心理因素对髌骨骨折患者术后功能康复的影响

The Effect of Psychological Factors on Postoperative Functional in Patients with Patella Fracture

摘要: 目的：探讨心理因素对髌骨骨折患者术后功能康复的影响。方法：选取2018年5月1日~2021年4月30日空军军医大学第二附属医院创伤骨科就诊且符合纳入标准的124例髌骨骨折行切开复位内固定术的患者，根据90项症状清单(Symptom Check list-90, SCL-90)将患者分为阳性症状组(20例)与阴性症状组(104例)，记录两组患者术后弃拐自主活动时间，术后6周、6个月患者膝关节活动度，Bostman髌骨骨折临床疗效评价，并对患者SCL-90各因子得分与Bostman髌骨骨折临床疗效评分行相关性分析。结果：1) 本研究中纳入患者心理阳性症状检出率为16.13%，其中人际关系敏感、抑郁、焦虑、敌对、恐怖为主要表现；2) 阳性症状组患者术后弃拐自主活动时间晚于阴性症状组，差异有统计学意义(P < 0.01)；3) 术后6周及6个月阳性症状组患者膝关节活动度均小于阴性症状组，差异有统计学意义(均P < 0.05)；4) 阳性症状组患者术后6个月Bostman髌骨骨折疗效评分优良率低于阴性症状组(85% VS 96.2%, P = 0.048)；5) SCL-90中抑郁、焦虑、敌对、饮食睡眠与Bostman髌骨骨折疗效评分中度相关，其中抑郁、焦虑、敌对与Bostman髌骨骨折疗效评分的关联性存在统计学差异。结论：诸多不良心理因素，尤其是焦虑、抑郁、敌对情绪对髌骨骨折术后患者膝关节功能康复疗效有负面影响。

Abstract: Objective: To investigate the effects of psychological factors on postoperative function in patients with patella fracture. Methods: One hundred and twenty-four patients with patella fracture who met the inclusion criteria and treated with open reduction internal fixation in the Department of Orthopedics of the second affiliated hospital of air force medical university, from May 2018 to April 2021 were included. The patients were divided into positive symptom group (20 cases) and nega-tive symptom group (104 cases) according to the Symptom Check List 90 (SCL-90), we record the time of independent activity of discard crutch after operation and evaluate the degree of knee joint activity at the time of 6 weeks and 6 months after operation and the clinical curative effect score of Bostman patella fracture at the time of 6 months after operation. At the same time, we analyze the relationship between SCL-90 and the clinical curative effect score of Bostman patella fracture. Re-sults: 1) The detection rate of psychological positive symptoms in this study was 16.13%, in which interpersonal sensitivity, depression, anxiety, hostility and terror were the main manifestations; 2) The time of independent activity after operation in the positive symptom group was later than that in the negative symptom group, the difference was statistically significant (P < 0.01); 3) The degree of knee joint activity in the positive symptom group was less than that in the negative symptom group at 6 weeks and 6 months after operation, the difference was statistically significant (all P < 0.05); 4) The Superior rate of Bostman patella fracture in positive symptom group was lower than that in negative symptom group at 6 months after operation (85% vs 96.2%, P = 0.048); 5) Depres-sion, anxiety, hostility and other factors (diet, sleep, etc.) in SCL-90 were moderately related with Bostman’s score of patella fracture. The relation between depression, anxiety, hostility and Bostman patella fracture efficacy score were statistically different. Conclusion: Many adverse psy-chological factors, especially anxiety depression and hostility, have a negative impact on the reha-bilitation effect of knee joint function in patients after patella fracture surgery.