Weinberg Douglas S, Narayanan Arvind S, Boden Kaeleen A, Breslin Mary A, Vallier Heather A
Department of Orthopaedic Surgery, University Hospitals, Case Medical Center, Case Western Reserve University, Cleveland, Ohio
School of Medicine, Case Western Reserve University, Cleveland, Ohio.
J Bone Joint Surg Am. 2016 Mar 2;98(5):341-8. doi: 10.2106/JBJS.15.00751.
Psychiatric disorders are common, and their functional consequences may be underappreciated by non-mental health-care providers. There exist limited data regarding the frequency of psychiatric illness in patients who sustain orthopaedic polytrauma. The purpose of this study was to describe the prevalence of psychiatric illness in patients with orthopaedic polytrauma, to determine whether psychiatric illnesses were identified and were accommodated by trauma providers, and, finally, to investigate any associations between postoperative complications and psychiatric illness.
Three hundred and thirty-two skeletally mature patients with surgically treated axial and/or femoral fractures and injuries to other body systems (Injury Severity Score of ≥ 16 points) were identified from a database at a Level-I trauma center. These included 238 men and ninety-four women with a mean value (and standard deviation) of 39 ± 16 years for age and 27 ± 12 points for the Injury Severity Score. Records were reviewed for preexisting diagnoses of psychiatric disorders. The inpatient courses and discharge recommendations regarding treatment of psychiatric illness were analyzed. Complications in the six-month postoperative period were determined by an independent committee.
Preexisting psychiatric disorders were identified in 130 patients (39.2%), including depression in seventy-four patients (22.3%) and substance abuse in fifty-six patients (16.9%). Patients managed by an orthopaedic surgery service were less likely to receive their home psychiatric medications while hospitalized (p = 0.001) and were less likely to receive instructions for psychiatric follow-up at discharge (p = 0.087). Postoperative complications occurred in sixty-six patients (19.9%) overall; depression was an independent predictor of increased complications, with an odds ratio of 2.956 (95% confidence interval, 1.502 to 5.816).
Psychiatric illness was common among individuals who sustained orthopaedic polytrauma, and patients with depression had more complications. This study highlights the need for greater attention to mental health disorders in this population.
精神疾病很常见，但其功能后果可能未得到非精神卫生保健提供者的充分重视。关于骨科多发伤患者精神疾病发生频率的数据有限。本研究的目的是描述骨科多发伤患者精神疾病的患病率，确定创伤提供者是否识别并处理了精神疾病，最后调查术后并发症与精神疾病之间的任何关联。
从一级创伤中心的数据库中识别出332例骨骼成熟的患者，这些患者接受了轴向和/或股骨骨折以及其他身体系统损伤的手术治疗（损伤严重程度评分≥16分）。其中包括238名男性和94名女性，年龄平均值（及标准差）为39±16岁，损伤严重程度评分为27±12分。审查记录以查找既往精神疾病诊断。分析了关于精神疾病治疗的住院病程和出院建议。术后六个月内的并发症由一个独立委员会确定。
130例患者（39.2%）被识别出患有既往精神疾病，其中74例患者（22.3%）患有抑郁症，56例患者（16.9%）存在药物滥用。接受骨科手术治疗的患者在住院期间不太可能服用其家庭精神科药物（p = 0.001），出院时接受精神科随访指导的可能性也较小（p = 0.087）。总体而言，66例患者（19.9%）发生了术后并发症；抑郁症是并发症增加的独立预测因素，比值比为2.956（95%置信区间，1.502至5.816）。
精神疾病在骨科多发伤患者中很常见，抑郁症患者并发症更多。本研究强调了对该人群心理健康障碍需要给予更多关注。
