全髋关节置换术后焦虑抑郁与功能锻炼情况的相关研究  

Correlative study on anxiety & depression and functional exercise after total hip arthroplasty

作　　者：李乐翔[1] 袁伟[1] 刘宁[1] 周嵘[1] 韩武翔 陈宜[1] 付奇伟[1] 钱齐荣[1] 

机构地区：[1]第二军医大学附属长征医院关节外科,上海200003

出　　处：《中国骨与关节外科》2017年第2期126-131,共6页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金资助项目(编号8171727)

摘　　要：背景:全髋关节置换术(THA)是治疗晚期髋骨关节炎的有效方法,术后的康复尤为重要,而大多数患者术后会出现焦虑、抑郁等负面情绪。目的:探讨THA后,患者焦虑抑郁等心理状况与术后髋关节功能锻炼后恢复情况的关系。方法:214例因髋骨关节炎接受THA的患者纳入本研究。术后1周采用焦虑自评量表(SAS)和抑郁自评量表(SDS)对患者术后心理状态进行评估。当SAS+SDS评分≥100分时,视患者有较为严重的焦虑抑郁症状,归其入试验组。当SAS+SDS评分<100分时,将患者归入对照组。同时在术后1周、1个月、3个月采用Harris评分与WOMAC评分对患者髋关节功能锻炼情况进行评定。结果:两组患者性别、术前Harris与WOMAC评分均无显著差异,但试验组患者年龄显著大于对照组。试验组术后1周、1个月、3个月Harris评分均低于对照组,而WOMAC评分高于对照组,两组相比有显著的差异,且随着时间的延续差异性增强。THA后,在所有患者中,在功能锻炼后,SAS+SDS评分与Harris评分呈明显负相关,与WOMAC评分呈明显正相关,且随着时间的延续相关性增强。结论:THA后,患者焦虑抑郁的心理状态严重影响功能锻炼的效果。术后在院内及院外均应实施心理干扰,防止患者焦虑抑郁的发生,以增强患者康复锻炼的效果。Background：Total hip arthroplasty （THA） is an effective method for the treatment of advanced hip osteoarthritis. Postoperative rehabilitation is particularly important, however, many patients develop negative emotions such as anxiety and depression after surgery. Objective：To assess the relationship between anxiety, depression and joint function recovery after THA. Methods：A total of 214 patients with hip arthritis undergoing THA were included in this study. A self-rating anxiety scale （SAS） and a self-rating depression scale （SDS） were used for questionnaires at 1 week postoperatively to assess the mental state. The patients were divided into experimental group （SAS＋SDS score≥100） and control group （SAS＋SDS score 〈100）. Harris score and WOMAC score were used to assess patient＇s hip joint exercise at 1 week, 1 month and 3 months after surgery. Results：There were no significant differences in gender composition, Harris score or WOMAC scores between two groups, but the age of experimental group was significantly higher than that of control group. The Harris score of the experimental group was significantly lower than that of the control group at 1 week, 1 month and 3 months after surgery, while the WOMAC score of the experimental group was significantly higher than that of the control group. With time going, the differences had been becoming larger. The overall score of SAS＋SDS was negatively related to the Harris score, but positively related to the WOMAC score. With time going, the correlation increased. Conclusions：After THA, patients with anxiety and depression have a serious impact on the patient＇s functional exercise. The severer anxiety and depression, the worse functional exercise effect. After the operation, psychological interference should be performed in and out of the hospital to prevent the occurrence of anxiety and depression in order to enhance the efficacy of rehabilitation exercise.

关 键 词：焦虑 抑郁 功能锻炼 院外 医疗干预 全髋关节置换术 关节疼痛 

分 类 号：R687.4[医药卫生—骨科学]