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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参考文献(20)

[1]	刘爽, 张利泰, 葛磊, 等. 前交叉韧带重建术后重返运动恐惧因素的临床研究[J]. 中国疗养医学, 2021, 30(10): 1083-1087. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLX202110026.htm LIU S, ZHANG L T, GE L, et al. Chinese Journal of Convalescent Medicine[J]. Chinese Journal of Convalescent Medicine, 2021, 30(10): 1083-1087. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLX202110026.htm
[2]	李宗阳, 简磊, 来佳辉, 等. Dynesys与Wallis系统治疗单节段腰椎间盘突出症的长期疗效及安全性[J]. 中华实用诊断与治疗杂志, 2020, 34(3): 268-273. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD202003015.htm LI Z Y, JIAN L, LAI J H, et al. Long-term efficacy and safety of Wallis versus Dynesys dynamic stabilization system for single-segment lumbar disc herniation[J]. Journal of Chinese Practical Diagnosis and Therapy, 2020, 34(3): 268-273. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD202003015.htm
[3]	REINKING S, SEEHUSEN C N, WALKER G A, et al. Transitory kinesiophobia after sport-related concussion and its correlation with reaction time[J]. J Sci Med Sport, 2022, 25(1): 20-24. doi: 10.1016/j.jsams.2021.07.010
[4]	王凌燕, 张春梅, 王宋超, 等. 浙江省腰椎微创术患者运动恐惧心理及影响因素分析[J]. 医学与社会, 2018, 31(8): 78-79, 89. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSH201808026.htm WANG L Y, ZHANG C M, WANG S C, et al. Kinesiophobia and Influencing Factors of Patients with Minimally Invasive Lumbar Surgery in Zhejiang Province[J]. Medicine and Society, 2018, 31(8): 78-79, 89. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSH201808026.htm
[5]	朱旭, 张林, 赵增同, 等. 中国患者全膝关节置换术后运动障碍的发生率及相关危险因素分析[J]. 中华骨与关节外科杂志, 2021, 14(2): 116-120. doi: 10.3969/j.issn.2095-9958.2021.02.08 ZHU X, ZHANG L, ZHAO Z T, et al. Incidence and risk factors of dyskinesia after total knee arthroplasty in Chinese patients[J]. Chinese Journal Bone and Joint Surgery\|Chin J Bone Joint Surg, 2021, 14(2): 116-120. doi: 10.3969/j.issn.2095-9958.2021.02.08
[6]	闫丹丹, 赵东旭. 早期康复训练结合Orem自理模式对交叉韧带损伤患者的影响研究[J]. 长春中医药大学学报, 2019, 35(3): 541-545. YAN D D, ZHAO D X. Effect of Early Rehabilitation Training Combined with Orem Self-care Model on Patients with Cruciate Ligament Injury[J]. Journal of Changchun University of Chinese Medicine, 2019, 35(3): 541-545.
[7]	KIM H K, KIM M E. Disturbed sleep may be a core risk factor for jaw functional limitation in patients with painful temporomandibular disorders[J]. J Oral Rehabil, 2021, 48(9): 1013-1024. doi: 10.1111/joor.13217
[8]	汤义民, 陶钧, 董斌, 等. 关节镜下前交叉韧带重建术的手术时机对患者膝关节功能恢复的影响[J]. 现代生物医学进展, 2019, 19(4): 755-758, 788. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX201904034.htm TANG Y M, TAO J, DONG B, et al. Effect of Operation Time on Knee Joint Function Recovery in Patient Undergone Arthroscopic Anterior Cruciate Ligament Reconstruction[J]. Progress in Modern Biomedicine, 2019, 19(4): 755-758, 788. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX201904034.htm
[9]	EUNSHINAE C, 徐才祺, 蒋佳, 等. 心理因素与前交叉韧带重建术后康复[J]. 国际骨科学杂志, 2019, 40(6): 343-347. https://www.cnki.com.cn/Article/CJFDTOTAL-GWGK201906006.htm EUNSHINAE C, XU C Q, JIANG J, et al. Psychological factors and rehabilitation after anterior cruciate ligament reconstruction[J]. International Journal of Orthopaedics, 2019, 40(6): 343-347. https://www.cnki.com.cn/Article/CJFDTOTAL-GWGK201906006.htm
[10]	杨雪, 周云, 丁呈彪, 等. 跑台运动结合认知训练对膝关节韧带损伤患者膝关节功能和恐动心理的影响[J]. 中国伤残医学, 2020, 28(10): 13-16. YANG X, ZHOU Y, DING C B, et al. Effects of treadmill training combined with cognitive therapy on knee joint function and psychology of fear movement in patients with knee ligament injury[J]. Chinese Journal of Trauma and Disability Medicine, 2020, 28(10): 13-16.
