全膝或全髋关节置换后老年人首次活动时跌倒恐惧的影响因素

Factors affecting fall fear in the first movement of elderly patients after total knee or hip arthroplasty

背景:髋、膝关节置换是目前改善老年髋、膝关节疾病所致关节功能严重障碍、疼痛的根本措施,但由于跌倒恐惧的存在严重影响老年患者下地活动时间,明确老年髋、膝关节置换患者跌倒恐惧的发生因素对此类患者的早期临床干预具有重要的指导意义。目的:探讨影响老年患者全膝关节置换和全髋关节置换后首次下地活动时跌倒恐惧的因素。方法:选择2015年1月至2019年1月在广西医科大学附属武鸣医院行髋、膝关节置换的242例老年患者作为研究对象,观察患者跌倒恐惧发生率,采用单因素与多因素Logistic分析影响跌倒恐惧的风险因素。结果与结论:①跌倒恐惧发生率为65.6%;②单因素分析显示,存在跌倒恐惧和无跌倒恐惧患者的性别、教育程度差异无显著性意义(P>0.05);存在跌倒恐惧和无跌倒恐惧患者的年龄、置换类型、既往跌倒史、疼痛评分、焦虑、抑郁、合并慢性病种类、视力减退情况差异有显著性意义(P<0.05);③多因素Logistic分析结果显示,年龄≥70岁、疼痛目测类比评分7-10分、焦虑、既往跌倒史是导致患者跌倒恐惧的风险因素(P<0.05);④提示老年患者髋、膝关节置换后首次下地活动时跌倒恐惧发生率较高,术后疼痛、焦虑、年龄、跌倒史等是影响患者跌倒恐惧的风险因素,临床应重视这些风险因素,以缓解患者跌倒的恐惧心理,促进其早日康复。

BACKGROUND:Hip and knee arthroplasty is currently the fundamental measure to improve the severe joint dysfunction and pain caused by elderly hip and knee joint diseases.However,the fear of falling seriously affects the time for elderly patients to go to the ground,and it is clear that the elderly patients with hip and knee arthroplasty are afraid of falling.The occurrence factors have important guiding significance for the early clinical intervention of such patients.OBJECTIVE:To explore the factors influencing the fear of falling during the first ambulation after total knee arthroplasty and total hip arthroplasty in elderly patients.METHODS:242 elderly patients who underwent hip and knee arthroplasty in Wuming Hospital,Guangxi Medical University from January 2015 to January 2019 were selected as the study subjects,and the incidence of fall fear was observed.The risk factors of fall fear were analyzed by single factor and multi-factor Logistic analysis.RESULTS AND CONCLUSION:(1)The incidence of fall fear was 65.6%.(2)The univariate analysis showed that there was no significant difference in gender and education level between patients with and without fear of falling(P>0.05).There were significant differences in age,type of replacement,past fall history,pain score,anxiety,depression,types of chronic diseases and visual impairment between patients with and without fall fear(P<0.05).(3)The multivariate Logistic analysis showed that age(≥70 years old),visual analogue scale pain score of 7-10,anxiety and past fall history were risk factors for falling fear(P<0.05).(4)It is suggested that elderly patients have a higher incidence of fear of falling when going to the ground for the first time after hip and knee arthroplasties.Post-operative pain,anxiety,age and history of falling are risk factors affecting fear of falling.Clinical attention should be paid to these risk factors in order to alleviate fear of falling and promote early recovery.