创伤性肘关节僵硬共病焦虑状态初步调查及僵硬危险因素分析

Concomitant anxiety in posttraumatic elbow stiffness and risk factors for stiffness

目的初步调查创伤性肘关节僵硬共病焦虑情况,分析肘关节僵硬患者肘关节屈伸和前臂旋转受限的危险因素。方法收集2017年9~10月、2018年5~6月笔者所在北京积水潭医院创伤骨科治疗组专家门诊就诊的肘关节损伤3个月后患者资料,通过发放问卷方式调查患者的人口学特征和疾病信息(性别、年龄、受教育程度、损伤时间、损伤类型、治疗方式和康复方式),使用焦虑自评量表(SAS)评估患者焦虑程度,由同一位骨科医师测量肘关节活动范围,分析创伤性肘关节僵硬与焦虑关系,以及肘关节僵硬的危险因素。结果共发放问卷74例,收回有效问卷70例。共有51例(72.9%)患者诊断为创伤性肘关节僵硬,22例(31.4%)患者处于焦虑状态。创伤性肘关节僵硬患者伴有焦虑的比例为39.2%(20/51),高于非创伤性肘关节僵硬患者伴有焦虑的10.5%(2/19);处于焦虑状态的患者患有创伤性肘关节僵硬的比例为90.9%(20/22),高于非处于焦虑状态的患者诊断为创伤性肘关节僵硬的64.6%(31/48),以上比较差异均有统计学意义(P<0.05)。创伤性肘关节僵硬患者SAS标准分(47.6±11.6)分高于无创伤性肘关节障碍患者(38.9±8.2)分,差异有统计学意义(P=0.004)。被动康复是肘关节损伤后屈伸活动受限的独立危险因素(95%CI 5.18~340.90,P<0.001),复杂关节内骨折(95%CI 2.88~708.69,P=0.007)、高能量损伤(95%CI 1.40~23.20,P=0.015)和被动康复(95%CI 1.61,47.80,P=0.012)是肘关节损伤后发生旋转功能受限的独立危险因素。结论创伤性肘关节僵硬与焦虑具有共病关系。被动康复是肘关节屈伸活动受限的危险因素,复杂关节内骨折、高能量损伤和被动康复是肘关节损伤后前臂旋转受限的危险因素。

Objective To investigate the situation of concomitant anxiety in posttraumatic elbow stiffness and analyze the risk factors for posttraumatic elbow stiffness.Methods Participants for this investigation were the outpatients who had sought special medical attention for elbow injury from September to October,2017 and from May to June,2018 at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital. Their demographic and injury-related data (gender,age,education,injury time,injury type,treatment and rehabilitation)were collected through questionnaires.Self-rating Anxiety Scale (SAS)was used to evaluate their anxiety.The range of motion (ROM)of the elbow was measured by the same qualified orthopedist.The relationship between posttraumatic elbow stiffness and anxiety and risk factors for stiffness were analyzed sta- tistically.Results The proportion of concomitant anxiety (39.2%)in the patients with posttraumatic elbow stiffness was significantly higher than that in those without posttraumatic elbow stiffness (10.5%,P = 0.021).The SAS score for the patients with posttraumatic elbow stiffness (47.6±11.6)was significantly higher than that (38.9±8.2)for those without posttraumatic elbow stiffness (P =0.004).Passive rehabil- itation was a risk factor for flexion-extension stiffness.Complex intra-articular fracture,high-energy injury and passive rehabilitation were risk factors for limited forearm rotation.Conclusions Our study suggests the comorbidity of posttraumatic elbow stiffness and anxiety.Complex intra-articular fracture,high-energy injury and passive rehabilitation are risk factors for forearm rotational stiffness after elbow trauma.Passive rehabil- itation is also a predictor of less range of flexion-extension of the elbow.