骨质疏松椎体压缩性骨折患者术后自我管理方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2026.04.002

摘要/Abstract

摘要：

目的构建骨质疏松椎体压缩性骨折（osteoporotic vertebral compression fracture，OVCF）患者术后自我管理方案，并评价其应用效果，以期为医护人员开展标准化、结构化的患者教育与管理提供循证依据与实用工具，并提升术后康复质量。方法在文献回顾、半结构式访谈及小组讨论基础上，形成初稿，经2轮专家函询确定最终方案。采用便利抽样法，选取2024年7—8月浙江省湖州市某三级甲等医院脊柱外科的40例OVCF手术患者为试验组，在常规护理基础上通过微信平台实施为期3个月的OVCF患者术后自我管理方案；选取2024年3—4月的40例患者为对照组，仅接受常规护理。于入院时、出院后1个月、出院后3个月评估两组的自我管理行为、自我效能、知识水平，并追踪其出院后6个月内再骨折发生情况。结果共15名专家完成2轮函询，2轮问卷有效回收率分别为100%、93.3%；专家权威系数为0.91、0.88，肯德尔和谐系数分别为0.117、0.191（P<0.05）。试验组和对照组最终各纳入38例患者，试验组在出院后1个月、3个月的自我管理行为、自我效能及知识水平得分均高于对照组（P<0.05）；两组再骨折发生率比较，差异无统计学意义（P=0.493），但试验组再骨折率（0）低于对照组（5.26%）。结论该研究构建的OVCF患者术后自我管理方案具有科学性和实用性，能有效提升OVCF患者的自我管理行为、自我效能和知识水平。

关键词: 骨质疏松, 椎体压缩性骨折, 能力-机会-动机-行为模型, 自我管理, 护理

Abstract:

Objective To develop a self-management program for patients undergoing surgery for osteoporotic vertebral compression fractures（OVCF） and evaluate its effects，so as to provide evidence-based and practical tools for clinical nursing staff to carry out standardized and structured patient education and management，and to improve the quality of postoperative rehabilitation. Methods Based on literature review，semi-structured interviews，and group discussions，a preliminary program was drafted and revised through 2 rounds of Delphi expert consultation. A quasi-experimental design was adopted. A total of 40 OVCF surgical patients from July to August 2024 were selected as an intervention group and received a 3-month WeChat-based self-management intervention in addition to routine care. Another 40 patients from March to April 2024 were assigned to a control group and received routine care only. Self-management behavior，self-efficacy，and knowledge level were assessed at admission，1 month and 3 months after discharge. The incidence of refracture within 6 months after discharge was also tracked. Results A total of 15 experts completed 2 rounds of consultation，with response rates of 100% and 93.3%，respectively. The authority coefficients were 0.91 and 0.88，and Kendall’s W values were 0.117 and 0.191（P<0.05）. Finally，38 patients were included in each group. The intervention group showed significantly higher scores in self-management behavior，self-efficacy，and knowledge at 1 and 3 months after discharge compared to the control group（P<0.05）. Although there was no statistically significant difference in refracture rate between the 2 groups（P=0.493），the intervention group had a lower rate（0） than the control group（5.26%）. Conclusion The constructed self-management program for OVCF surgical patients is scientific and practical. It effectively improves patients’ self-management behavior，self-efficacy，and knowledge level.

Key words: Osteoporosis, Vertebral Compression Fracture, Capability, Opportunity, Motivation-Behavior Model, Self-Management, Nursing Care

杜姝姝, 曹亚琴, 闵继康, 冯悦, 吴琦, 蒋凤仙. 骨质疏松椎体压缩性骨折患者术后自我管理方案的构建及应用研究[J]. 中华护理杂志, 2026, 61(4): 442-451.

DU Shushu, CAO Yaqin, MIN Jikang, FENG Yue, WU Qi, JIANG Fengxian. Construction and application of a postoperative self-management program for patients with osteoporotic vertebral compression fractures[J]. Chinese Journal of Nursing, 2026, 61(4): 442-451.

图/表 5

表1 基于能力-机会-动机-行为模型的骨质疏松椎体压缩性骨折患者术后自我管理方案

Table 1 Self-management program for OVCF surgery patients based on the COM-B model

表2 两组一般资料的比较

Table 2 Baseline characteristics of 2 groups of patients

表3 两组自我管理行为水平的比较[分，M（P25，P75）]

Table 3 Comparison of self-management behavior levels between the 2 groups [scores，M（P25，P75）]

表4 两组自我效能的比较[分，M（P25，P75）]

Table 4 Comparison of self-efficacy between the 2 groups[scores，M（P25，P75）]

表5 两组知识水平的比较[分，M（P25，P75）]

Table 5 Comparison of knowledge levels between the 2 groups[scores，M（P25，P75）]

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