全膝关节置换患者关节遗忘变化轨迹及影响因素研究

doi:10.3761/j.issn.0254-1769.2024.09.009

摘要/Abstract

摘要：

目的探究全膝关节置换患者关节遗忘的变化轨迹及其影响因素。方法采用便利抽样法，选取2021年7月—2022年3月在山东省青岛市某三级甲等医院关节外科住院的280例全膝关节置换患者作为调查对象。在术前（T0）调查患者的一般资料、骨关节炎严重程度、焦虑抑郁、自我效能感，在术后1个月（T1）、术后3个月（T2）及术后6个月（T3）分别调查关节遗忘度。采用潜变量增长模型探究关节遗忘的变化轨迹、潜类别增长模型识别变化轨迹是否存在异质性亚组，Logistic回归分析判断相关变量对关节遗忘变化轨迹的影响。结果 241例全膝关节置换患者全称参与3次调查。在T1~T3时间点，全膝关节置换患者的关节遗忘得分分别为（32.70±5.80）、（47.67±4.67）、（61.53±7.81）分，关节遗忘呈线性增长趋势（P<0.001）；关节遗忘变化轨迹分为快速增长组（61.83%）、缓慢增长组（38.17%）；年龄、BMI、是否合并其他慢性疾病、骨关节炎患病年限、骨关节炎严重程度、焦虑、抑郁、自我效能感影响关节遗忘的变化趋势（均P<0.05）。结论全膝关节置换患者关节遗忘随术后时间的延长呈现线性增长趋势，关节遗忘变化轨迹存在2个潜在亚组。医护人员可以根据全膝关节置换患者关节遗忘的影响因素制订相应干预措施，提高患者术后对人工关节的遗忘度。

关键词: 全膝关节置换, 关节遗忘, 变化轨迹, 影响因素分析, 纵向研究, 护理

Abstract:

Objective To explore the trajectory and influencing factors of joint awareness after total knee arthroplasty. Methods With the method for convenience sampling，patients who met the standards for total knee arthroplasty from July 2021 to March 2022 were selected. General information，severity of osteoarthritis，anxiety and depression，and self-efficacy were investigated before surgery（T0）. Joint awareness was investigated at 1 month （T1），3 months（T2），and 6 months（T3） after surgery，respectively. Latent growth curve model was used to describe the overall trend of joint awareness；latent class growth model was used to analyze latent subgroups；logistic regression analysis was used to determine the impact of related variables on the trajectory of joint awareness. Results The scores of joint awareness were（32.70±5.80），（47.67±4.67） and （61.53±7.81） respectively at T1 to T3，and joint awareness showed an increasing trend（P<0.001）. The trajectory of joint awareness was divided into 2 potential subgroups：the rapid growth group（61.83%） and the slow growth group（38.17%）. Age，BMI，other chronic diseases or not，years of osteoarthritis，severity of osteoarthritis，anxiety，depression，and self-efficacy affected the trend of joint awareness（all P<0.05）. Conclusion Joint awareness showed a linear growth trend with the postoperative time，and there were 2 potential subgroups in the trajectory. Medical workers could develop corresponding interventions based on the influencing factors to improve patients’ postoperative awareness of artificial joints.

Key words: Total Knee Arthroplasty, Joint Awareness, Trajectory, Root Cause Analysis, Longitudinal Study, Nursing Care

李琪, 苏晴晴, 张瑶瑶, 王田田, 吕静, 李亚可, 李海燕. 全膝关节置换患者关节遗忘变化轨迹及影响因素研究[J]. 中华护理杂志, 2024, 59(9): 1084-1090.

LI Qi, SU Qingqing, ZHANG Yaoyao, WANG Tiantian, LÜ Jing, LI Yake, LI Haiyan. A study on the trajectory and influencing factors of joint awareness in patients with total knee arthroplasty[J]. Chinese Journal of Nursing, 2024, 59(9): 1084-1090.

