髋、膝关节置换术后患者恐动症发生现状及影响因素分析  

Current status and influencing factors of kinesiophobia in patients after hip arthroplasty or knee arthroplasty

作　　者：黄莉 杨旭 李芳芳[4] 郑群怡[5] 周嘉莉 曹晶[1] HUANG Li;YANG Xu;LI Fangfang;ZHENG Qunyi;ZHOU Jiali;CAO Jing(Department of Nursing,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730;School of Nursing,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144;Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730;Department of Endocrinology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730;Department of Orthopaedics,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院护理部,北京100730 [2]中国医学科学院北京协和医学院护理学院,北京100144 [3]中国医学科学院北京协和医学院北京协和医院骨科,北京100730 [4]中国医学科学院北京协和医学院北京协和医院内分泌科,北京100730 [5]北京大学人民医院骨关节科,北京100044

出　　处：《中华骨与关节外科杂志》2023年第11期1001-1007,共7页Chinese Journal of Bone and Joint Surgery

基　　金：中央高水平医院临床科研业务费(2022-PUMCH-A-049);中国医学科学院医学与健康科技创新工程项目(2020-I2M-C&T-B-024)。

摘　　要：目的:了解髋、膝关节置换术后患者恐动症发生情况,并探索恐动症形成机制。方法:通过便利抽样法,选取2023年2—5月行全髋或全膝关节置换术的173例患者,采用一般资料调查表、恐动症评分表、疼痛数字评分表、疾病感知简易问卷、医院焦虑抑郁量表和简明围手术期疲劳评测量表进行评估。结果:髋、膝关节置换术后患者恐动症得分为(39.3±4.7)分,恐动症发生率为50.9%(88/173),其中全髋关节置换术后患者恐动症得分为(40.8±5.1)分,恐动症发生率为58.7%(37/60),均高于全膝关节置换术后患者[(38.4±4.3)分,P=0.001;45.1%(51/113),P=0.038]。路径分析显示,疼痛程度通过术后疲劳及焦虑抑郁对恐动症产生间接效应,间接效应值为0.190;疾病感知对恐动症有直接影响(β=0.290,P<0.001),并通过焦虑抑郁产生间接效应,间接效应值为0.114;焦虑抑郁对恐动症有直接影响(β=0.194,P<0.05),并通过术后疲劳产生间接效应,间接效应值为0.146;术后疲劳对恐动症有直接正向影响(β=0.328,P<0.001)。结论:髋、膝关节置换术后患者恐动症发生率较高,各影响因素之间存在相互影响作用。应提高对关节置换术后患者恐动症的关注,做到早期评估、早期预防、早期干预,以促进患者康复。Objective:To investigate the incidence of kinesiophobia in patients after hip or knee arthroplasty,and to explore the mechanism of underlying kinesiophobia formation.Methods:From February 2023-May 2023,173 patients who underwent total hip arthroplasty(THA)or total knee arthroplasty(THA)were selected by convenience sampling.The patients were investigated by general information questionnaire,tampa scale of kinesiophobia(TSK),numerical rating scale(NRS)for pain,brief illness perception questionnaire(BIPQ),hospital anxiety and depression scale(HADS),and identity-consequence fatigue scale-10(ICFS-10).Results:The patients underwent hip or knee arthroplasty had an kinesiophobia score of(39.3±4.7),and the incidence rate of kinesiophobia was 50.9%(88/173).The score and incidence of kinesophobia in patients with THA[40.8±5.1,58.7%(37/60)]were higher than those with TKA[38.4±4.3,P=0.001;45.1%(51/113),P=0.038].The results of path analysis showed that pain level had an indirect effect on kinesiophobia through postoperative fatigue and anxiety and depression,with an indirect effect value of 0.190.The illness perception had a direct positive effect on kinesiophobia(β=0.290,P<0.001)and an indirect effect through anxiety and depression,with an indirect effect value of 0.114.The anxiety and depression had a direct positive effect on kinesiophobia(β=0.194,P<0.05)and an indirect effect through postoperative fatigue,with an indirect effect value of 0.146.The postoperative fatigue had a direct positive effect on kinesiophobia(β=0.328,P<0.001).Conclusions:The incidence of kinesiophobia is high in hip or knee arthroplasty patients,and there are interrelationships among the influencing factors.The kinesiophobia in joint arthroplasty patients should be given more attention,with early assessment,prevention,and intervention to promote patient recovery.

关 键 词：全膝关节置换术 全髋关节置换术 恐动症 影响因素 

分 类 号：R684[医药卫生—骨科学]