认知行为干预降低全膝关节置换后恐动症

摘要

背景:全膝关节置换后早期康复功能锻炼有助于膝关节的快速康复,而恐动症的存在使患者对运动锻炼产生恐惧和逃避心理,继而影响到膝关节功能的恢复.国外研究证实,认知行为干预能够有效降低患者的恐动程度,目前国内尚无相关研究.目的:探讨认知行为对全膝关节置换后恐动症的干预效果.方法:选择郑州大学第一附属医院骨科2014年3月至2015年1月收治的108例全膝关节置换后恐动症患者作为研究对象,采用随机数字表法分为2组,试验组和对照组各54例.2组患者均接受骨科术后常规的干预及随访,试验组在常规干预的基础上进行认知行为干预.分别于出院日及出院后1,3,6个月评价2组患者的恐动情况及膝关节功能恢复情况,并于出院日比较2组患者的住院时间及总住院费用.结果与结论:①试验组患者的恐动症坦帕评分在术后各个时间点上均低于对照组(P＜0.05);出院日及出院后1个月2组患者的美国膝关节协会评分差异无显著性意义(P＞0.05),出院后3,6个月时,试验组患者美国膝关节协会评分高于对照组(P＜0.01),且呈持续增强的趋势;②2组患者的住院时间及总住院费用比较,试验组均低于对照组(P＜0.01);③结果表明,认知行为干预能够有效降低全膝关节置换后恐动症患者的恐动程度,缩短住院时间,减少住院相关费用,加快膝关节功能的恢复.%BACKGROUND:Early rehabilitation after total knee arthroplasty (TKA) can help the rapid functional recovery of knee,but some patients are fear of moving and refuse to do exercising because of kinesiophobia,thereby delaying functional recovery.Foreign study has confirmed that patients with cognitive behavioral therapy (CBT) can effectively alleviate kinesiophobia,but no related studies have been reported in China.OBJECTIVE:To explore the effectiveness of CBT on patients with kinesiophobia after TKA.METHODS:108 patients with kinesiophobia after TKA were recruited from Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University,China between March 2014 and January 2015,and were then equivalently randomized into experimental and control groups using random number table.Both groups were subjected to conventional treatment,while the experimental group received extra CBT.The scores of Tampa Scale of Kinesiophobia and American Knee Society were evaluated immediately,1,3,and 6 months after hospital discharge;the hospitalization time and total hospitalization expenditure were compared between two groups immediately after discharge.RESULTS AND CONCLUSION:The scores of Tampa Scale of Kinesiophobia in the experimental group were significantly lower than those in the control group at different time points postoperatively (P ＜ 0.05).The scores of American Knee Society in the experimental group were significantly higher than those in the control group at 3 and 6 months after discharge and kept on rising (P ＜ 0.01),but showed no significant difference at discharge and 1 month after discharge (P ＞ 0.05).(2) The hospitalization time and total hospitalization expenditure in the experimental group were significantly lower than those in the control group (P ＜ 0.01).(3) To conclude,CBT cannot only shorten the hospitalization time and total hospitalization expenditure,but also relieve kinesiophobia,which is conductive for functional recovery of the knee.