图/表 4

表1 全膝关节置换患者的一般资料及关节遗忘发展轨迹亚组的单因素分析

Table 1 Univariate analysis of the developmental trajectory subgroup of joint awareness in patients with total knee anthroplasty

表2 全膝关节置换患者关节遗忘的无条件潜变量增长模型参数估计表（n=241）

Table 2 Parameter estimation for unconditional LGCM of joint awareness in patients with total knee anthroplasty（n=241）

表3 全膝关节置换患者关节遗忘的潜类别增长模型拟合指数（n=241）

Table 3 Summary of LCGM fitting indices for joint awareness in patients with total knee anthroplasty（n=241）

表4 全膝关节置换患者关节遗忘变化轨迹的Logistic回归分析（n=241）

Table 4 Logistic regression analysis of the developmental trajectory subgroup of joint awareness（n=241）

参考文献 24

[1]	张文忠, 季红, 王宁, 等. 全膝关节置换术后患者康复治疗体验质性研究的Meta整合[J]. 中华护理杂志, 2023, 58(24):3028-3036. DOI
	Zhang WZ, Ji H, Wang N, et al. Rehabilitation experience of patients after total knee arthroplasty:a qualitative meta-syn-thesis[J]. Chin J Nurs, 2023, 58(24):3028-3036.
[2]	Christiansen MB, Thoma LM, Master H, et al. Feasibility and preliminary outcomes of a physical therapist-administered physical activity intervention after total knee replacement[J]. Arthritis Care Res, 2020, 72(5):661-668. DOI URL
[3]	Eymard F, Charles-Nelson A, Katsahian S, et al. “Forgotten knee”after total knee replacement:a pragmatic study from a single-centre cohort[J]. Joint Bone Spine, 2015, 82(3):177-181. DOI URL
[4]	Hiyama Y, Wada O, Nakakita S, et al. Joint awareness after total knee arthroplasty is affected by pain and quadriceps streng-th[J]. Orthop Traumatol-SuR, 2016, 102(4):435-439. DOI PMID
[5]	Jain D, Nguyen LL, Bendich I, et al. Higher patient expectations predict higher patient-reported outcomes,but not satisfaction,in total knee arthroplasty patients:a prospective multicenter study[J]. J Arthroplasty, 2017, 32(9):166-170. DOI URL
[6]	张辉, 李鸿, 李叶天, 等. 后交叉韧带保留型和后稳定型全膝关节假体置换后早期关节遗忘度的对比[J]. 中国组织工程研究, 2020, 24(30):4802-4806.
	Zhang H, Li H, Li YT, et al. Comparison of early joint amnesia degree after posterior cruciate-retaining and posterior stabilized total knee arthroplasty[J]. J Clin Rehabil Tis Eng Res, 2020, 24(30):4802-4806.
[7]	中华医学会骨科学分会关节外科学组. 骨关节炎诊疗指南(2018年版)[J]. 中华骨科杂志, 2018, 38(12):705-715.
	Osteoporosis Group of Chinese Orthopaedic Association. Chinese guideline for diagnosis and management of osteoarthritis(2018 edition)[J]. Chin J Orthop, 2018, 38(12):705-715.
[8]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[9]	刘晓宇, 陆海英, 单亚维, 等. 全膝关节置换患者术前心理弹性现状及其影响因素分析[J]. 中华护理杂志, 2022, 57(17):2102-2108. DOI
	Liu XY, Lu HY, Shan YW, et al. The status and influencing factors associated with psychological resilience in preoperative patients with total knee arthroplasty[J]. Chin J Nurs, 2022, 57(17):2102-2108. DOI
[10]	Xie F, Li SC, Goeree R, et al. Validation of Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients scheduled for total knee replacement[J]. Qual Life Res, 2008, 17(4):595-601. DOI PMID
[11]	Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale[J]. Acta Psychiatr Scand, 1983, 67(6):361 DOI URL
