心理因素对膝关节置换术后疼痛和生活质量的影响

发布时间：2018-06-24 08:10

本文选题：关节炎 + 焦虑　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景膝关节炎症中最常见的病因是骨性关节炎(OA),在老年人中最为常见。长期的慢性疼痛及行动功能障碍使得膝关节骨性关节炎患者的情感、认知、生理多种功能受到影响,患者社会活动受限,与外界沟通交流减少,晚期膝关节骨性关节炎患者常需要家人照料生活起居,加之医疗效果较差,患者常常出现情绪低落、焦虑、抑郁、自责等心理障碍。目前对于TKA来说,关节假体设计较前明显提高,手术技术相当成熟,并发症的发生率较前明显减少。然而在临床工作中,有一部分患者TKA手术成功,X线检查未见假体松动或下肢力线不良情况,在其复诊的过程中往往抱怨手术部位仍存在疼痛或者关节功能不能满足其日常生活需要。在我国,由于人文医学发展的限制,国内大多临床医生较少关注患者心理因素对疾病的影响。目的观察接受单侧TKA手术的KOA患者术前心理因素对TKA术后疼痛和生活质量的影响,为临床工作提供一定的参考价值,进一步完善TKA术后管理工作。方法选择我院2015年1月到2016年1月间行单侧全膝关节置换术(TKA)101例KOA患者,排除未完成随访患者9例,共观察92例因KOA而接受单侧TKA手术患者。患者同意进入本研究并签署知情同意书后,首先采用医院焦虑抑郁量表(HADS)评估患者术前心理状态,22例患者HADS≥9分纳入心理组;术前、术后7天、术后1月、术后6月采用视觉模拟评分法评分(VAS)评估患者疼痛;术前、术后1月、术后6月采用美国膝关节协会评分(KSS)评估患者膝关节功能;术前、术后6月采用36条简明健康问卷(SF-36)评估患者生活质量。同时记录患者年龄、病史、是否留守、体重指数(BMI)、术前血沉(ESR)、C-反应蛋白(CRP)指标。结果1、经评估,术前HADS≥9分共有共有22例患者,其中男性5例,女性17例,纳入心理组,剩余70例患者纳入对照组;本研究共有留守老年人49例,其中术前HADS≥9分共20例患者。2、心理组和对照组患者在术前、术后7天、术后1月和术后6月经VAS评分评估:心理组术前VAS评分6.50±0.28,对照组6.07±0.14,两组差异无统计学意义(P0.05);术后7天、术后1月、术后6月心理组VAS评分分别为3.86±0.15、3.09±0.13、2.23±0.11,对照组分别为3.09±0.08、2.24±0.07、1.00±0.08,两组术后随访差异均具有统计学意义(P0.05);3、心理组和对照组KSS膝关节评分与膝功能评分对比:术前关节评分心理组为25.32±0.69,对照组25.60±0.51;功能评分心理组为42.05±1.50,对照组41.93±0.85差异均无统计学意义(P0.05)。在术后1月和术后6月对比中,关节评分心理组分别为76.50±0.70、80.55±0.31,对照组分别为81.46±0.42、84.63±0.19;功能评分心理组分别为60.00±0.74、81.82±0.70,对照组分别为65.57±0.45、88.21±0.53,差异均具有统计学意义(P0.05);4、心理组和对照组SF-36评分对比:术前PHC中生理功能、躯体疼痛、总体健康、MHC中活力的差异无统计学意义(P0.05),术前生理职能及心理健康内容包括社会功能、情感职能、心理健康的对比具有统计学意义(P0.05)。术后SF-36评分对比中,生理健康内容和心理健康内容的8个维度对比差异均具有统计学意义(P0.05);5、本研究中有53%(49/92)的患者为留守老年人口。在老年人口中,心理组(n=20)在术后7天、术后1月和术后6月VAS评分分别为3.50±0.19、2.60±0.23、1.75±0.22,对照组(n=29)分别为3.03±0.12、2.10±0.10、1.24±0.12,两组相比差异均具有统计学意义(P0.05)。术后1月、术后6月KSS膝关节评分心理组分别为77.95±0.59、80.50±0.30,对照组分别为81.34±0.58、84.66±0.29;膝功能评分心理组分别为61.75±1.16、81.75±0.75,对照组分别为64.83±0.63、89.14±0.90。两组对比差异均具有统计学意义(P0.05)。结论1、术前存在焦虑、抑郁的患者TKA术后疼痛的程度较重,膝关节功能的恢复较无心理疾病的患者差,生活质量较差,在留守老年患者中更为突出。2、术前患者存在焦虑、抑郁预示着患者特别是留守老年人术后较差的膝关节功能和生活质量,且术后疼痛症状的缓解达不到患者期望值。
[Abstract]:Background: the most common cause of inflammation of the knee joint is osteoarthritis (OA), which is the most common in the elderly. Chronic pain and dysfunction of the knee are affected by the emotional, cognitive, physiological functions of the patients with osteoarthritis of the knee and the limited communication and communication with the outside world, and the late knee joint osteoarthritis. The patient often needs family care to live and live, and the medical effect is poor. Patients often have mental disorders such as depression, anxiety, depression and self blame. For TKA, the design of joint prosthesis is obviously improved, the surgical technique is quite mature and the incidence of complications is significantly reduced. However, there are some patients in clinical work. TKA was successful in operation. X-ray examination showed no prosthesis loosening or poor lower extremity force line. In the process of re diagnosis, it was often complained that there was still pain in the surgical site or the joint function could not meet the needs of daily life. In our country, most clinicians in China are less concerned about the psychological factors of the patients because of the limitations of the development of humanities. Objective To observe the effect of preoperative psychological factors on the pain and quality of life of KOA patients undergoing unilateral TKA surgery, to provide some reference value for clinical work, and to further improve the management of TKA after operation. Methods 101 cases of KOA patients were selected from January 2015 to January 2016 in our hospital, and 101 cases of KOA patients were excluded. 