焦虑和灾难性疼痛意念对桡骨远端骨折术后早期恢复的影响。
Effect of anxiety and catastrophic pain ideation on early recovery after surgery for distal radius fractures.
作者信息
Roh Young Hak, Lee Beom Koo, Noh Jung Ho, Oh Joo Han, Gong Hyun Sik, Baek Goo Hyun
机构信息
Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
出版信息
J Hand Surg Am. 2014 Nov;39(11):2258-64.e2. doi: 10.1016/j.jhsa.2014.08.007. Epub 2014 Oct 3.
PURPOSE
To evaluate the effects of preoperative anxiety and catastrophic pain ideation on perceived disability and objective measures after distal radius fracture surgery.
METHODS
A total of 121 patients with distal radius fractures treated with volar plate fixation were enrolled. The wrist range of motion (ROM), grip strength, and perceived disability as measured by the Michigan Hand Questionnaire (MHQ) score were assessed 4, 12, and 24 weeks after surgery. To evaluate psychological factors related to pain, catastrophic pain ideation was measured using the Pain Catastrophizing Scale (PCS) and pain anxiety was measured using the Pain Anxiety Symptom Scale (PASS). Then relative contributions of pain anxiety and catastrophic pain ideation and other clinical parameters to functional recovery in terms of grip strength, ROM, and MHQ score were assessed.
RESULTS
An increase in the PCS score was associated with the wrist ROM and grip strength only at week 4, whereas an increase in the PASS score was associated with the wrist ROM at week 4 and grip strength at weeks 4 and 12. According to a multivariate regression analysis, an increase in the PCS score was associated with a decrease in grip strength, ROM, and MHQ score at week 4; and an increase in the PASS score was associated with a decrease in grip strength, ROM, and MHQ score at week 4 and grip strength and MHQ score at week 12. At week 24, only age and fracture severity were associated with the MHQ score. In addition, age was associated with grip strength and fracture type was associated with ROM.
CONCLUSIONS
Preoperative PCS and PASS were significantly associated with delayed recovery as evidenced by scores on both objective and subjective measures of function. Given these relationships, it becomes important to assess preoperative PCS and PASS and address issues for patients at risk with brief psychosocial intervention early in the recovery process.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
目的
评估桡骨远端骨折手术后术前焦虑和灾难性疼痛意念对感知残疾及客观指标的影响。
方法
共纳入121例行掌侧钢板固定治疗的桡骨远端骨折患者。在术后4周、12周和24周评估腕关节活动范围（ROM）、握力以及用密歇根手功能问卷（MHQ）评分衡量的感知残疾情况。为评估与疼痛相关的心理因素，采用疼痛灾难化量表（PCS）测量灾难性疼痛意念，采用疼痛焦虑症状量表（PASS）测量疼痛焦虑。然后评估疼痛焦虑、灾难性疼痛意念及其他临床参数对握力、ROM和MHQ评分方面功能恢复的相对贡献。
结果
仅在第4周时，PCS评分增加与腕关节ROM和握力相关，而PASS评分增加在第4周与腕关节ROM相关，在第4周和第12周与握力相关。根据多变量回归分析，PCS评分增加在第4周与握力、ROM和MHQ评分降低相关；PASS评分增加在第4周与握力、ROM和MHQ评分降低相关，在第12周与握力和MHQ评分降低相关。在第24周，仅年龄和骨折严重程度与MHQ评分相关。此外，年龄与握力相关，骨折类型与ROM相关。
结论
术前PCS和PASS与功能客观和主观测量评分所证明的恢复延迟显著相关。鉴于这些关系，在恢复过程早期评估术前PCS和PASS并通过简短的心理社会干预解决有风险患者的问题变得很重要。
研究类型/证据水平：预后性II级。
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