[12]	叶维菲, 徐俊冕. 100例住院心脏病病人的焦虑抑郁调查[J]. 上海精神医学, 1993, 5(4):253-255,248.
	Ye WF, Xu JM. Anxiety and depression survey of 100 inpatients with heart disease[J]. Shanghai Arch Psychiatry, 1993, 5(4):253-255,248.
[13]	Lorig KR, Sobel DS, Ritter PL, et al. Effect of a self-management program on patients with chronic disease[J]. Eff Clin Pract, 2001, 4(6):256-262. PMID
[14]	傅东波, 傅华, Patrick McGowan, 等. 上海慢性病自我管理项目实施效果的评价[J]. 中国公共卫生, 2003(2):99-101.
	Fu DB, Fu H, Patrick M, et al. Evaluation on Shanghai chronic disease self-management program[J]. Chin J Publ Heal, 2003(2):99-101.
[15]	Behrend H, Giesinger K, Giesinger JM, et al. The“fogotten joint”as the ultimate goal in joint arthroplasty:validation of a new patient-reported outcome measure[J]. J Arthroplasty, 2012, 27(3):430-436. DOI PMID
[16]	Cao S, Liu N, Han W, et al. Simplified Chinese version of the Forgotten Joint Score(FJS) for patients who underwent joint arthroplasty:cross-cultural adaptation and validation[J]. J Orthop Surg Res, 2017, 12(1):6. DOI URL
[17]	Bade MJ, Struessel T, Dayton M, et al. Early high-intensity ver-sus low-intensity rehabilitation after total knee arthroplasty:a randomized controlled trial[J]. Arthritis Care Res, 2017, 69(9):1360-1368. DOI URL
[18]	罗海萍, 田梅梅. 全膝关节置换术后病人慢性疼痛的影响因素分析及预测模型构建[J]. 护理研究, 2022, 36(7):1281-1286.
	Luo HP, Tian MM. Factors analysis and prediction model construction of chronic pain patients after total knee arthroplasty[J]. Chin Nurs Res, 2022, 36(7):1281-1286.
[19]	李琳, 林坚, 刘晓林, 等. 髋膝踝关节周围肌群肌力训练对老年全膝关节置换术后患者下肢运动功能的影响[J]. 中国康复医学杂志, 2018, 33(4):436-440.
	Li L, Lin J, Liu XL, et al. Effect of progressive resistant training of muscles around the hip,knee and ankle on functional performance after unilateral total knee arthroplasty[J]. Chin J Rehabil Med, 2018, 33(4):436-440.
[20]	郦杭婷, 沈娇妮, 万昕瑞, 等. 髋膝关节置换术患者康复自我效能感在正念与恐动症间的中介效应研究[J]. 中华护理杂志, 2022, 57(10):1177-1183. DOI
	Li HT, Shen JN, Wan XR, et al. The mediating effect of rehabilitation self-efficacy between mindfulness and kinesiophobia in patients undergoing hip or knee arthroplasty[J]. Chin J Nurs, 2022, 57(10):1177-1183. DOI
[21]	Butnaru M, Sigonney G, Müller JH, et al. Wiberg type Ⅲ patellae and J-sign during extension compromise outcomes of total knee arthroplasty without patellar resurfacing[J]. Knee, 2020, 27(3):787-794. DOI URL
[22]	吴乾, 王宏志, 陈张欢, 等. 体质指数过低对全膝关节置换术后疗效的影响[J]. 中国矫形外科杂志, 2021, 29(8):679-683.
	Wu Q, Wang HZ, Chen ZH, et al. Impact of low body mass index on the clinical outcomes of total knee arthroplasty[J]. Orth J Chin, 2021, 29(8):679-683.
[23]	Dunbar MJ, Richardson G. I can’t get no satisfaction after my total knee replacement rhymes and reasons[J]. Bone Joint J, 2013,95-B(Supple A):148.
[24]	Behrend H, Graulich T, Gerlach R, et al. Blackburne-peel ratio predicts patients’ outcomes after total knee arthroplasty[J]. Knee Surg Sports Tr A, 2019, 27(5):1562-1569.