Cho Chul-Hyun, Song Kwang-Soon, Hwang Ilseon, Coats-Thomas Margaret S, Warner Jon J P
1Departments of Orthopedic Surgery (C.-H.C. and K.-S.S.) and Pathology (I.H.), Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea 2Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Bone Joint Surg Am. 2017 Jun 21;99(12):1030-1035. doi: 10.2106/JBJS.16.00954.
There has been little documentation of the effects of total shoulder arthroplasty (TSA) on psychological status and health-related quality of life (HRQoL). We investigated changes in psychological status (depression and anxiety) and HRQoL following TSA and assessed the effect of preoperative psychological status on postoperative clinical and functional outcome. We hypothesized that TSA would improve both psychological status and HRQoL.
We prospectively enrolled 46 patients undergoing TSA for osteoarthritis. Preoperatively and at 3, 6, and 12 months postoperatively, all of the subjects completed the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons Scale (ASES), the Subjective Shoulder Value (SSV) measure, the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF).
From 3 months after surgery, significant improvement in HADS-depression, HADS-anxiety, and WHOQOL-BREF scores as well as in the other outcome measures of VAS pain score, ASES score, and SSV were observed. The prevalence of depression and anxiety decreased from a rate of 15.2% and 19.5%, respectively, preoperatively to a rate of 6.5% for each at 12 months postoperatively. Preoperative HADS-depression and HADS-anxiety scores did not correlate with any of the clinical and functional outcome measures at 12 months after surgery.
This study showed significant improvement in psychological status and HRQoL as well as in pain and functional ability from 3 months after TSA in patients with osteoarthritis. Preoperative depression and anxiety did not predict poor postoperative outcome. Our findings suggest that TSA offers an excellent chance of improving psychological status and HRQoL.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
关于全肩关节置换术（TSA）对心理状态和健康相关生活质量（HRQoL）影响的文献报道较少。我们研究了TSA术后心理状态（抑郁和焦虑）及HRQoL的变化，并评估术前心理状态对术后临床和功能结局的影响。我们假设TSA能改善心理状态和HRQoL。
我们前瞻性纳入了46例因骨关节炎接受TSA的患者。术前以及术后3个月、6个月和12个月，所有受试者均完成了疼痛视觉模拟量表（VAS）、美国肩肘外科医师量表（ASES）、主观肩关节价值（SSV）测量、医院焦虑抑郁量表（HADS）以及世界卫生组织生活质量量表简版（WHOQOL - BREF）。
术后3个月起，观察到HADS - 抑郁、HADS - 焦虑和WHOQOL - BREF评分以及VAS疼痛评分、ASES评分和SSV等其他结局指标有显著改善。抑郁和焦虑的患病率分别从术前的15.2%和19.5%降至术后12个月时的6.5%。术前HADS - 抑郁和HADS - 焦虑评分与术后12个月的任何临床和功能结局指标均无相关性。
本研究表明，骨关节炎患者在TSA术后3个月起心理状态、HRQoL以及疼痛和功能能力均有显著改善。术前抑郁和焦虑并不能预测术后不良结局。我们的研究结果表明，TSA为改善心理状态和HRQoL提供了绝佳机会。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
