术前心理困扰并非延迟全膝关节置换术的理由：一项基于登记的 458 例患者的前瞻性队列研究。
Preoperative psychological distress no reason to delay total knee arthroplasty: a register-based prospective cohort study of 458 patients.
机构信息
Department of Orthopaedics, Örebro County Council, Örebro, Sweden.
School of Medical Sciences, Örebro University, Örebro, Sweden.
出版信息
Arch Orthop Trauma Surg. 2020 Nov;140(11):1809-1818. doi: 10.1007/s00402-020-03537-w. Epub 2020 Jul 28.
INTRODUCTION
Total knee arthroplasty (TKA) is effective in alleviating pain and improving function in patients with knee arthritis. Psychological factors are known to affect patient satisfaction after TKA. It is important to determine the effectiveness of TKA in patients with presurgical anxiety and/or depression to avoid excluding them from surgery.
MATERIALS AND METHODS
A prospective cohort study was conducted on all patients who underwent TKA during 2016-2018. Patients were divided into four groups: with anxiety, without anxiety, with depression, and without depression. Outcome measures comprised both generic and knee-specific instruments. Each patient group was compared regarding changes in outcome measures one year after surgery. Between-group comparison was also performed.
RESULTS
Of the 458 patients with complete data, 15.3% and 9.6% had experienced presurgical anxiety and depression, respectively. All patient groups displayed statistical (P < 0.001) and clinical improvement in all outcome measures. Patients with presurgical anxiety and/or depression generally displayed less improvement, though the only significant mean differences concerned the Knee Injury and Osteoarthritis Outcome Score (KOOS)-sport score in the non-anxiety and non-depression groups (P = 0.006 and 0.03, respectively), a higher proportion of clinically improved KOOS pain in the non-anxiety group (P = 0.03), and the general health state in the anxiety and depression groups (P = 0.004 and 0.04, respectively).
CONCLUSIONS
All patients improved in outcome measures 1 year after TKA, regardless of presurgical psychological state. Patients with presurgical anxiety and/or depression benefit greatly from surgery and should not be discriminated against based on presurgical psychological distress, though this fact should not eliminate the preoperative psychological assessment of patients.
LEVEL OF EVIDENCE
II.
简介
全膝关节置换术（TKA）可有效缓解膝关节炎患者的疼痛并改善其功能。心理因素会影响 TKA 术后患者的满意度。因此，确定术前有焦虑和/或抑郁的 TKA 患者的手术效果非常重要，以免将其排除在手术之外。
材料与方法
对 2016 年至 2018 年期间接受 TKA 的所有患者进行前瞻性队列研究。将患者分为四组：焦虑组、无焦虑组、抑郁组和无抑郁组。评估指标包括一般指标和膝关节特定指标。比较每组患者术后 1 年的评估指标变化，并进行组间比较。
结果
在 458 例资料完整的患者中，分别有 15.3%和 9.6%的患者术前有焦虑和抑郁。所有患者组在所有评估指标上均显示出统计学上（P<0.001）和临床上的显著改善。然而，术前有焦虑和/或抑郁的患者的改善程度通常较低，只有在非焦虑和非抑郁组中，膝关节损伤和骨关节炎结果评分（KOOS）-运动评分（P=0.006 和 0.03）、非焦虑组中 KOOS 疼痛的临床改善比例较高（P=0.03）以及焦虑和抑郁组的一般健康状况（P=0.004 和 0.04）有显著的均值差异。
结论
所有患者在 TKA 术后 1 年的评估指标上均有改善，无论术前心理状态如何。尽管这一事实不应消除对患者的术前心理评估，但术前有焦虑和/或抑郁的患者从手术中获益巨大，不应因其术前心理困扰而受到歧视。
证据等级
II。
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