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      标题:骨质疏松性髋部骨折患者心理状况与预后的相关性研究
      作者:丁修龙,张建华,李玉前,王霞    (南通市第三人民医院骨科,江苏 南通 226001)
      卷次: 2018年29卷1期
      【摘要】 目的 观察骨质疏松性髋部骨折患者发病后的心理状况,并探讨心理状况对该病预后的影响。方法 收集 2011年 10月至 2015年 9月在南通市第三人民医院住院的骨质疏松性髋部骨折手术患者 189例,采用SCL-90心理评分量表评估患者发病后的心理状况,根据评分结果将患者分为心理异常组和心理正常组。采用日常生活活动能力(ADL)量表评估患者入院时骨折严重程度,出院后6个月来院复诊再次进行ADL评分,并将两组患者的ADL评分进行比较。随访1年,比较两组患者的死亡率。结果 SCL-90评分发现心理异常者58例(其中焦虑者21例,抑郁者37例),心理正常者131例。心理异常组和心理正常组患者入院时的ADL评分比较差异无统计学意义(P>0.05),6个月时 ADL评分比较[65(60,75)分 vs 80(70,85)分]差异具有统计学意义(P<0.05)。通过Kaplan-Meier (卡普兰-迈耶)分析发现心理异常组患者 1年死亡率明显高于心理正常组 (17.2% vs 6.9%,log rank=5.029,P=0.025)。应用COX回归分析校正年龄、性别、糖尿病史、骨质疏松严重程度、住院期间是否出现并发症、出院后是否选择正规康复以及ADL评分等因素后,仍显示心理异常组患者 1年死亡率高于心理正常组(OR=0.250,95% CI 0.068~0.909,P=0.035)。结论 骨质疏松性髋部骨折患者的焦虑、抑郁情绪的出现与骨折的严重程度无明显相关性,骨折6个月后的转归及1年死亡率与心理状况有关,故针对骨质疏松性髋部骨折患者,须重视其心理状况,及时予以针对性的心理疏导,必要时药物干预。
      【关键词】 骨质疏松;髋部骨折;心理;预后
      【中图分类号】 R683.3 【文献标识码】 A 【文章编号】 1003—6350(2018)01—0050—03
Correlation between the prognosis and psychological status in patients with osteoporotic hip fracture. DINGXiu-long, ZHANG Jian-hua, LI Yu-qian, WANG Xia. Department of Orthopedics, the Third People's Hospital of Nantong,Nantong 226001, Jiangsu, CHINA
      【Abstract】 Objective To observe the psychological status of patients with osteoporotic hip fracture, and to ex-plore the influence of psychological status on the prognosis of the disease. Methods A total of 189 patients with osteo-porotic hip fracture who were hospitalized in the Third People's Hospital of Nantong from October 2011 to September2015 were enrolled in the study. The psychological status of the patients was evaluated by the Symptom Checklist-90(SCL-90) scale. According to the results of the score, the patients were divided into the psychological abnormal groupand psychological normal group. The severity of the fracture was assessed by activities of daily living (ADL) scale, andreassessed 6 months after discharge. The scores of the two groups were compared. After 1 year of follow-up, the mortali-ty was compared between the two groups. Results A total of 58 cases of psychological abnormalities (21 cases of anxi-ety, 37 cases of depression) and 131 cases of normal mental were identified by SCL-90. There was no statistically signif-icant difference in ADL score between the psychological abnormal group and the psychological normal group at admis-sion (P>0.05), and the difference of ADL score after 6 months was statistically significant (65 [60, 75] vs 80 [70, 85],Z=-6.591, P=0.00). The Kaplan-Meier analysis found that the 1-year mortality rate was significantly higher in the psy-chological abnormal group than that in the psychologically normal group (17.2% vs 6.9%, log rank=5.029, P=0.025).After adjusting for age, sex, diabetes history, severity of osteoporosis, complications during hospitalization, whether ornot to choose regular recovery treatment and ADL scores after the hospitalization, COX regression analysis showedthat the 1-year mortality rate of psychological abnormal group was higher (OR=0.250, 95% CI 0.068-0.909, P=0.035).Conclusion There is no correlation between anxiety and depression in the patients with osteoporotic hip fractures andthe severity of fractures. The prognosis after 6 months of fracture and the 1-year mortality are related to psychologicalstatus. Therefore, we should pay attention to the mental status of the osteoporotic hip fracture patients, give timely psy-chological guidance, and intervene the drugs when necessary.
      【Key words】 Osteoporosis; Hip fracture; Psychological; Prognosis·论 著·doi:10.3969/j.issn.1003-6350.2018.01.015

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