老年髋部骨折术后恐动症发生的影响因素分析及预测模型构建

施翠; 熊飞; 芮碧宇

doi:10.16766/j.cnki.issn.1674-4152.004206

老年髋部骨折术后恐动症发生的影响因素分析及预测模型构建

doi: 10.16766/j.cnki.issn.1674-4152.004206

施翠¹,
熊飞^1, ,,
芮碧宇²

1.
上海市第六人民医院护理部，上海 200233
2.
上海市第六人民医院骨科，上海 200233

基金项目:

上海市卫生健康委员会科研项目 202240142

上海市第六人民医院院级课题 hlyjkt-2023-30

详细信息

通讯作者:
熊飞，E-mail：18930177671@163.com

中图分类号: R683.3
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出版历程
- 收稿日期: 2025-03-11

The influencing factors and prediction model construction of postoperative kinesiophobia in elderly patients with hip fractures

SHI Cui¹,
XIONG Fei^{1
, ,},
RUI Biyu²

1.
Department of Nursing, Shanghai Sixth People ' s Hospital, Shanghai 200233, China

摘要

摘要: 目的分析老年髋部骨折术后恐动症发生的影响因素并构建预测模型，为术后恐动症的发生进行临床干预提供理论依据。方法采用前瞻性研究的方法，便利选取2023年11月—2024年7月于上海市第六人民医院接受手术治疗的223例老年髋部骨折患者为研究对象，评测患者术后2天恐动症发生情况，并将其分为恐动症组与非恐动症组，分析老年髋部骨折患者术后恐动症发生的影响因素，基于得到的影响因素构建预测模型。结果共回收有效问卷219份，其中66例发生恐动症，发生率为30.14%。单因素及多因素分析结果显示，主要照护者(P=0.008)、麻醉药物不良反应(P=0.003)、运动自我效能感(P=0.010)、社会支持高水平(P=0.027)和疼痛情况(P=0.026)均为老年髋部骨折患者术后恐动症发生的影响因素(P＜0.05)。基于各项影响因素，构建列线图预测模型并绘制校准曲线、决策曲线，结果显示预测模型对术后恐动症有较好的预测效能。结论老年髋部骨折患者术后恐动症发生与主要照顾者照护、发生麻醉药物不良反应、运动自我效能感低下、社会支持低下和疼痛灾难化有关，据此构建的预测模型有较好的预测效能。
- 髋部骨折 /
- 老年患者 /
- 手术 /
- 恐动症 /
- 影响因素 /
- 预测模型
Abstract: Objective To analyze the influencing factors of kinesiophobia after hip fracture surgery in the elderly and construct a predictive model, providing a theoretical basis for clinical intervention of postoperative kinesiophobia. Methods A prospective study was conducted to select 223 elderly patients with hip fractures who underwent surgical treatment at Shanghai Sixth People ' s Hospital from November 2023 to July 2024 as the research subjects. The occurrence of kinesiophobia was evaluated within 2 days after the operation, and patients were divided into the kinesiophobia group and the non-kinesiophobia group. The influencing factors of postoperative phobias in elderly hip fracture patients were analyzed. Based on the obtained influencing factors, a prediction model was constructed. Results A total of 219 valid questionnaires were retrieved. Out of 219 patients, 66 developed phobias, with an incidence rate of 30.14%. The results of single factor and multi-factor analysis showed that the primary caregiver (P=0.008), adverse drug reactions to anesthesia (P=0.003), exercise self-efficacy (P=0.010), social high support level (P=0.027), and pain situation (P=0.026) were all influencing factors for postoperative kinesiophobia in elderly hip fracture patients (P < 0.05). Based on various influencing factors, a nomogram prediction model was constructed, and calibration curves and decision curves were plotted. The results showed that the prediction model has good predictive performance for postoperative anxiety in elderly patients with hip fractures. Conclusion The occurrence of postoperative fear of movement in elderly patients with hip fractures is related to the care of the primary caregiver, adverse drug reactions to anesthesia, low exercise self-efficacy, low social support, and catastrophic pain. The predictive model constructed based on this has good predictive performance.
- Hip fracture /
- Elderly patients /
- Operation /
- Kinesiophobia disorder /
- Influencing factors /
- Prediction model
利益冲突 无

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图 1 Lambda与模型误差

Figure 1. Lambda and model error

下载: 全尺寸图片幻灯片

图 2 Lambda与患者术后恐动症影响因素的解决路径

Figure 2. Lambda and the path of influencing factors on postoperative kinesiophobia

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图 3 预测模型的列线图

Figure 3. Nomogram of the predictive model

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图 4 预测模型的校准曲线

Figure 4. Calibration curve of the predictive model

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图 5 预测模型的决策曲线

Figure 5. Decision curve of the predictive model

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表 1 恐动症组与非恐动症组老年髋部骨折患者各指标比较

Table 1. Comparison of various indicators between the phobic group and the non-phobic group

