强化自我管理对老年骨质疏松症骨折髋关节置换术后假体松动并发症和心理状态的影响

Effects of strengthened self-management on prosthetic loosening complication and psychological status in elderly patients with osteoporosis fractures after hip replacement

目的:探讨强化自我管理对老年骨质疏松症骨折髋关节置换术后假体松动并发症和心理状态的影响。方法:将2012年2月-2017年2月于我院择期行髋关节置换术治疗的2400例老年骨质疏松症骨折患者随机均分为观察组(n=1200)和对照组(n=1200),对照组给予常规护理干预,观察组在常规护理的基础上给予强化自我管理干预,比较两组干预前后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、自我管理行为评分、Harris评分、Barthel(BI)指数及世界卫生组织生活质量简表(WHOQOL-BREF)评分,并记录两组并发症情况。结果:干预后观察组SAS、SDS评分显著低于对照组,差异有统计学意义(t=-7.716,-7.677;P<0.001);干预后观察组饮食、治疗、躯体活动、社会心理自我管理行为评分均显著高于对照组,差异有统计学意义(t=7.606,7.348,7.997,7.481;P<0.001);干预后观察组Harris评分、BI指数显著高于对照组,差异有统计学意义(t=6.097,7.354;P<0.001);干预后观察组生理功能、心理功能、社会关系、环境领域及总体感觉等各项WHOQOL-BREF评分显著高于对照组(t=7.174,7.587,8.430,7.500,8.440;P<0.001);观察组感染、静脉血栓、关节脱位、压疮、假体松动并发症发生率均显著低于对照组,差异均有统计学意义(χ~2=4.318,3.893,7.501,4.341,7.533;P<0.05)。结论:对老年骨质疏松症骨折髋关节置换术患者给予强化自我管理干预,可显著改善患者心理状态,提高患者自我管理能力及日常生活能力,促进术后关节功能的恢复,降低术后假体松动等并发症发生风险。

Objective:To explore the effects of strengthened self-management on prosthetic loosening complication and psychological status in elderly patients with osteoporosis fractures after hip replacement.Methods:A total of2,400 elderly patients with osteoporosis fractures undergoing elective hip replacement in our hospital from February2012 to February 2017 were randomly divided into the observation group(n=1200)and the control group(n=1200).The control group was given routine nursing intervention,and the observation group was combined with strengthened self-management intervention.The self-rating anxiety scale(SAS)score,self-rating depression scale(SDS)score,self-management behaviors scores,Harris score,Barthel index(BI)and World Health Organization Quality of Life Scale-Brief Form Questionnaire(WHOQOL-BREF)score were compared between the two groups before and after intervention,and the complications were recorded in the two groups.Results:After intervention,the scores of SAS and SDS in the observation group were significantly lower than those in the control group(t=-7.716,-7.677;P<0.001).The self-management behaviors scores of diet,treatment,physical activity and social psychology in the observation group after intervention were significantly higher than those in the control group(t=7.606,7.348,7.997,7.481;P<0.001).The Harris score and BI index in the observation group after intervention were significantly higher than those in the control group(t=6.097,7.354;P<0.001).After intervention,the every items scores of WHOQOL-BREF in the observation group were significantly higher than those in the control group(t=7.174,7.587,8.430,7.500,8.440,P<0.001).The incidence rates of complications such as infection,venous thrombosis,joint dislocation,pressure ulcer and prosthetic loosening in the observation group were significantly lower than those in the control group(χ~2=4.318,3.893,7.501,4.341,7.533,P<0.05).Conclusion:Strengthened self-management intervention for elderly patients with osteoporosis fractures after hip replacement can significantly improve the psychological status,self-management ability and daily living ability of patients,and promote postoperative recovery of joint function,and it has low risk of postoperative prosthesis loosening and other complications.