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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 286 -290. doi: 10.3877/cma.j.issn.1674-134X.2020.03.005

所属专题： 文献；

临床论著

抑郁症状对老年人工股骨头置换手术预后的不良影响
刘驰1, 石磊2, 何婧3, 张耀南2, 王林2, 闵楠2, 薛庆云1,†()   
  1. 1. 100730　北京医院骨科，国家老年医学中心；100005　北京协和医学院研究生院
    2. 100730　北京医院骨科，国家老年医学中心
    3. 100730　北京医院神经内科，国家老年医学中心
  • 收稿日期:2020-01-07 出版日期:2020-06-01
  • 通信作者: 薛庆云

Adverse effect of depression on surgical outcome of artificial femoral head replacement in elderly patients

Chi Liu1, Lei Shi2, Jing He3, Yaonan Zhang2, Lin Wang2, Nan Min2, Qingyun Xue1,†()   

  1. 1. Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Beijing 100730, China; Graduate School of Peking Union Medical College, Beijing 100005, China
    2. Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
    3. Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
  • Received:2020-01-07 Published:2020-06-01
  • Corresponding author: Qingyun Xue
  • About author:
    Corresponding author: Xue Qingyun, Email:
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引用本文：

刘驰, 石磊, 何婧, 张耀南, 王林, 闵楠, 薛庆云. 抑郁症状对老年人工股骨头置换手术预后的不良影响[J]. 中华关节外科杂志(电子版), 2020, 14(03): 286-290.

Chi Liu, Lei Shi, Jing He, Yaonan Zhang, Lin Wang, Nan Min, Qingyun Xue. Adverse effect of depression on surgical outcome of artificial femoral head replacement in elderly patients[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(03): 286-290.

目的

探讨抑郁症状对老年股骨颈骨折患者人工股骨头置换术手术疗效的影响。

方法

纳入2015年1月至2019年1月于北京医院骨科接受人工股骨头置换术的老年股骨颈骨折患者434例，男133例，女301例，年龄平均(75.0±4.4)岁。排除病理性骨折、认知功能障碍等患者。术前按照老年人抑郁量表(GDS)评分，将患者分为抑郁组(226例)和非抑郁组(208例)。术后疗效评价指标包括髋关节功能评分(Harris评分)及疼痛视觉模拟评分(VAS)。术后3个月及12个月对两组患者上述指标进行评价。计数数据的比较采用卡方检验，计量数据的比较采用t检验，VAS评分的比较采用重复测量的方差分析。

结果

抑郁组和非郁组术前人口统计学数据之间的差异均无统计学意义。两组患者术后3个月及12个月的Harris评分，抑郁组的(73±3)分和(82±4)分均低于非抑郁组的(85±5)分和(93±4)分，差异有统计学意义(t＝29.614、t＝32.252，P<0.001)；两组患者术后3个月VAS评分均较术前明显降低，差异不具有统计学意义(t＝1.031，P>0.05)；术后12个月时VAS评分在非抑郁组为(0.7±0.4)，而抑郁组再次升高(2.7±0.7)(t＝35.739，P<0.001)。

结论

术前抑郁状态对老年人工股骨头置换术后的功能恢复及疼痛缓解产生不良影响。

关键词: 老年人, 半关节成形术, 髋, 股骨颈骨折, 抑郁
Objective

To investigate the effect of depression on surgical outcome of femoral head replacement in elderly patients with femoral neck fracture.

Methods

Between January 2015 and January 2019 in Beijing Hospital, artificial femoral head replacement was performed in 434 elderly patients with femoral neck fracture that were enrolled in the study. There were 133 males and 301 females with an average age of (75.0±4.4)years. Pathological fracture and cognitive impairment were excluded.All patients were divided into depression group (226 cases) and non-depressed group (208 cases) by geriatric depression scale (GDS). The Harris hip joint scoreand visual analogue scale (VAS) were compared after three months and 12 months postoperatively. The data were analyzed by chi-square test, t test and repeated measure ANOVA.

Results

There was no statistically significant difference between the two groups in demographic data. The patients with preoperative depression showed poorer improvement than non-depressed patients in the surgery outcome: Harris scores improved (73±3) versus(85±5)at three months(t=29.614, P<0.001), and (82±4) versus (93±4) at 12 months(t=32.252, P<0.001). VAS scores increased at 12 months (2.7±0.7) versus (0.7±0.4)(t=35.739, P<0.001).

Conclusion

Preoperative depression has adverse effects on functional recovery and pain relief after artificial femoral head replacement in elderly patients.

Key words: Aged, Hemiarthroplasty, Hip, Femoral neck fracture, Depression
表1 两组患者社会人口学背景、生活方式、基本健康情况比较
组别 例数 年龄[岁，(±s)] 性别(男/女) 婚姻状况(配偶无/有) 居住状况(独居/非独居) 教育程度[年，(±s)] 吸烟情况(是/否) 慢性疾病病史(有/无)
非抑郁组 203 75.6±4.2 57/146 63/140 60/143 11.7±1.7 45/158 132/71
抑郁组 223 75.8±3.5 65/158 74/149 76/147 11.5±2.9 47/176 150/73
统计值 ? t＝0.564 χ2＝0.059 χ2＝0.225 χ2＝1.001 t＝0.931 χ2＝0.075 χ2＝0.238
P值 ? >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表2 两组患者术后Harris评分、住院时间及费用比较(±s)
组别 例数 术后3月Harris评分 术后12月Harris评分 术后住院时间(d) 住院费用(元)
非抑郁组 203 85±5 93±4 9±5 65 219±9 370
抑郁组 223 73±3 82±4 10±9 76 261±23 327
t值 ? 29.614 32.252 1.972 6.297
P值 ? <0.001 <0.001 <0.05 <0.001
图1 不同时间点VAS(视觉模拟评分)变化趋势折线图
表3 不同随访时间VAS评分比较(±s)
组别 例数 术前 术后3个月 术后12个月 F值a P值
非抑郁组 203 7.1±1.2 2.1±1.1 0.7±0.4 2654.833 <0.001
抑郁组 223 7.1±1.0 2.0±0.9 2.7±0.7 2251.212 <0.001
t值 ? 0.000 1.031 35.739 ? ?
P值 ? >0.05 >0.05 <0.001 ? ?
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