人工髋关节翻修术后患者满意度影响因素的研究

Influence factors for patients' satisfaction with revision hip arthroplasty

目的探讨人工髋关节翻修术后患者主观满意度及其影响因素。方法回顾性分析自2010-01—2015-04行人工髋关节翻修术的40例的临床资料,记录术前期望值评分、术前术后SF-36评分、术后Harris评分,通过电子病历系统收集术前Harris评分及术后VAS评分。结果术后患者主观满意度满意34例,不满意6例。均行单侧人工髋关节翻修术,至末次随访,患髋稳定性良好,主观满意率85%,术后1年Harris评分(81.6±5.54)分,较术前[(40.5±3.76)分]有明显改善,差异有统计学意义(P<0.05);单因素分析显示满意组术后Harris评分、术前期望评分、术后VAS评分及术前术后RE评分优于不满意组,差异有统计学意义(P<0.05);秩相关回归分析显示满意度与术后Harris评分(r=0.347,P=0.028)、术后RE评分(r=0.584,P<0.001)、术前RE评分(r=0.443,P=0.004)呈正相关,与术后VAS评分(r=-0.451,P=0.003)、术前期望评分(r=-0.330,P=0.038)呈负相关。结论术后关节疼痛、术前期望、术后髋关节功能状况、术后情感状况与患者满意度有关,术后疼痛缓解、关节功能改善明显、术后情绪稳定、术前期望值较低的患者易获得较高满意度;术前谈话了解患者期望、帮助其建立合理预期,术后给予情感支持有助于提升满意度。

Objective To investigate the subjective satisfaction and its influencing factors of patients after revision total hip arthroplasty. Methods A retrospective study was conducted on 40 cases of unilateral hip revision in Nanjing General Hospital from January 2010 to April 2015. The preoperative expectation score, preoperative and postoperative SF-36 score,postoperative Harris score, and collected preoperative pain score and postoperative Harris score were recorded through the electronic medical record system. Results Of the 40 cases, 34 cases were satisfied with their procedure while the others were not. The subjective satisfaction rate was 85%. All the cases underwent unilateral hip revision. And the hip stability was keeping well till the last follow-up date. Compared with the preoperative Harris score（40.5±3.76）, the Harris score one year after surgery（81.6 ±5.54） increased significantly（P 0.05）. And two-tailed independent t-tests showed that preoperative expectation level, postoperative functional status, role emotional and pain level were significantly different between satisfied and dissatisfied groups（P 0.05）. Rank correlation regression analysis showed that the satisfaction of patients was positively related to postoperative Harris score（r =0.347, P =0.028）, postoperative RE score（r =0.584, P 0.001） and preoperative RE score（r =0.443, P =0.004）, while it was negatively related to postoperative pain scores（r =-0.451, P =0.003） and preoperative expectation score（r =-0.330, P =0.038）. Conclusion Preoperative expectation level, postoperative functional status, role emotional and pain level have significant influence on patient satisfaction. Pain-relieving, functional recovery, emotional support and reasonable expectation would help development of the patients＇ satisfaction to the surgery. Identifying and addressing expectations, particularly possibly unrealistic expectations, and giving patients emotional support can contribute much to improving patient＇s satisfaction to the surgery.