反刍性沉思对PTSD合并股骨骨折患者髋关节置换术后的影响

Effect of rumination on patients with PTSD and femoral fracture undergoing hip replacement

目的研究反刍性沉思对股骨骨折患者全关节置换术后的影响。方法选择因创伤致股骨骨折行全关节置换术,且合并创伤后应激障碍(posttraumatic stressdisorder, PTSD)的住院患者150例,随访1年后保留133例,通过问卷调查分析研究对象骨关节评分(The Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC)与反刍性思维评分的相互关系及影响因素。结果髋关节置换术后患者的反刍总体得分术后1个月为(21.51±12.45)分,术后12个月下降到(12.61±3.82)分。侵入性反刍随术后的康复时间延长呈显著下降(P <0.05);主动反刍得分呈先升高后下降趋势。在术后1个月及6个月主动性反刍得分均显著高于侵入性(P <0.05)。侵入性反刍得分与WOMAC评分呈负相关,主动性反刍得分与WOMAC评分呈正相关;WOMAC评分的影响因素为侵入性反刍得分、主动性反刍得分、年龄及收入情况。结论髋关节置换术患者的反刍性沉思具有时间相关性:侵入性反刍随术后的康复时间延长呈显著下降,主动反刍得分呈先升高后下降。侵入性反刍得分与WOMAC评分呈负相关,主动性反刍得分与WOMAC评分呈正相关;侵入性反刍得分、主动性反刍得分、年龄及收入情况均是影响WOMAC评分的因素。

Objective To explore the effect of rumination on patients with femoral fracture undergoing total hip replacement.Methods A total of 150 inpatients who underwent total hip replacement due to femoral fracture from trauma and presented with posttraumatic stress disorder(PTSD) were selected and followed up for one year. After the follow-up, 133 patients were included and completed the questionnaire surveys to analyze the correlation between the score of bone joint(The Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC) and the score of ruminative thought of the subjects and its affecting factors. Results The total score of rumination of patients undergoing hip replacement was 21.51 ±12.45 one month after the operation and reduced to12.61 ±3.82 twelve months after the operation. The score of intrusive rumination decreased significantly with the extension of postoperative recovery time(P < 0.05), the score of deliberate rumination showed a downward trend after rise. The score of deliberate rumination one month and six months after the operation was significantly higher than the score of intrusive rumination(P < 0.05).The score of intrusive rumination was negatively correlated with WOMAC score, while the score of deliberate rumination was positively correlated with WOMAC score. The affecting factors of WOMAC score included the score of intrusive rumination, the score of deliberate rumination, age and income. Conclusion The score of rumination of patients undergoing hip replacement is of temporal correlation. The score of intrusive rumination shows marked decline with the extension of postoperative recovery time and the score of deliberate rumination rises first and then falls. The score of intrusive rumination is negatively correlated with WOMAC score, while the score of deliberate rumination is positively correlated with WOMAC score. The score of intrusive rumination, the score of deliberate rumination, age and income are the factors affecting WOMAC score.