术后恐动症对单侧全膝关节置换患者康复结局的影响

发布时间：2018-01-07 08:26

  本文关键词：术后恐动症对单侧全膝关节置换患者康复结局的影响　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 全膝关节置换术 恐动症 膝关节 疼痛 屈曲度

【摘要】：目的探讨术后恐动症对单侧全膝关节置换患者康复结局的影响;调查单侧全膝关节置换患者术后恐动症发生现状;了解单侧全膝关节置换患者术后恐动症发生现状及其与康复结局之间的相关性,以便为单侧全膝关节置换患者实施针对性的干预提供循证依据。方法1.根据本研究的纳入和排除标准便利选取2015年9月~2016年5月在郑州大学第一附属医院骨科接受单侧全膝关节置换术的患者244例。2.所有患者于术后48h内收集基线资料及空腹血糖、血红蛋白等生化指标,并运用恐动症Tampa评分表(TSK)对全膝关节置换患者进行评估,恐动症Tampa评分得分37分即可认为患者伴有恐动症。3.研究者分别于术后2周(住院期间)、4周、3个月、6个月对244例患者进行随访调查。术后2周、4周时,运用疼痛数字评分表及量角器评估患者术后膝关节疼痛程度及膝关节屈曲度;术后3个月及术后6个月时除了收集以上信息外,仍需运用美国膝关节协会评分表对患者膝关节功能进行评估。4.采用SPSS19.0软件对研究数据进行统计分析,运用描述性统计分析对患者的一般资料进行描述。运用卡方检验对组间分类变量进行比较。运用重复测量方差分析对结局变量的变化趋势进行判断。运用Pearson相关性检验分析单侧全膝关节置换患者术后恐动症与术后膝关节疼痛、膝关节屈曲度以及膝关节功能之间的相关性。P0.05有显著性统计学意义。结果1.本研究共纳入单侧全膝关节置换患者244例,平均年龄为66.95±7.53岁,其中179例女性患者占74.27%,213例已婚患者占88.38%。患者恐动症Tampa评分平均得分为36.80±10.89,平均体质指数为24.98±3.67,平均空腹血糖为4.82±0.77 mmol/L。经过6个月的随访,失访3例,失访率1.23%。实际纳入研究对象为241例。2.全膝关节置换患者术后恐动症发生现状:在241例研究对象中,伴有恐动症的患者为67例,无恐动症患者为174例,全膝关节置换患者术后恐动症发生率为27.80%。3.恐动组与无恐动组患者术后膝关节疼痛程度的比较:在术后2周、4周、3个月、6个月,统计两组患者的术后膝关节疼痛程度,运用重复测量方差分析对数据进行统计分析,结果表明,在各个评价时间点恐动组患者的疼痛强度均明显高于无恐动组,具有显著性统计学意义(P0.05)。4.恐动组与无恐动组患者术后膝关节屈曲度比较:在术后2周、4周、3个月、6个月,统计两组患者的术后膝关节屈曲度,运用重复测量方差分析对数据进行统计分析,结果表明,在各个评价时间点恐动组患者的术后膝关节屈曲度均明显低于无恐动组,具有显著性统计学意义(P0.05)。5.恐动组与无恐动组患者术后膝关节功能评分比较:在术后3个月、6个月,统计两组患者的膝关节功能评分,运用两独立样本t检验对数据进行统计分析,结果表明,恐动组患者的膝关节功能评分均明显低于无恐动组,具有显著性统计学意义(P0.05)。6.随着时间推移,两组患者的疼痛强度和关节屈曲度均有所改善运用重复测量方差分析对两组患者的膝关节疼痛强度及膝关节屈曲度进行统计分析,结果显示,两组患者在各个时间点的膝关节疼痛程度不同,恐动组患者术后膝关节疼痛程度均高于无恐动组患者,具有显著性统计学意义(P0.05);两组患者在各个时间点的术后膝关节屈曲度不同,恐动组患者术后膝关节屈曲度均低于无恐动组,具有显著性统计学意义(P0.05)。在术后2周到4周,无恐动组患者的膝关节疼痛强度和膝关节屈曲度均有明显改善(P0.05);术后4周到3个月,术后3个月到6个月,两组患者术后膝关节疼痛强度变化程度的差异无统计学意义(P0.05)。另外,术后2周到4周,无恐动组患者术后膝关节屈曲度变化程度明显(t=2.654,P0.05);术后4周到3个月,恐动组患者术后膝关节屈曲度变化程度明显(t=2.763,P0.05)。7.术后恐动症与全膝关节置换患者康复结局之间的相关性在所有时间点的测量中,全膝关节置换患者恐动症Tampa评分得分与术后膝关节屈曲度之间存在负相关,其中,术后2周两者呈高度负相关(r=-0.72,P0.05),术后4周、术后3个月及术后6个月,两者呈中度负相关(P0.05)。在所有时间点的测量中,全膝关节置换患者恐动症Tampa评分得分与术后膝关节疼痛程度之间存在正相关,其中,术后4周呈高度正相关(r=0.76,P0.05),术后2周及术后3个月呈中度正相关(P0.05),术后6个月呈低度正相关(r=0.24,P0.05)。全膝关节置换患者TSK得分与膝关节功能评分之间呈负相关,术后3个月呈中等负相关(r=-0.33,P0.05),术后6个月呈低度负相关(r=-0.28,P0.05)。结论1.术后恐动症对单侧全膝关节置换患者康复结局存在负性影响;2.无恐动症的患者膝关节功能恢复良好;3.临床医务人员应针对全膝关节置换患者术后恐动症实施干预措施,以提高全膝关节置换患者的康复效果,提高患者生活质量。
[Abstract]:Objective to investigate the postoperative effect on fear of moving in unilateral total knee replacement patients rehabilitation outcome; fear of moving in investigation of unilateral total knee replacement surgery patients; understand the unilateral total knee replacement surgery patients fear of moving correlation between disorder and the present situation of rehabilitation, so as to provide evidence for the intervention of the implementation evidence for unilateral total knee replacement patients. Methods 1. according to the inclusion and exclusion criteria of convenience from September 2015 ~2016 year in May 244 Cases.2. Department of orthopedics the First Affiliated Hospital of Zhengzhou University underwent unilateral total knee arthroplasty patients in all patients within 48h after collecting baseline data and fasting blood glucose, hemoglobin and other biochemical indicators, and the fear of sickness Tampa scale (TSK) assessment of patients undergoing total knee arthroplasty, fear of moving in the Tampa scores 37 points to be considered in.3. of patients with fear of moving persons In 2 weeks after operation (hospitalization), 4 weeks, 3 months, 6 months follow-up study was performed in 244 patients. After 2 weeks, 4 weeks, the pain score table and evaluation of patients with postoperative protractor knee pain and knee flexion; 3 months after the operation and after 6 months in addition to collect the above information, still need to use the American Knee Society was