症组的VAS评分高于非恐动症组,AKSS、ROM、Berg平衡量表得分、SRSS评分均低于非恐动症组,差异具有统计学意义(t=41.772、-21.384、-34.295、-22.906、-26.374,均为P<0.05)。TSK分数与VAS分数呈正相关(r=0.860,P<0.001),与AKSS、ROM、Berg平衡、SRSS分数呈负相关(r=-0.499、-0.664、-0.529、-0.574,均为P<0.001),SRSS分数与NRS呈负相关(r=-0.639,P<0.001),与AKSS、ROM、Berg平衡呈正相关(r=0.842、0.864、0.849,均为P<0.001)。二元logistic回归分析结果显示,年龄[比值比(OR)=1.695,95%置信区间(CI)(1.513,1.899)]、性别[OR=0.257,95%CI(0.149,0.441)]、身体质量指数[OR=6.342,95%CI(4.308,9.335)]、疼痛年限[OR=5.390,95%CI(3.597,8.075)]、VAS[OR=2.510,95%CI(1.872,3.366)]、Berg平衡量表得分[OR=0.477,95%CI(0.391,0.581)]、SRSS评分[OR=0.594,95%CI(0.523,0.675)]是影响恐动症发生的独立影响因素(均为P<0.05)。结论膝关节置换术恐动症发生率较高,与非恐动症患者相比其康复效果、社会支持更差。恐动症发生与康复效果、社会支持情况存在紧密联系,且康复效果与社会支持有正相关性,应该加强对膝关节置换术患者术后康复效果与社会支持的干预。
Objective To explore the occurrence of phobia in knee replacement patients and its effect on rehabilitation exercise compliance and rehabilitation effect.Methods A total of 372 patients with knee osteoarthritis who received total knee arthroplasty(TKA)at the First Central Hospital of Baoding from December 2020 to December 2021 and met the inclusion and exclusion criteria were selected for postoperative evaluation using the Tampa scale of kinesiophobia(TSK)for fear of movement.Inclusion criteria:the patients meet the diagnosis of knee osteoarthritis,primary TKA,age is from 50 to 75 years.Exclusion criteria:osteoarthritis of other joints,mental disorders,combining neuropathy or other skeletal muscular diseases,severe dysfunction of organs,prosthesis loosening,infection or bone fractures after surgery.They were divided into a fear group(TSK>37 points)and a non fear group(TSK≤37 points).The general information and rehabilitation effectiveness indicators of the two groups were compared by chi square test and t test,including visual analogue scale(VAS),American Knee Association rating scale(AKSS),knee range of motion(ROM),Berg balance scale,and social support rating scale(SSRS).The correlation between the occurrence of anxiety disorder and rehabilitation outcomes as well as social support were analyzed.Results Among the 372 patients undergoing TKA surgery,108 patients developed fear of movement,while 264 patients did not.The incidence of fear of movement was 29.03%.The average score of the TSK scale in the panic group(42±3)was higher than that in the non panic group(21±6)(t=36.061,P<0.001).VAS score of the motor phobia group was higher than that of the non motor phobia group,while the AKSS,ROM,Berg balance scale and SRSS scores were lower than those of the non motor phobia group,with statistically significant differences(t=41.772,-21.384,-34.295,-22.906,-26.374,all P<0.05).TSK score was positively correlated with VAS score(r=0.860,P<0.001),negatively correlated with AKSS,ROM,Berg balance scale and SRSS scores(r=-0.499,-0.664,-0.529,-0.574,all P<0.001),negatively correlated with VAS score(r=-0.639,P<0.001),and positively correlated with AKSS,ROM,Berg balance scale score(r=0.842,0.864,0.849,all P<0.001).The results of binary logistic regression analysis showed that age[odds ratio(OR)=1.695,95%confidence interval(CI)(1.513,1.899)],gender[OR=0.257,95%CI(0.149,0.441)],body mass index[OR=6.342,95%CI(4.308,9.335)],years of pain[OR=5.390,95%CI(3.597,8.075)],VAS[OR=2.510,95%CI(1.872,3.366)],Berg balance scale[OR=0.477,95%CI(0.391,0.581)]and SRSS scores[OR=0.594,95%CI(0.523,0.675)]were independent influencing factors on the occurrence of motor phobia(all P<0.05).Conclusions Knee arthroplasty has a higher incidence of phobia,and its rehabilitation effect and social support are worse than those of non phobia patients.The occurrence of ADHD is closely related to rehabilitation effect and social support,and there is a positive correlation between rehabilitation effect and social support.The intervention of postoperative rehabilitation effect and social support of patients undergoing knee arthroplasty should be enhanced.
作者
姚轶超
张麒
滕海茂
黄攀
吴雷涛
韩哲
Yao Yichao;Zhang Qi;Teng Haimao;Huang Pan;Wu Leitao;Han Zhe(Baoding First Central Hospital,Baoding 071000,China)
出处
《中华关节外科杂志（电子版）》
CAS
CSCD
2023年第5期613-618,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
保定市科技计划项目(2141ZF67)
关键词
关节成形术
置换
膝
恐动症
视觉模拟评分
total knee arthroplasty
Kinesiophobia
Visual analogue scale
