Crichlow Renn J, Andres Patricia L, Morrison Suzanne M, Haley Stephen M, Vrahas Mark S
Partners Orthopaedic Trauma Service, 305 West Fayette Street, Apartment 406, Baltimore, MD 21201, USA.
J Bone Joint Surg Am. 2006 Sep;88(9):1927-33. doi: 10.2106/JBJS.D.02604.
There is a known connection between physical injury and disability and emotional distress. Several investigators have shown a relationship between trauma, depression, and poor outcomes. The literature on trauma and depression is limited with regard to clarifying the relationship between the degree of injury and depression and the relationship between physical function of patients with less severe injuries and depression.
One hundred and sixty-one patients who presented to our orthopaedic trauma services were enrolled in the study and interviewed. We obtained information about patient demographics and administered several self-reported outcome measures: the Beck Depression Inventory (BDI), the Short Musculoskeletal Function Assessment (SMFA), and the Physical Function-10 (PF-10) subset of the Short Form-36 (SF-36). We documented the nature and severity of the injury or injuries and calculated correlations between the outcome measures and the BDI. Injury-specific factors such as the AO Fracture Classification, the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS), and the Gustilo and Anderson grade of open fractures were also examined.
Fifty-five percent of the patients had minimal depression, as measured with the BDI; 28% had moderate depression; 13% had moderate-to-severe depression; and 3.7% had severe depression. When the somatic elements of the BDI were removed, the prevalence of moderate, moderate-to-severe, or severe depression was 26%. The SMFA scores had a strong negative correlation with the BDI (-0.75; p < 0.001). Of the injury-specific factors, only open factures were found to have an impact on the presence of depression, with an odds ratio of 4.58 (95% confidence ratio, 1.57 to 12.35).
The prevalence of clinically relevant depression approached 45% in a diverse cohort of orthopaedic trauma patients. Global disability is strongly correlated with depression. The presence of an open fracture may also increase the risk of depression.
Prognostic Level II.
身体损伤、残疾与情绪困扰之间存在已知关联。多位研究者已表明创伤、抑郁与不良预后之间存在关联。关于创伤与抑郁的文献在阐明损伤程度与抑郁之间的关系以及伤势较轻患者的身体功能与抑郁之间的关系方面较为有限。
161名到我们骨科创伤科就诊的患者纳入本研究并接受访谈。我们获取了患者人口统计学信息，并进行了多项自我报告结局测量：贝克抑郁量表（BDI）、简短肌肉骨骼功能评估（SMFA）以及简短健康调查问卷（SF-36）中的身体功能10项（PF-10）子量表。我们记录了一处或多处损伤的性质和严重程度，并计算结局测量指标与BDI之间的相关性。还检查了特定损伤因素，如AO骨折分类、简明损伤定级（AIS）、损伤严重程度评分（ISS）以及开放性骨折的 Gustilo 和 Anderson 分级。
用BDI测量，55%的患者有轻度抑郁；28%有中度抑郁；13%有中度至重度抑郁；3.7%有重度抑郁。去除BDI中的躯体因素后，中度、中度至重度或重度抑郁的患病率为26%。SMFA评分与BDI呈强负相关（-0.75；p<0.001）。在特定损伤因素中，仅发现开放性骨折对抑郁的存在有影响，比值比为4.58（95%置信区间，1.57至12.35）。
在不同的骨科创伤患者队列中，临床相关抑郁的患病率接近45%。整体残疾与抑郁密切相关。开放性骨折的存在也可能增加抑郁风险。
预后II级。
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