assessed with the.4. SPSS19.0 software was used for statistical analysis of research data on patients with knee joint function score, using descriptive statistical analysis to describe the general information of patients. For comparison between the groups for categorical variables using chi square test. Using repeated measures analysis of variance change trend on the outcome variable to judge. Analysis of unilateral total knee arthroplasty in patients with postoperative fear sickness and postoperative pain of knee joint using the Pearson correlation test, the relationship between knee flexion and knee joint function There was a statistical significance.P0.05. 1. results of this study included 244 Cases of unilateral total knee replacement patients, the average age was 66.95 + 7.53 years, including 179 cases of female patients accounted for 74.27%, 213 cases of married patients accounted for 88.38%. patients in fear of moving average Tampa score score was 36.80 + 10.89, the average body mass index was 24.98. 3.67, the average fasting blood glucose was 4.82 + 0.77 mmol/L. after 6 months of follow-up, 3 cases were lost, the lost rate of 1.23%. in this study included 241 cases of.2. patients after total knee arthroplasty in fear of moving status: in 241 patients, with fear of moving patients 67 cases no fear of moving patients for 174 cases, total knee arthroplasty in patients with postoperative disease incidence for fear of moving 27.80%.3. fear of moving groups with and without fear of moving patients after knee joint pain: after 2 weeks, 4 weeks, 3 months, 6 months, two groups were statistical after knee joint pain, Using repeated measures ANOVA statistical analysis of the data showed that, in the evaluation of each time point fear of moving pain intensity groups were significantly higher than those without fear of moving group, with significant difference (P0.05) of.4. group and without fear of fear of moving dynamic groups of patients with knee flexion: after 2 week, 4 weeks, 3 months, 6 months, statistics of two groups of patients with postoperative knee flexion, using repeated measures ANOVA statistical analysis of data showed that, in the evaluation of each time point fear of moving the group of patients with postoperative knee flexion were significantly lower than the group with no fear. Statistical significance (P0.05).5. fear of moving groups with and without fear of moving patients after knee joint function score: 3 months after operation, 6 months, the knee joint function score statistics of two groups of patients, using two independent sample t test for statistical analysis of data. The results show that the fear of moving The knee function score of patients were significantly lower than those without fear of moving group, with significant statistical significance (P0.05).6. with the passage of time, the two groups of patients with pain intensity and joint flexion were improved by using repeated measures ANOVA of knee pain in the two groups of patients of knee joint flexion for statistical analysis the results showed that two groups of patients in different time points of knee joint pain, fear of moving groups of patients with knee joint pain were higher than those without fear of moving groups, with statistical significance (P0.05); the two groups of patients at each time point after operation of knee flexion, fear of moving patients the postoperative knee flexion were lower than those without fear of moving group, with significant statistical significance (P0.05). After 2 to 4 weeks, without fear of moving patients with knee pain and knee flexion strength were significantly improved (P0.05); operation 鍚，

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