胫骨骨折髓内钉术后患者疼痛程度、关节评分和生活质量的相关性

Correlation between Postoperative Pain Degree,Joint Score and Quality of Life for Pateitns undergoing Tibial Fracture Intramedullary Nailing

目的调查胫骨骨折髓内钉术后患者疼痛程度、关节评分和生活质量的相关性。方法 2009年8月至2010年7月,采用疼痛视觉评分(visual analogue scale,VAS)、膝关节评分(American knee score,AKS)和踝关节评分(Kofoed)量表以及SF-36生活质量量表对胫骨骨折髓内钉术后10～15个月再次入住上海交通大学附属第六人民医院取胫骨髓内钉的患者68例进行调查,并进行Spearman相关性分析。结果 27例(39.7%)患者休息时膝关节周围存在疼痛,13例(19.1%)患者出现不同程度的踝关节周围疼痛,9例(13.2%)患者仍感骨折部位疼痛;67.0%以上患者AKS、Kofoed评分为优;SF-36生活质量量表中躯体活动功能、疼痛、活力及社会功能等条目的得分均低于四川省居民常模的得分(均P<0.01)。Spearman相关性分析显示,AKS、Kofoed评分与SF-36生活质量量表的躯体及心理维度具有相关性;SF-36躯体总分与膝关节、踝关节和骨折端VAS评分具有相关性;心理总分仅与膝关节VAS评分具有相关性(P<0.01)。结论有效的护理评估和积极合理的功能锻炼指导可有效减少髓内钉治疗胫骨骨折患者的术后并发症,提高患者生活质量。

Objective To determine the correlation between postoperative pain degree,joint score and qualify of life（QOL） for patients undergoing tibial intramedullary nailling.Methods From August 2009 to July 2010,68 patients who were readmitted 10-15 months after ibial intramedullary nailling in the hospital were surveyed with visual analogue scale（VAS）,American knee score（AKS）,Kofoed scale and SF-36 scale.The outcomes were managed with Spearman correlation analysis.Results Pains around knee occurred in 27（39.7%） during rest,varying degrees of pains around ankle in 13（19.1%）,and pains in the fracutre sites in 9（13.2%）.More than 67% of patients were graded at a superior level for knee and ankle scores.The score of physical function,body pain,vitality and social function were below the norm score of the residents of Sichuan Province（P〈0.05）.Spearman correlation analysis showed a correlation between knee and ankle scores and the total somatic and psychological scores of SF-36 survival scale.Correlation was also detected between SF-36 somatic total score and knee,ankle,and fracture pain.Psychological score was only correlated with knee pain（P〈0.01）.Conclusion Effective nursing assessment and active functional exercise guidance can be effective in reducing the intramedullary nailing for tibial shaft fractures in patients with postoperative complications and improve patients’ quality of life.