影响前交叉韧带重建术后运动恐惧心理的危险因素分析及相关干预措施

陈琰琰; 吕畅; 刘晓莉; 陈珍珍; 陶爱萍

doi:10.16766/j.cnki.issn.1674-4152.002790

影响前交叉韧带重建术后运动恐惧心理的危险因素分析及相关干预措施

doi: 10.16766/j.cnki.issn.1674-4152.002790

温州医科大学附属第二医院骨科, 浙江温州 325000

详细信息

通讯作者:
陈琰琰, E-mail: chenyy36989@163.com

中图分类号: R687.2
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出版历程
- 收稿日期: 2022-01-21
- 网络出版日期: 2023-02-07

Analysis of risk factors affecting fear of exercise after anterior cruciate ligament reconstruction and related intervention measures

Department of Orthopedics, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探究前交叉韧带重建术后运动恐惧心理的危险因素, 分析相关预防干预措施。方法选择2019年5月—2021年10月于温州医科大学附属第二医院接受前交叉韧带重建术治疗的患者216例纳入研究, 采用运动恐惧量表(TSK)、一般自我效能感量表(GSES)、数字评定量表(NRS)调查患者情况, 经多因素logistic回归分析研究前交叉韧带重建术后患者运动恐惧心理的危险因素。结果 216例接受前交叉韧带损伤重建术治疗的患者中, 72例(33.33%)出现运动恐惧心理。非运动恐惧组患者的TSK评分[(24.32±3.18)分]低于运动恐惧组[(45.27±4.51)分, t=39.495, P＜0.001]。多因素分析结果显示, 患者学历初中及以下、非在职、家庭月收入 < 3 000元、受伤次数≥3次、伤膝大腿肌肉力量减弱、失眠、GSES评分 < 25分、术后中度/重度疼痛为影响前交叉韧带重建术后运动恐惧心理发生的危险因素(均P < 0.05)。结论前交叉韧带重建术后患者受文化水平、伤膝大腿肌肉力量减弱和疼痛等多种因素影响, 易出现运动恐惧心理, 应实施针对性干预措施, 消除患者运动恐惧心理, 提升运动积极性, 加速康复进程。
- 前交叉韧带重建术 /
- 运动恐惧心理 /
- 危险因素 /
- 干预措施 /
- 康复进程
Abstract: Objective To explore the risk factors of exercise fear after anterior cruciate ligament reconstruction and analyse related intervention measures. Methods A total of 216 cases of patients who underwent anterior cruciate ligament reconstruction at the Second Affiliated Hospital of Wenzhou Medical University from May 2019 to October 2021 were selected as subjects of the study. The patients were investigated with tampa scale for kinesiophobia (TSK), general self-efficacy scale (GSES) and numeric rating scale (NRS). Multivariate logistic regression analysis was used to analyse the risk factors of exercise fear in patients after anterior cruciate ligament reconstruction. Results Among the 216 patients who underwent reconstruction of anterior cruciate ligament injury, 72 developed fear of movement (33.33%). The TSK score of the non-kinaesthetic group was lower than that of the kinaesthetic group [(24.32±3.18) points vs.(45.27±4.51) points, t=39.495, P < 0.001]. The results of multivariate analysis showed that junior high school education and below, unemployed, family monthly income < 3 000 yuan, number of injuries ≥ 3 times, weakened muscle strength of injured knee and thigh, insomnia, GSES score < 25 points and moderate/severe postoperative pain were risk factors for the fear of exercise after anterior cruciate ligament reconstruction (all P < 0.05). Conclusion Patients who underwent anterior cruciate ligament reconstruction are affected by various factors, such as educational level and weakened muscle strength of the injured knee and thigh and pain, and are prone to exercise fear. Targeted intervention measures should be implemented to eliminate the patients ' fear of exercise, improve their exercise enthusiasm and accelerate their exercise and recovery process.
- Anterior cruciate ligament reconstruction /
- Fear of exercise /
- Risk factors /
- Intervention measures /
- Rehabilitation process

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表 1 前交叉韧带重建术后患者运动恐惧心理的危险因素单因素分析

Table 1. Univariate analysis of risk factors for fear of movement in patients after ACL reconstruction

项目	运动恐惧组(n=72)	非运动恐惧组(n=144)	统计量	P值
性别[例(%)]
男性	35(48.61)	68(47.22)	0.037^a	0.847
女性	37(51.39)	76(52.78)
GSES评分(x±s，分)	21.35±1.62	29.64±3.58	18.698^b	＜0.001
年龄[例(%)]
< 40岁	36(50.00)	78(54.17)	0.772^c	0.649
40~59岁	22(30.56)	45(31.25)
≥60岁	14(19.44)	21(14.58)
文化程度[例(%)]
初中及以下	64(88.89)	28(19.44)	94.671^a	＜0.001
高中及以上	8(11.11)	116(80.56)
职业状态[例(%)]
在职	6(8.33)	61(42.36)	27.348^a	＜0.001
非在职	66(91.67)	83(57.64)
家庭月收入[例(%)]
< 3 000元	29(40.28)	32(22.22)	7.721^a	0.006
≥3 000元	43(59.72)	112(77.78)
受伤次数[例(%)]
< 3次	54(75.00)	128(88.89)	6.981^a	0.008
≥3次	18(25.00)	16(11.11)
伤膝大腿肌肉力量[例(%)]
和健侧相同	48(66.67)	125(86.81)	12.210^a	0.001
弱于健侧	24(33.33)	19(13.19)
失眠[例(%)]
是	49(68.06)	52(36.11)	19.675^a	＜0.001
否	23(31.94)	92(63.89)
术后疼痛程度[例(%)]
无痛感	0	0	8.684^c	＜0.001
轻度疼痛	45(62.50)	113(78.47)
中度疼痛	21(29.17)	26(18.06)
重度疼痛	6(8.33)	5(3.47)
注: ^a为χ²值, ^b为t值, ^c为Z值。

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表 2 前交叉韧带重建术后患者运动恐惧心理的危险因素多因素logistic分析

Table 2. Multivariate logistic analysis of risk factors for fear of movement in patients after ACL reconstruction

变量	B	SE	Wald χ²	P值	OR(95% CI)
文化程度(初中及以下)	0.888	0.301	8.713	0.003	2.431(1.348~4.384)
职业状态(非在职)	1.273	0.308	17.116	＜0.001	3.571(1.954~6.528)
家庭月收入 < 3 000元	0.859	0.313	7.533	0.006	2.360(1.278~4.359)
受伤次数≥3次	0.981	0.380	6.663	0.010	2.667(1.266~5.616)
伤膝大腿肌肉力量减弱	1.191	0.351	11.515	0.001	3.289(1.654~6.544)
失眠	1.327	0.307	18.732	＜0.001	3.769(2.067~6.874)
GSES评分 < 25分	0.684	0.300	4.092	0.043	1.836(1.019~3.309)
术后中度/重度疼痛	0.783	0.317	6.102	0.014	2.187(1.175~4.069)

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