9 cases of uncompleted follow-up patients were observed and 92 patients received unilateral TKA surgery for KOA. The patients agreed to enter this study and signed informed consent. First, the hospital anxiety and Depression Scale (HADS) was used to evaluate the psychological state of the patients before operation, and 22 patients were included in the psychological group with HADS or more than 9 points. Before operation, 7 days after operation, January, and June after the operation, visual models were used. The score (VAS) was used to evaluate the pain of patients. Preoperative, January, and June after the operation, the American Knee association score (KSS) was used to evaluate the patients' knee joint function. Before operation, 36 simple health questionnaire (SF-36) was used to evaluate the quality of life in June, and the patient's age, medical history, body mass index (BMI), preoperative ESR (ESR), C- were recorded. Reactivity protein (CRP) index. Results 1, there were 22 patients with HADS > 9 scores before operation, including 5 males and 17 females, and 70 patients were included in the control group. There were 49 left behind elderly patients in this study. There were 20 patients with HADS more than 9 before operation and.2, 7 days after operation, 7 days after operation, and January after operation. The VAS score of 6 menstruation after operation was evaluated: the VAS score of the psychological group was 6.50 + 0.28 before operation, and the control group was 6.07 + 0.14. The difference between the two groups was not statistically significant (P0.05). The VAS score of the psychological group was 3.86 + 0.15,3.09 + 0.11 + 0.11 after the operation on 7 days after the operation, and the control group was 3.09 + 0.08,2.24 + 0.07,1.00 + 0.08 respectively in the control group, and the follow-up differences were all in the two groups after the operation. Statistical significance (P0.05); 3, the comparison between the psychological group and the control group KSS knee score and the knee function score: the preoperative joint score was 25.32 + 0.69, the control group was 25.60 + 0.51, the functional score was 42.05 + 1.50 and the control group was 41.93 + 0.85 (P0.05). In the January and postoperative June post operation comparison, the joint score psychology The group was 76.50 + 0.70,80.55 + 0.31 respectively, the control group was 81.46 + 0.42,84.63 + 0.19, the functional score group was 60 + 0.74,81.82 + 0.70, the control group was 65.57 + 0.45,88.21 + 0.53 respectively, the difference was statistically significant (P0.05); 4, the psychological group and the control group were compared with the SF-36 score: the physiological function, somatic pain, the total in PHC before the operation. There was no significant difference in the difference of vitality in MHC (P0.05). The pre operation physiological function and mental health content included social function, emotional function and psychological health (P0.05). The comparison of the 8 dimensions of physical health content and mental health content were statistically significant (P0.05) in the comparison of the SF-36 score after the operation (P0.05); 5 In this study, 53% (49/92) of the patients were left behind the elderly. In the elderly population, the psychological group (n=20) was 3.50 + 0.19,2.60 + 0.23,1.75 + 0.22 after operation in January and June after operation, and the control group (n=29) was 3.03 + 0.12,2.10 + 0.10,1.24 + 0.12 respectively. The difference between the two groups was statistically significant (P0.05). In January, the group was statistically significant (P0.05). The psychological group of KSS knee joint score in June was 77.95 + 0.59,80.50 + 0.30, the control group was 81.34 + 0.58,84.66 + 0.29, and the psychological group of the knee function score was 61.75 + 1.16,81.75 + 0.75 respectively. The contrast group was 64.83 + 0.63,89.14 0.90. two, respectively, the difference was statistically significant (P0.05). Conclusion 1. There was anxiety and depression before operation. After TKA, the degree of pain was heavier, the recovery of knee function was worse than those without mental illness, poor quality of life, more prominent.2 in the elderly patients left behind, anxiety in the patients before operation, and depression in the patients, especially the poor knee function and quality of life after the operation, and the relief of postoperative pain symptoms was reached. No expected value of the patient.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【参考文献】