全膝关节置换术后恐动的相关因素△

Factors associated with kinesiophobia after total knee arthroplasty

摘要:

［目的］探讨全膝关节置换术后恐动症发生的相关因素。［方法］2020 年 1 月—2021 年 12 月本院行全膝关节置换术患者 205 例纳入本研究，采用恐动症 TSK （Tampa Scale of Kinesiophobia, TSK） 评分评估患者状态，TSK>37 分确定为恐动症， 将患者分为两组行单因素比较。行 TSK 评分与临床指标行单项相关分析和多元逐步回归分析。［结果］205 例患者中，36 例确诊为恐动症，发生率为 17.6%。单项因素比较表明，恐动症组患者术前疼痛持续时间、术前 VAS 评分、翻修手术比例以及一期双侧置换比例显著高于非恐动症组（P<0.05）；而恐动症组患者文化程度、术前 HSS 评分、术前 KSS 临床评分和功能评分、K-SES 评分和社会支持评分显著低于非恐动症组（P<0.05）。单项相关分析结果显示，文化程度、术前 HSS 评分、KSS 临床评分、K-SES 评分及社会支持评分与 TSK 评分呈显著负相关 （P<0.05）；而术前 VAS 评分及疼痛持续时间与 TSK 评分呈显著正相关 （P< 0.05）。多元逐步回归分析结果表明术前疼痛时间长和社会支持评分低是发生恐动症发生的主要相关因素。［结论］术前疼痛持续时间长是全膝关节置换术后恐动症发生的危险因素，而社会支持评分高是减少恐动症发生的保护因素。

Abstract:

[Objective] To explore the factors related to kinesiophobia after total knee arthroplasty. [Methods] A total of 205 patients who underwent total knee arthroplasty in our hospital from January 2020 to December 2021 were enrolled in this study. The motion status was evaluated by the Tampa Scale of Kinesiophobia (TSK) score, and TSK＞37 was identified as kinesiophobia. The patients were divided in- to two groups based on whether kinesiophobia happened for univariate comparison. In addition, Pearson or Spearman correlation analysis and multiple stepwise regression analysis were performed between TSK score and clinical parameters. [Results] Among 205 patients, 36 pa- tients were diagnosed of kinesiophobia, with an incidence of 17.6% . As consequence of univariate comparison, the kinesiophobia group proved significantly greater than the non- kinesiophobia group in terms of duration of preoperative pain, preoperative VAS score, the propor- tion of revision surgery and the proportion of one-stage bilateral replacement (P＜0.05) . However, the former proved significantly lower than the latter in terms of education level, preoperative HSS score, preoperative KSS clinical score and functional score, K-SES score and social support score (P＜0.05) . Regarding Pearson or Spearman correlation analysis, the education level, preoperative HSS score, KSS clinical score, K-SES score and social support score were negatively correlated with TSK score (P＜0.05) , whereas the preoperative VAS score and pain duration were positively correlated with TSK score (P＜0.05) . In term of multiple stepwise regression analysis, the longer preoperative pain duration and lower social support score were the main factors related to the occurrence of kinesiophobia. [Conclusion] Long duration of preoperative pain is the main risk factor for the occurrence of kinesiophobia after total knee arthroplasty, while high social support score is a protective factor for reducing the occurrence of kinesiophobia.