特发性脊柱侧凸患者背痛强度与临床和心理社会因素的关系

The relationship between back pain intensity and clinical and psychosocial factors in patients with idiopathic scoliosis

目的探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者背痛强度与临床和心理社会因素的关系。方法选择2019年1月~2023年3月于该院就诊的147例AIS患者作为研究对象,收集患者性别、年龄、体质量指数(body mass index,BMI)、教育水平、父母职业、父母教育水平、过去7 d体育活动水平、治疗方式、核心结果测量指数(core outcome measurement index,COMI)第7项、疼痛程度、主弯Cobb角、AIS类型、运动恐惧量表、脊柱侧凸研究学会22项问卷量表(scoliosis research society-22 questionnair,SRS-22)、家庭关怀度指数问卷(family APGAR index,APGAR)、家庭或社会对患者的影响等资料并进行单因素分析,采用Logistic回归模型进行多因素分析,观察临床和心理社会因素对AIS患者感知性疼痛(pain perception,PP)的影响。结果PP发生率为27.89%。PP和NPP组患者BMI、母亲职业、母亲教育水平、过去7 d活动水平、SRS-22功能活动、SRS-22自我形象、APGAR问卷中的P4、侧凸类型、最大Cobb角等比较,差异均无统计学意义(均P>0.05);PP组和NPP组患者性别、年龄、教育水平、父亲职业、父亲教育水平、治疗方式、COMI第7项、TSK评分、SRS-22总分、SRS-22疼痛、SRS-22心理、APGAR问卷中的P1、P2、P3、P5比较,差异均存在统计学意义(均P<0.05)。多因素Logistic分析结果显示,年龄、TSK、COMI第7项是影响PP的风险因素(均P<0.05),支具、SRS-22疼痛、SRS-22心理健康、P2、P3是PP的保护性因素(均P<0.05)。结论AIS患者受社会心理因素影响较大,支具干预可减少患者的疼痛程度。

Objective To investigate the relationship between back pain intensity and clinical and psychosocial factors in adolescent idiopathic scoliosis(AIS).Methods A total of 147 AIS patients who visited our hospital from January 2019 to march 2023 were selected as the study subjects.The patient's sex,age,body mass index(BMI),education level,parents'occupation,parents'education level,physical activity level in the past 7 days,treatment methods,item 7 of core outcome measurement index(COMI),pain degree,Cobb angle of main bend,AIS type,sports fear scale,SRS-22 scale,APGAR questionnaire,family or social impact on patients and other clinical data were collected.Single factor analysis was conducted by chi square test or t test,and multivariate analysis was conducted by logistic regression to observe the influence of clinical and psychosocial factors on perceived pain(PP)of AIS patients.Results The incidence of PP was 27.89%.There were no significant differences between PP and NPP groups in BMI,maternal occupation,maternal education level,activity level in the past 7 days,SRS-22 functional activity,SRS-22 self-image,P4,scoliosis type,maximum Cobb angle,etc(all P>0.05).The gender,age,education level,father's occupation,father's education level,treatment method,COMI item 7,TSK score,total SRS-22 score,SRS-22 pain,SRS-22 psychology,APGAR questionnaire,P1,P2,P3,P5 of patients in PP group and NPP group were statistically significant(all P<0.05).Multivariate logistic analysis showed that age,TSK,COMI item 7 were risk factors affecting PP(all P<0.05),while brace,SRS-22 pain,SRS-22 mental health,P2,P3 were protective factors(all P<0.05).Conclusion The patients with AIS are greatly affected by social and psychological factors,and the intervention of brace can reduce the pain degree of the patients.