心理和精神因素对全膝关节置换术后功能恢复及生活质量的影响

Effects of psychological and spiritual factors on functional recovery and life quality after total knee arthroplasty

目的探讨患者在全膝关节置换术前后心理和精神因素的变化,对膝关节功能恢复和健康相关生活质量的影响关系。方法对62例(女37例,男25例)单侧全膝关节置换术的患者进行术前、术后1个月和6个月的调查研究,所使用的检测项目有贝克尔焦虑、抑郁量表(BAI、BDI),状态-特质焦虑量表(S-AI、T-AI),艾森克人格问卷简式量表中国版(EPQ),膝关节评分(KSS),和健康相关生活质量问卷(SF-36)。结果手术后1个月及6个月患者的焦虑、抑郁和KSS评分各项指标较术前差异有统计学意义(P<0.01),SF-36各项指标在手术前后的提高率各有不同,EPQ的神经质性与手术前后的生理健康(PCS)(P=0.001和P<0.001)和心理健康(P<0.001和P<0.001)差异有统计学意义,术前KSS评分与术后KSS评分及术前心理相关评分相关拟合程度不佳(r^2=0.12和r^2=0.25),术后6个月KSS功能评分与特质焦虑(TAI)和艾森克神经质性(N)负相关(P<0.05,B=-0.32和P<0.001,B=-0.54),而与艾森克外-内倾向性(E)成正相关(P<0.05,B=0.32)。结论患者在接受单侧全膝人工关节表面置换术后1个月及6个月膝关节功能恢复和健康相关生活质量显著提高,心理和精神因素对TKA术后功能恢复有影响,焦虑和抑郁程度低的患者功能恢复好;同时,术前应对焦虑和抑郁程度高的患者采取适当的干预措施,以获得满意的疗效。

Objective To study the changes of psychological and spiritual factors before and after total knee arthroplasty （ TKA ） and their effects on knee functional recovery and health-related quality of life. Methods A research on 62 patients who underwent unilateral TKA was performed preoperatively and at 1 and 6 months after the operation, including 37 females and 25 males. The test items included Beck Anxiety Inventory （ BAI ） and Beck Depression Inventory （ BDI ）, State Anxiety Inventory （ S-AI ） and Trait Anxiety Inventory （ T-AI ）, Eysenck Personality Questionnaire-Revised, Short Scale for Chinese （ EPQ-RSC ）, Knee Society Knee Scoring System （KSS）, and health,related quality of life questionnaire （ the short-form-36 [ SF-36 ] ）. Results There were statistically significant differences in the anxiety degree, depression degree and KSS score at 1 and 6 months after the operation and preoperatively （ P〈0.01 ）. The increasing rates of various indexes of SF-36 were different before and after the operation. Statistical significance existed in the differences between neuroticism in EPQ and the preoperative and postoperative physical health （ P=0.001 ＆ P〈0.001 ） and the differences between neuroticism in EPQ and the preoperative and postoperative mental health （ P〈0.001 ＆ P〈0.001 ）. The fitting degree of the preoperative KSS scores and the postoperative KSS scores and preoperative psychology-related scores was not good （r^2=0.12 ＆ r^2=0.25 ）. A negative correlation existed between the KSS scores at 6 months after the operation and TAI and between the KSS scores at 6 months after the operation and neuroticism in EPQ （ P〈0.05, B=-0.32 ＆ P〈0.001, B=-0.54 ）. A positive correlation existed between the KSS scores at 6 months after the operation and extraversion-introversion in EPQ （ P〈0.05, B=0.32 ）. Conclusions Knee function is adequately restored and health-related quality of life is significantly improved, when the patients undergo unilateral TKA at 1 and 6 months after the operation. There are certain effects of psychological and spiritual factors on functional recovery after TKA, and the patients with low degrees of anxiety and depression have better recovery. And meanwhile, appropriate intervention measures should be taken before the operation for the patients with high degrees of anxiety and depression, so as to achieve satisfactory curative effects.