[11]	蔡立柏, 刘延锦, 崔妙然, 等. 全膝关节置换术恐动症患者术后早期功能锻炼体验的质性研究[J]. 中华护理杂志, 2019, 54(11): 1663-1668. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201911016.htm CAI L B, LIU Y J, CUI M R, et al. Early rehabilitation exercise in total knee arthroplasty patients with kinesiophobia: a qualitative study[J]. Chinese Journal of Nursing, 2019, 54(11): 1663-1668. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201911016.htm
[12]	安玉兰, 孙晴, 郭鑫, 等. 胸腰椎骨折术后患者恐动症成因的调查及影响因素分析[J]. 中国卫生统计, 2021, 38(4): 581-584. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT202104027.htm AN Y L, SUN Q, GUO X, et al. Investigation on the causes and influencing factors of dyskinesia in patients with postoperative thoracolumbar fractures[J]. Chinese Journal of Health Statistics, 2021, 38(4): 581-584. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT202104027.htm
[13]	伍磊, 冉华国. 术后悬吊运动训练在膝关节置换术后伴恐动症患者康复治疗中的应用效果[J]. 反射疗法与康复医学, 2021, 2(2): 159-161. WU L, RAN H G. Application Effect of Postoperative Suspension Exercise Training in Rehabilitation Treatment of Patients with Panic Disorder after Knee Arthroplasty[J]. Reflexology And Rehabilitation Medicine, 2021, 2(2): 159-161.
[14]	郭玉茹, 刘延锦, 徐慧萍, 等. 功能锻炼决策辅助对单侧全膝关节置换恐动症患者的影响[J]. 护理学杂志, 2021, 36(8): 73-76. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202108024.htm GUO Y R, LIU Y J, XU H P, et al. Effect of functional exercise decision aids on patients with kinesiophobia after unilateral total knee arthroplasty[J]. Journal of Nursing Science, 2021, 36(8): 73-76. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202108024.htm
[15]	宋莹莹, 张岚, 刘秀梅, 等. 多学科协作干预对腰椎术后恐动症患者康复结局的影响[J]. 护理学杂志, 2019, 34(9): 76-79. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201909027.htm SONG Y Y, ZHANG L, LIU X M, et al. Effect of multidisciplinary cooperative intervention on the rehabilitation outcome of lumbar surgery patients with kinesiophobia[J]. Journal of Nursing Scien, 2019, 34(9): 76-79. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201909027.htm
[16]	SERTEL M, ARSLAN S A, DEMIRCI C S, et al. Investigation of the relationship between physical activity, kinesiophobia and fear of falling in older adults with chronic pain[J]. Somatosen Mot Res, 2021, 38(3): 241-247.
[17]	王敏, 王霞, 侯文秀. 腰椎间盘突出症患者术后恐动症现状及影响因素分析[J]. 齐鲁护理杂志, 2020, 26(10): 15-17. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL202010005.htm WANG M, WANG X, HOU W X. Analysis of the Status and Influencing Factors of Postoperative Motility Phobia in Patients with Lumbar Disc Herniation[J]. Journal of Qilu Nursing, 2020, 26(10): 15-17. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL202010005.htm
[18]	王萍丽, 刘彩彦, 付文丽, 等. 腰椎间盘突出症患者微创手术治疗后并发恐动症的相关因素筛选及护理对策分析[J]. 山西医药杂志, 2020, 49(20): 2738-2740. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY202020007.htm WANG P L, LIU C Y, FU W L, et al. Screening of related factors of kinesiophobia in patients with lumbar disc herniation after minimally invasive surgery and analysis of nursing countermeasures[J]. Shanxi Medical Journal, 2020, 49(20): 2738-2740. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY202020007.htm
[19]	李光宝, 尹建文, 张轶群, 等. 侧后路椎间孔镜技术对腰椎间盘突出症患者手术优化与术后恢复效果的观察[J]. 河北医学, 2020, 26(6): 1036-1039. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX202006035.htm LI G B, YIN J W, ZHANG Y Q, et al. Surgery Optimization and Postoperative Recovery of Lumbar Disc Herniation After Posterolateral Percutaneous Transforaminal Endoscopic Discectomy[J]. Hebei Medicine, 2020, 26(6): 1036-1039. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX202006035.htm
[20]	孙玉娟, 常晶晶, 康晓荣. 协同护理配合健康指导对老年绝经期女性骨质疏松症患者应对方式、自我效能的影响[J]. 齐鲁护理杂志, 2021, 27(3): 103-105. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL202103038.htm SUN Y J, CHANG J J, KANG X R. Effects of collaborative nursing and health guidance on coping style and self-efficacy in elderly postmenopausal women with osteoporosis[J]. Journal of Qilu Nursing, 2021, 27(3): 103-105. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL202103038.htm