髋部骨折患者术后恐动症风险的列线图分析

doi:10.6040/j.issn.1671-7554.0.2023.0792

摘要/Abstract

摘要： 目的了解髋部骨折(HF)术后恐动症的发生现状,探讨其危险因素并构建列线图预测模型。方法采用便利抽样法,选取2022年1月至2023年5月滨州医学院附属医院创伤骨科符合纳排标准的328例患者,调查患者的一般资料、恐动症评分、心理弹性评分、社会支持评分等,通过Logistic回归分析HF术后恐动症的影响因素,建立列线图风险预测模型并验证模型预测效果。结果 HF术后恐动症的概率为39.94%。Logistic回归分析显示,年龄、疼痛、睡眠障碍是HF恐动症的危险因素;心理弹性、社会支持是HF恐动症的保护因素。列线图模型内部验证显示,C-index为0.880,绘制受试者工作特征(ROC)曲线下面积为0.880(95%CI: 0.845~0.915),H-L检验P=0.181,校正曲线趋近于理想曲线,决策曲线临床应用净效益价值较高。结论年龄、疼痛、睡眠障碍、社会支持、心理弹性是HF术后恐动症的独立影响因素,构建的列线图模型预测效能良好,具有一定的临床应用价值。

关键词: 髋部骨折, 恐动症, 危险因素, 列线图, 预测模型

Abstract: Objective To investigate the incidence of kinesiophobia after hip fracture(HF), and explore the risk factors and construct a nomogram prediction model. Methods A total of 328 patients treated during Jan. 2022 and May 2023 who met the inclusion and exclusion criteria were collected with convenience sampling. The general information, kinesiophobia score, psychological resilience and sleep disorder of patients were investigated. The risk factors of kinesiophobia after HF were analyzed with Logistic regression. A nomogram prediction model was established and its prediction effects were verified. Results The probability of kinesiophobia after HF was 39.94%. Logistic regression showed that age, pain and sleep disorder were risk factors, while social support and psychological resilience were protective factors. The internal verification of the nomogram model showed that the C-index was 0.880; the area under the receiver operating characteristic(ROC)curve was 0.880(95%CI: 0.845-0.915). H-L test showed P=0.181, the correction curve was close to the ideal curve, and the net benefit value of decision curve in clinical application was high. Conclusion Age, pain, sleep disorder, social support and psychological resilience are independent influencing factors for kinesiophobia after HF. The nomogram model has good predictive efficiency and certain clinical value.

Key words: Hip fracture, Kinesiophobia, Risk factor, Nomogram, Prediction model

中图分类号:

R641

张明慧,王丽云,王芸,张新月,沙凯辉. 髋部骨折患者术后恐动症风险的列线图分析[J]. 山东大学学报 (医学版), 2023, 61(11): 74-81.

ZHANG Minghui, WANG Liyun, WANG Yun, ZHANG Xinyue, SHA Kaihui. A nomogram analysis of the risk of kinesiophobia in patients with hip fracture after surgery[J]. Journal of Shandong University (Health Sciences), 2023, 61(11): 74-81.

