心理和精神因素对全膝关节置换术后功能恢复及生活质量的影响  

Effects of psychological and spiritual factors on functional recovery and life quality after total knee arthroplasty

作　　者：何明[1] 朱锦宇[2] 王仁[1] 仲霄鹏[2] 朱庆生[2] 

机构地区：[1]宝鸡市解放军第三医院骨科,陕西721004 [2]第四军医大学西京医院关节外科,西安710032

出　　处：《中国骨与关节杂志》2014年第6期433-438,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨患者在全膝关节置换术前后心理和精神因素的变化,对膝关节功能恢复和健康相关生活质量的影响关系。方法对62例(女37例,男25例)单侧全膝关节置换术的患者进行术前、术后1个月和6个月的调查研究,所使用的检测项目有贝克尔焦虑、抑郁量表(BAI、BDI),状态-特质焦虑量表(S-AI、T-AI),艾森克人格问卷简式量表中国版(EPQ),膝关节评分(KSS),和健康相关生活质量问卷(SF-36)。结果手术后1个月及6个月患者的焦虑、抑郁和KSS评分各项指标较术前差异有统计学意义(P<0.01),SF-36各项指标在手术前后的提高率各有不同,EPQ的神经质性与手术前后的生理健康(PCS)(P=0.001和P<0.001)和心理健康(P<0.001和P<0.001)差异有统计学意义,术前KSS评分与术后KSS评分及术前心理相关评分相关拟合程度不佳(r^2=0.12和r^2=0.25),术后6个月KSS功能评分与特质焦虑(TAI)和艾森克神经质性(N)负相关(P<0.05,B=-0.32和P<0.001,B=-0.54),而与艾森克外-内倾向性(E)成正相关(P<0.05,B=0.32)。结论患者在接受单侧全膝人工关节表面置换术后1个月及6个月膝关节功能恢复和健康相关生活质量显著提高,心理和精神因素对TKA术后功能恢复有影响,焦虑和抑郁程度低的患者功能恢复好;同时,术前应对焦虑和抑郁程度高的患者采取适当的干预措施,以获得满意的疗效。Objective To study the changes of psychological and spiritual factors before and after total knee arthroplasty （ TKA ） and their effects on knee functional recovery and health-related quality of life. Methods A research on 62 patients who underwent unilateral TKA was performed preoperatively and at 1 and 6 months after the operation, including 37 females and 25 males. The test items included Beck Anxiety Inventory （ BAI ） and Beck Depression Inventory （ BDI ）, State Anxiety Inventory （ S-AI ） and Trait Anxiety Inventory （ T-AI ）, Eysenck Personality Questionnaire-Revised, Short Scale for Chinese （ EPQ-RSC ）, Knee Society Knee Scoring System （KSS）, and health,related quality of life questionnaire （ the short-form-36 [ SF-36 ] ）. Results There were statistically significant differences in the anxiety degree, depression degree and KSS score at 1 and 6 months after the operation and preoperatively （ P〈0.01 ）. The increasing rates of various indexes of SF-36 were different before and after the operation. Statistical significance existed in the differences between neuroticism in EPQ and the preoperative and postoperative physical health （ P=0.001 ＆ P〈0.001 ） and the differences between neuroticism in EPQ and the preoperative and postoperative mental health （ P〈0.001 ＆ P〈0.001 ）. The fitting degree of the preoperative KSS scores and the postoperative KSS scores and preoperative psychology-related scores was not good （r^2=0.12 ＆ r^2=0.25 ）. A negative correlation existed between the KSS scores at 6 months after the operation and TAI and between the KSS scores at 6 months after the operation and neuroticism in EPQ （ P〈0.05, B=-0.32 ＆ P〈0.001, B=-0.54 ）. A positive correlation existed between the KSS scores at 6 months after the operation and extraversion-introversion in EPQ （ P〈0.05, B=0.32 ）. Conclusions Knee function is adequately restored and health-related quality of life is significantly improved, when the patients undergo unilateral TKA at

关 键 词：人工膝关节 膝关节 康复 焦虑症 抑郁症 生活质量 

分 类 号：R687.4[医药卫生—骨科学]