全膝关节置换疗效及患者满意度与人格特征的关联性

Correlation of total knee arthroplasty efficacy with satisfaction and personality characteristics

背景:患者术后满意度是多因素共同决定的,心理因素可能起着重要作用,目前很少有研究涉及人格分型对全膝关节置换后患者满意度和临床结果的影响。在患者中识别和确定这些因素,可以针对患者特定的人格分型进行教育干预和预期管理,从而提高总体满意度。目的:探讨人格特征对全膝关节置换患者主观结果的影响。方法:调查108例接受全膝关节置换治疗的患者,根据随访得到的患者满意度,将患者分为2组,满意组82例,不满意组26例。采用艾森克人格问卷简式量表中国版(EPQ-RSC评分)对患者的人格特征进行测试;术前以及术后1年膝关节特异性测量包括美国特种外科医院膝关节评分、美国膝关节协会评分(临床评分和功能评分)及目测类比评分。结果与结论:①术后1年随访患者均没有发生术后并发症需要行翻修手术,所有患者中76%的患者满意,24%的患者不满意;②人格特征分为4种类型:"外向-稳定"型人格的患者中满意为93%,不满意为7%;"外向-不稳定"型人格的患者中满意为40%,不满意为60%;"内向-稳定"型人格的患者中满意为87%,不满意为13%;"内向-不稳定"型人格的患者中满意为47%,不满意为53%;4种人格之间差异有显著性意义(P<0.05);③术后1年,美国特种外科医院评分满意组显著高于不满意组(P<0.05),目测类比评分满意组显著低于不满意组(P<0.05);满意组及不满意组的美国膝关节协会临床评分及功能评分相比,差异均无显著性意义(P>0.05);④多因素Logistic回归分析显示,患者的人格特征及术后疼痛是影响满意度的独立危险因素;⑤提示人格特征可能会影响患者的满意度和全膝关节置换后的临床结果,因此患者的人格特征可能是全膝关节置换后满意度的一个有用的预测因素,这一特征对于准备行全膝关节置换治疗的患者很重要,因为可以提供有针对性的教育和管理,以改善预后。

BACKGROUND:Patients’postoperative satisfaction is determined by many factors,and psychological factors may play an important role;at present,few studies have shown the effect of personality classification on patient satisfaction and clinical outcome after total knee arthroplasty.Identifying and determining these factors in patients can carry out educational intervention and expectation management according to the specific personality types of patients,so as to improve overall satisfaction.OBJECTIVE:To investigate the impact of personality traits on the subjective outcome of total knee arthroplasty.METHODS:We investigated 108 patients undergoing total knee arthroplasty.Patients were divided into satisfied group(n=82)and unsatisfied group(n=26)based on the patient satisfaction obtained during the follow-up.The Eysenck Personality Questionnaire-Revised Short Scale for Chinese was used to test the personality characteristics of patients.Knee-specific measurements included the American Hospital for Special Surgery Knee Score,Knee Society Score(clinical and functional scores)and the visual analogue scale score before and one year after surgery.RESULTS AND CONCLUSION:(1)None of the follow-up patients had postoperative complications requiring revision surgery.76%of patients were satisfied and 24%were not satisfied.(2)Among them,personality characteristics were divided into four types:93%of patients with"extroversion-stable"personality were satisfied and 7%were dissatisfied;40%of patients with"extroversion-unstable"personality were satisfied,and 60%were dissatisfied;87%of patients with"introverted-stable"personality were satisfied and 13%were dissatisfied;47%of patients with"introverted-unstable"personality were satisfied and 53%were dissatisfied;the difference was statistically significant(P<0.05).(3)At 1 year postoperatively,American Hospital for Special Surgery Knee Score was significantly higher in the satisfied group than in the unsatisfied group(P<0.05).Visual analogue scale score was significantly lower in the satisfied group than in the unsatisfied group(P<0.05).Clinical and functional scores of Knee Society Score were not significantly different between the satisfied and unsatisfied groups(P>0.05).(4)Multivariate Logistic regression analysis showed that patient personality and postoperative pain were independent risk factors that affected patient satisfaction.(5)It is concluded that personality characteristics may affect patient satisfaction and clinical outcomes after total knee arthroplasty.Therefore,the personality characteristics of patients may be a useful predictor of satisfaction after total knee arthroplasty.This feature is important for patients preparing for total knee arthroplasty,because we can provide targeted education and management to improve their prognosis.