Children's Medical Center Sports Medicine, Children's Medical Center Legacy, 7609 Preston Road P3.07, Plano, TX 75024, USA.
J Bone Joint Surg Am. 2012 Jun 20;94(12):e84. doi: 10.2106/JBJS.K.00888.
Factors other than surgical technique and implants impact patient outcomes following a total knee arthroplasty. The purpose of this study was to analyze the effects of psychopathology on the rate of improvement following total knee arthroplasty in an indigent population.
One hundred and fifty-four consecutive indigent patients undergoing a primary total knee arthroplasty for arthritis were enrolled and available for follow-up. Patients were classified as having psychopathology on the basis of the presence of somatization, depression, and/or a panic or anxiety disorder as assessed with the Patient Health Questionnaire. Outcome measures were completed preoperatively and one year postoperatively. Univariate analyses, controlled for sex and age, were used to compare the rates of improvement in patients who exhibited psychopathology with the rates in those without psychopathology.
Fifty-four patients (35%) were diagnosed with at least one Axis-I psychological disorder. The psychopathology group showed significantly lower Short Form-36 mental component summary scores both at baseline and one year postoperatively (p < 0.001 for both). The psychopathology group also reported significantly higher levels of perceived disability at baseline on the Pain Disability Questionnaire (p < 0.001) and worse scores on the Western Ontario and McMaster Universities Osteoarthritis Index (p = 0.004); however, the improvement on both of these scales did not differ significantly between the two groups (p > 0.05). The Knee Society Score differed significantly between the two groups at both baseline and the one-year follow-up evaluation (p = 0.003 and p = 0.001, respectively), but there was no significant difference in the total rate of improvement between the two comparison groups (p > 0.05).
Not only is there a high prevalence of psychopathology in the indigent population, but psychopathology may result in lower patient-perceived outcome scores at one year after a total knee arthroplasty. Even though outcome scores may be worse for patients with psychopathology, our study showed that these patients still benefit, with the same degree of improvement in function.
除手术技术和植入物外，其他因素会影响全膝关节置换术后患者的结果。本研究的目的是分析贫困人群中精神病理学对全膝关节置换术后改善率的影响。
共纳入 154 例因关节炎接受初次全膝关节置换术的贫困患者，并进行了随访。根据躯体化、抑郁和/或惊恐或焦虑障碍的存在，使用患者健康问卷对患者进行精神病理学分类。在术前和术后 1 年完成了结果测量。采用单变量分析，控制性别和年龄，比较有精神病理学的患者与无精神病理学的患者的改善率。
54 例患者（35%）被诊断患有至少一种轴 I 类心理障碍。精神病理学组在基线和术后 1 年均表现出明显较低的简明健康状况调查问卷 36 项精神分量表评分（均为 p < 0.001）。精神病理学组在疼痛残疾问卷的基线期也报告了明显更高的感知残疾水平（p < 0.001）和较差的西部安大略省和麦克马斯特大学骨关节炎指数评分（p = 0.004）；然而，两组在这两个量表上的改善程度均无显著差异（p > 0.05）。两组在基线和 1 年随访评估时的膝关节学会评分均有显著差异（p = 0.003 和 p = 0.001），但两组间的总改善率无显著差异（p > 0.05）。
贫困人群中不仅存在较高的精神病理学患病率，而且精神病理学可能导致全膝关节置换术后 1 年时患者感知的结果评分降低。尽管精神病理学患者的结果评分可能更差，但我们的研究表明，这些患者仍能受益，功能改善程度相同。