项目	恐动症组(n=66)	非恐动症组(n=153)	统计量	P值
年龄(x ±s，岁)	73.79±5.18	73.99±4.96	0.278^a	0.781
性别[例(%)]			0.228^b	0.633
男性	14(21.21)	37(24.18)
女性	52(78.79)	116(75.82)
BMI(x ±s)	24.90±3.13	24.66±2.66	0.551^a	0.583
文化程度[例(%)]			2.474^b	0.013
初中及以下	58(87.88)	111(72.55)
高中及以上	8(12.12)	42(27.45)
宗教信仰[例(%)]			0.284^b	0.594
有	20(30.30)	52(33.99)
无	46(69.70)	101(66.01)
婚姻状况[例(%)]			4.988^b	0.129
未婚	0	1(0.65)
已婚	48(72.73)	122(79.74)
离异	7(10.61)	5(3.27)
丧偶	11(16.67)	25(16.34)
主要照护者[例(%)]			8.087^b	0.004
子女/配偶	40(60.61)	121(79.08)
护工	26(39.39)	32(20.92)
费用支付方式[例(%)]			1.318^b	0.548
医保/新农合	56(84.85)	133(86.93)
自费	7(10.61)	17(11.11)
其他	3(4.55)	3(1.96)
月收入[例(%)]			0.292^c	0.770
＜2 000元	22(33.33)	48(31.37)
2 000~4 999元	37(56.06)	88(57.52)
5 000~10 000元	6(9.09)	13(8.50)
10 000元以上	1(1.52)	4(2.61)
居住地[例(%)]			0.098^b	0.755
城市	21(31.82)	52(33.99)
农村	45(68.18)	101(66.01)
居住方式[例(%)]			0.680^b	0.898
独居	13(19.70)	26(16.99)
与家人同居	42(63.64)	102(66.67)
与亲戚朋友同居	4(6.06)	7(4.58)
其他	7(10.61)	18(11.76)
职业[例(%)]			0.622^b	0.733
在职	25(37.88)	60(39.22)
退休	20(30.30)	52(33.99)
无业	21(31.82)	41(26.80)
骨折类型[例(%)]			2.557^b	0.238
股骨颈骨折	44(66.67)	117(76.47)
股骨转子间骨折	21(31.82)	34(22.22)
股骨转子下骨折	1(1.52)	2(1.31)
手术类型[例(%)]			1.540^b	0.463
髋关节置换术	35(53.03)	68(44.44)
髓内钉内固定	15(22.73)	45(29.41)
人工股骨头置换术	16(24.24)	40(26.14)
术后麻醉药物不良反应[例(%)]			6.484^b	0.011
有	18(27.27)	20(13.07)
无	48(72.73)	133(86.93)
并存慢性病[例(%)]			3.302^b	0.069
是	31(46.97)	52(33.99)
否	35(53.03)	101(66.01)
运动自我效能感[例(%)]			2.808^c	0.005
低水平	32(48.48)	44(28.76)
较高水平	34(51.52)	109(71.24)
社会支持[例(%)]			3.049^c	0.002
低水平	21(31.82)	28(18.30)
中等水平	35(53.03)	74(48.37)
高水平	10(15.15)	51(33.33)
疼痛灾难化[例(%)]			7.351^b	0.007
阳性	28(42.42)	37(24.18)
阴性	38(57.58)	116(75.82)
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 各因素赋值情况

Table 2. Variable assignment

变量	赋值方法
文化程度	初中及以下=1，高中及以上=0
主要照护者	护工=1，子女/配偶=0
术后麻醉药物不良反应	有=1，无=0
运动自我效能感	低水平=1，较高水平=0
社会支持	低水平=1，中等水平=2，高水平=3
疼痛灾难化	阳性=1，阴性=0

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表 3 老年髋部骨折患者术后恐动症发生的影响因素分析

Table 3. Analysis of factors influencing postoperative hypokinesia in elderly patients with hip fractures

变量	单因素			多因素
变量	P值	OR值	95% CI	P值	OR值	95% CI
文化程度	0.016	2.743	1.208~6.229	0.546	1.443	0.438~4.750
主要照护者	0.005	2.458	1.310~4.610	0.008	2.593	1.288~5.221
术后麻醉药物不良反应	0.013	2.494	1.217~5.109	0.003	3.440	1.511~7.833
运动自我效能感	0.005	2.332	1.284~4.233	0.010	2.376	1.229~4.593
社会支持
中等水平	0.193	0.631	0.315~1.262	0.167	0.576	0.264~1.260
高水平	0.003	0.261	0.108~0.632	0.027	0.257	0.077~0.855
疼痛灾难化	0.007	2.310	1.252~4.262	0.026	2.173	1.099~4.299
注：社会支持以低水平为参照。

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