Hossain Munier, Parfitt Daniel J, Beard David J, Darrah Clare, Nolan John, Murray David W, Andrew John G
Department of Trauma and Orthopaedics, Ysbyty Gwynedd, Bangor, UK.
Hip Int. 2011 Jul-Aug;21(4):421-7. doi: 10.5301/HIP.2011.8561.
Preoperative psychological distress has been reported to predict poor outcome and patient dissatisfaction after total hip arthroplasty (THA). The purpose of this study was to investigate if pre-operative psychological distress was associated with adverse functional outcome after primary THR. We analysed the database of a prospective multi-centre study undertaken between January 1999 and January 2002. We recorded the Oxford Hip Score (OHS) and SF36 score preoperatively and up to five years after surgery for 1055 patients. We dichotomised the patients into the mentally distressed (Mental Health Scale score - MHS =56) and the not mentally distressed (MHS >56) groups based on their pre-operative MHS of the SF36. 762 (72.22%). Patients (595 not distressed and 167 distressed) were followed up at 5 years. Both pre and post-operative OHS and SF-36 scores were significantly worse in the distressed group (both p<0.001). However, both groups experienced statistically significant improvement in OHS and MHS, which was maximal at 1 year after surgery and was maintained over the follow up (p=0.00). There was a substantial improvement in mental distress in patients who reported mental distress prior to surgery. The results suggest that pre-operative psychological distress did not adversely compromise functional outcome gain after THA. Despite having worse absolute values both pre and post operatively, patients with mental distress did not have any less functional gain from THA as measured by improvement in OHS.
据报道，术前心理困扰可预测全髋关节置换术（THA）后预后不良及患者满意度低。本研究的目的是调查术前心理困扰是否与初次全髋关节置换术（THR）后不良功能预后相关。我们分析了1999年1月至2002年1月间进行的一项前瞻性多中心研究的数据库。我们记录了1055例患者术前及术后长达五年的牛津髋关节评分（OHS）和SF36评分。根据患者术前SF36的心理健康量表评分（MHS），将患者分为心理困扰组（心理健康量表评分 - MHS =56）和非心理困扰组（MHS>56）。762例（72.22%）患者（595例无困扰和167例有困扰）在5年时接受了随访。有困扰组术前和术后的OHS及SF - 36评分均显著更差（均p<0.001）。然而，两组的OHS和MHS在统计学上均有显著改善，在术后1年时改善最大，并在随访期间保持（p =0.00）。术前报告有心理困扰的患者心理困扰有显著改善。结果表明，术前心理困扰并未对THA后的功能预后改善产生不利影响。尽管术前和术后的绝对值均较差，但通过OHS改善衡量，有心理困扰的患者从THA中获得的功能改善并不少。