参考文献

[1] 李兴国, 邓叶龙, 刘朝晖, 等. 中国老年髋部骨折流行病学特征分析[J]. 实用骨科杂志, 2021, 27(7): 601-606. LI Xingguo, DENG Yelong, LIU Zhaohui, et al. The epidemiology of hip fractures of the elderly in China [J]. Practical Orthopaedics, 2021, 27(7): 601-606.
[2] Choong PF. Hip fracture surgery: the importance of evidence-based practice [J]. Med J Aust, 2022, 216(8): 406-407.
[3] Hua Y, Li Y, Zhou J, et al. Mortality following fragility hip fracture in China: a record linkage study [J]. Arch Osteoporos, 2023, 18(1): 105-112.
[4] Schoeneberg C. Current management of hip fracture [J]. Medicina(Kaunas), 2022, 59(1): 26-29.
[5] Kori SH, Miller RP, Todd DD. Kinisophobia: a new view of chronic pain behavior [J]. Pain Management, 1990, 3(1): 35-43.
[6] 吴红雅, 丰硕, 刘会子, 等. 骨质疏松性椎体压缩骨折患者术后恐动症的影响因素分析[J].中国医学创新, 2023, 20(9): 147-151. WU Hongya, FENG Shuo, LIU Huizi, et al. Analysis of influencing factors of postoperative kinesiophobia in patients with osteoporotic vertebral compression fractures [J]. Medical Innovation of China, 2023, 20(9): 147-151.
[7] 梁飞燕, 王富珍. 成人下肢创伤性骨折病人术后恐动症的影响因素及路径分析[J]. 护理研究, 2022, 36(7): 1170-1174. LIANG Feiyan, WANG Fuzhen. Influencing factors and paths of postoperative kinesiophobia in adult patients with lower extremity traumatic fracture [J]. Nursing Research, 2022, 36(7): 1170-1174.
[8] Orucu AM, Demir Y, Tekin E, et al. Kinesiophobia and associated factors in patients with traumatic lower extremity amputation[J]. Turk J Phys Med Rehabil, 2022, 68(4): 493-500.
[9] 史可为, 吴亚飞, 方亚. 临床预测模型的可解释性及应用进展[J]. 现代预防医学, 2023, 50(6): 1122-1127. SHI Kewei, WU Yafei, FANG Ya. Interpretability and application of clinical prediction models [J]. Modern Preventive Medicine, 2023, 50(6): 1122-1127.
[10] 胡文. 简体中文版TSK和FABQ量表的文化调适及其在退行性腰腿痛中的应用研究[D]. 上海:第二军医大学, 2012.
[11] 刘贤臣, 唐茂芹, 胡蕾, 等. 匹兹堡睡眠质量指数的信度和效度研究[J]. 中华精神科杂志, 1996(2): 103-107. LIU Xianchen, TANG Maoqin, HU Lei, et al. Reliability and validity of the Pittsburgh sleep quality index [J].China J Psychiatry, 1996(2): 103-107.
[12] Qaseem A, McLean RM, O' Gurek D, et al. Nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults: a clinical guideline from the american college of physicians and american academy of family physicians[J]. Ann Intern Med, 2020, 173(9): 739-748.
[13] Sharif NH, She L, Froelicher ES, et al. Psychometric evaluation of the Connor-Davidson Resilience Scale among Iranian population[J]. BMC Psychiatry, 2023, 23(1): 92-100.
[14] 肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994(2): 98-100.
[15] 孔静静, 王红玉, 汤云云. 髋部骨折患者恐动症发生现状及其影响因素分析[J]. 中西医结合护理(中英文), 2022, 8(3): 175-177.
[16] Wang X, Li X, Qi M, et al. Incidence of post-traumatic stress disorder in survivors of traumatic fracture: a systematic review and meta-analysis [J]. Psychol Health Med, 2022, 27(4): 902-916.
[17] Alpalhao V, Cordeiro N, Pezarat-Correia P. Kinesiophobia and fear avoidance in older adults: a scoping review on the state of research activity [J]. J Aging Phys Act, 2022, 30(6): 1075-1084.
[18] 温艳, 赵世新, 罗洋, 等. 全膝关节置换术后恐动的相关因素[J]. 中国矫形外科杂志, 2023, 31(5): 413-417. WEN Yan, ZHAO Shixin, LUO Yang, et al. Factors associated with kinesiophobia after total knee arthroplasty[J]. Orthopedic Journal of China, 2023, 31(5): 413-417.
[19] Lopez-Bravo MD, Zamarron-Cassinello MD, Touche R, et al. Psychological factors associated with functional disability in patients with hip and knee osteoarthritis [J]. Behav Med, 2021, 47(4): 285-295.
[20] 许小芬, 朱晓, 马伟, 等. 123例癌症患者癌性疼痛管理障碍的影响因素[J]. 山东大学学报(医学版), 2022, 60(9): 119-124. XU Xiaofen, ZHU Xiao, MA Wei, et al. Influencing factors of cancer pain management disorder in 123 cancer patients [J]. Journal of Shandong University(Medical Edition), 2022, 60(9): 119-124.
[21] Kovacs F, Abraira V, Cano A, et al. Fear avoidance beliefs do not influence disability and quality of life in Spanish elderly subjects with low back pain [J]. Spine, 2007, 32(19): 2133-2138.
[22] Karartı C, Basat H Ç, Özsoy O, et al. Biopsychosocial approach in identifying risk factors of kinesiophobia in persons with subacromial pain syndrome and developing a clinical prediction tool [J]. Indian J Orthop, 2023, 57(1): 124-136.
[23] 张婕, 张火垠, 李红, 等. 睡眠对恐惧学习的影响及其认知神经机制[J]. 心理科学进展, 2023, 31(4): 631-640. ZHANG Jie, ZHANG Huoyin, LI Hong, et al. The effect of sleep on fear learning and its cognitive neural mechanisms [J]. Advances in Psychological Science, 2023, 31(4): 631-640.
[24] Challa SA, Graziano R, Strasshofer DR, et al. Perceived sleep quality mediates the relationship between posttraumatic stress and somatic symptoms [J]. Psychol Trauma, 2022, 14(7): 1080-1088.
[25] 王晔, 吴萍. 膝骨关节炎患者关节镜术后恐动行为现状及与社会支持、心理弹性的关系调查研究[J]. 现代预防医学, 2023, 50(3): 540-544. WANG Ye, WU Ping. Investigation on the current situation of kinesiophobia behavior after arthroscopic surgery in patients with knee osteoarthritis and its relationship with social support and psychological resilience[J]. Modern Preventive Medicine, 2023, 50(3): 540-544.
[26] Wang Y, Chen Y, Xu J, et al. Association between resilience and frailty among Chinese older adults[J]. Front Psychiatry, 2022, 13: 948958. doi: 10.3389/fpsyt.2022.948958.
[27] Liang Z, Wu L, Tang F, et al. Acute stress disorder in patients with accidental traumatic fractures: what can we do[J]. Nurs Open, 2022, 9(5): 2418-2424.
[28] Keessen P, Latour C, van Duijvenbode I, et al. Factors related to fear of movement after acute cardiac hospitalization [J]. BMC Cardiovasc Disord, 2020, 20(1): 495.
[29] 安玉兰, 孙晴, 郭鑫, 等. 胸腰椎骨折术后患者恐动症成因的调查及影响因素分析[J]. 中国卫生统计, 2021, 38(4): 581-584.
[30] Gable SL, Bedrov A. Social isolation and social support in good times and bad times [J]. Curr Opin Psychol, 2022, 44(1): 89-93.

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