老年膝骨关节炎患者社会衰弱现状及影响因素分析

Current situation and influencing factors of social frailty in elderly with knee osteoarthritis

摘要:

[目的] 分析影响老年膝骨关节炎 （knee osteoarthritis, KOA） 患者社会衰弱 （social frailty, SF） 的相关因素。[方法] 收集 2024 年 3 月—2025 年 3 月在中国人民解放军联勤保障部队第九六〇医院骨科门诊就诊的 KOA 患者 202 例为研究对象， 根据 HALFT 量表得分将患者分为无 SF 组和 SF 组，采用单因素分析和二元多因素逻辑回归分析探讨患者发生 SF 的危险因素。 [结果]202 例患者中，无 SF（HALFT 0 分）75 例，占 37.1%；SF 前期（HALFT 1~2 分）67 例，占 33.2%；SF 期（HALFT 3~ 5 分） 60 例，占 29.7%。SF 组的年龄 [(72.2±6.3) 岁 vs (67.8±5.8) 岁, P＜0.001]、K-L 分期 [I/II/III/IV, (7/46/48/26) vs (19/31/20/5), P＜0.001]、居住方式 [独居/与他人居住, (2/73) vs (21/106), P=0.010]、屈服应对方式评分 [(13.7±2.3) vs (11.4±2.1), P＜0.001]、回避应对方式评分 [(18.8±2.7) vs (16.5±2.8), P＜0.001] 均显著高于非 SF 组，但是，SF 组运动频率 [从不/偶尔/经常, (50/52/25) vs (19/26/ 30), P=0.006]、双向社会支持评分 [(38.1±7.7) vs (44.7±7.0), P＜0.001]、积极心理资本评分 [(101.7±19.1) vs (119.6±20.7), P＜0.001]、 面对应对方式评分 [(19.0±3.6) vs (22.4±4.3), P＜0.001] 均显著低于非 SF 组。二元多因素逻辑回归分析显示：与他人一同居住 （OR=0.105, P＜0.05）、双向社会支持评分高 （OR=0.881, P＜0.05）、积极心理资本评分高 （OR=0.952, P＜0.05） 是老年 KOA 患者发生 SF 的保护因素；而高龄 （OR=1.104, P＜0.05）、K-L 分期高 （OR=7.685, P＜0.05）、屈服应对方式评分高 （OR=1.398, P＜ 0.05）是老年 KOA 患者发生 SF 的危险因素。[结论]高龄、独居、高 KOA 分期、低社会支持、低心理资本、屈服应对的患者发生 SF 的风险较高，临床应采取有针对性的干预措施来降低老年 KOA 患者 SF 水平。

Abstract:

[Objective] To search the factors related to social frailty (SF) in elderly patients with knee osteoarthritis (KOA). [Methods] A total of 202 patients with KOA who visited the orthopedic outpatient department of our hospitals from March 2024 to March 2025 were enrolled into this study. The patients were divided into the non-SF group and the SF group according to the HALFT scale. Univariate comparison and binary multivariate logistic regression analysis were used to explore the risk factors of SF. [Results] Among the 202 patients, 75 had no SF with HALFT score of 0, accounting for 37.1%, whereas 67 in the early stage of SF with HALFT score from 1 to 2 points, accounting for 33.2%; 60 in the SF stage with HALFT score from 3 to 5, accounting for 29.7%. Regarding univariate comparison, the SF group proved significantly greater than the non-SF group in terms of age [(72.2±6.3) years vs (67.8±5.8) years, P＜0.001], Kellgren-Lawrence (KL) scale [I/II/III/IV, (7/46/48/26) vs (19/31/20/5), P＜0.001], and living style [living alone/with others, (2/73) vs (21/106), P=0.010], score of yielding coping style [(13.7±2.3) vs (11.4±2.1), P＜0.001], avoidance coping style sore [(18.8±2.7) vs (16.5±2.8), P＜0.001]. However, the SF group was significantly less than the non-SF group in terms of the exercise frequency [never/occasionally/often, (50/52/25) vs (30/19/26), P= 0.006], two-way social support score [(38.1±7.7) vs (44.7±7.0), P＜0.001], positive psychological capital score [(101.7±19.1) vs (119.6± 20.7), P＜0.001] and coping style score [(19.0±3.6) vs (22.4±4.3), P＜0.001]. As results of binary multivariate logistic regression analysis, living with others (OR=0.105, P＜0.05), higher two- way social support score (OR=0.881, P＜0.05), and high positive psychological capital score (OR=0.952, P＜0.05) were protective factors for the SF in elderly with KOA. However, advanced age (OR=1.104, P＜0.05), advanced K-L stage (OR=7.685, P＜0.05), and high yielding coping style score (OR=1.398, P＜0.05) were the risk factors for SF. [Conclusion] The patients with advanced age, living alone, higher KOA stage, lower social support, lower psychological capital, and yield coping have a higher risk of developing SF. Clinically, targeted intervention measures should be taken to reduce the SF level of elderly with KOA.