摘要目的 探讨全膝关节置换术前患者心理状态与术后膝关节功能的相关性.方法 2010年7至10月接受全膝关节置换且符合纳入标准的骨关节炎患者111例(155膝),按照医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HADS)对术前心理状态进行评估.HADS≥8分(有焦虑、抑郁)者纳人心理组(21例),HADS＜8者纳入对照组(90例).采用WOMAC骨关节炎评分、HSS膝关节评分对两组患者术前、术后1、3、6个月膝关节功能进行比较；对患者术前心理因素与术后1、3、6个月的功能指标进行Pearson相关性分析.结果 术后1、3、6个月心理组WOMAC骨关节炎评分均较对照组高(t=0.226,0.242,0.250;P＜ 0.05),HSS膝关节评分均较对照组低(t=0.233,0.254,0.227;P＜0.05).术前HADS评分中焦虑、抑郁两项亚指标与术后1、3个月WOMAC骨关节炎评分及HSS膝关节评分各亚指标均无相关性(P＞0.05)；与术后6个月膝关节疼痛呈正相关(r=0.613,0.530,0.500,0.473；P＜ 0.05),与功能呈负相关(r=-0.551,-0.642,-0.486,-0.524;P＜0.05),与活动度、肌力、屈曲畸形、稳定性、僵硬不相关(P＞0.05).结论患者术前的焦虑、抑郁状态对全膝关节置换术后膝关节功能的恢复有负面影响.

abstractsObjective To explore the correlation of preoperative psychological status and postoperative functional outcome of patients undergoing total knee arthroplasty(TKA).Methods From July to October 2010,111 patients with osteoarthritis(155 knees)who accord with our standard underwent TKA in our department.After the patients were admitted,their mental condition was evaluated by the Hospital Anxiety and Depression Scale(HADS).If HADS was over 8 points,the patient was believed to have anxiety and depression,and assigned into mental group.There were 21 and 90 patients in the mental and control group.The postoperative knee functional outcomes were compared between the two groups at 1,3,6 months according to the WOMAC score and HSS score.The correlation of preoperative HADS psychological scores and WOMAC scores,HSS scores after 1,3,6 months were analyzed by the Pearson correlation analysis.Results The 1,3,6 month postoperative WOMAC scores of mental group were higher than the control group(t=0.226,0.242,0.250,P＜0.05).The 1,3,6 month postoperative HSS scores of mental group were lower than the control group(t=0.233,0.254,0.227,P＜0.05).However,the preoperative anxiety and depression of HADS and WOMAC scores,and HSS score of 1 month,3 months after operation for the Pearson correlation analysis showed P＞0.05.The preoperative anxiety and depression had a positive correlation with knee pain of 6 months postoperation(r=0.613,0.530,0.500,0.473,P＜0.05),a negative correlation with the function(r=-0.551,-0.642,-0.486,-0.524,P＜0.05),the correlation with activities,muscle strength,flexion deformity,stability,stiffness showed r values were between-0.31 and 0.31,indicating no significant correlation among them(P＞0.05).Conclusion Preoperative anxiety and depression have a negative impact on postoperative knee functional outcome.