骨质疏松性胸腰椎骨折术后患者康复期恐动症影响因素分析-现代医学

骨质疏松性胸腰椎骨折术后患者康复期恐动症影响因素分析

单位：武汉市第一医院麻醉科手术室, 湖北武汉 430022

分类号：R683.1

出版年·卷·期（页码）：2025·53·第八期（1284-1290）

摘要：

目的：分析骨质疏松性胸腰椎骨折术后患者康复期恐动症影响因素及风险预测。方法: 回顾性分析 2020年1月至2024年1月于我院行手术治疗的156例骨质疏松性胸腰椎骨折患者的临床资料，根据坦帕运动恐惧症量表(TSK)评分将其分为恐动症组(n=51，TSK评分＞37分)和非恐动症组(n=105，TSK评分≤37分)；采用二元Logistic回归分析影响患者恐动症发生的危险因素，采用受试者工作特征(ROC)曲线分析预测患者恐动症发生的效能。结果：两组年龄、性别、体质量指数(BMI)、吸烟史、饮酒史、合并慢性病种类、文化程度、婚姻状态、居住状态、医保类型、致伤原因、骨折类型比较，差异无统计学意义(P＞0.05)。恐动症组的无家庭照顾者、月收入3 000元以下、手术类型为开放手术、骨质疏松程度为重度的比例高于非恐动症组，同时恐动症组的术后疼痛视觉模拟(VAS)评分高于非恐动症组，差异有统计学意义(P＜0.05)。无家庭照顾者、家庭月收入3 000元以下、开放手术、重度骨质疏松、术后VAS评分高是影响骨质疏松性胸腰椎骨折患者术后康复期恐动症发生的独立危险因素(P＜0.05)。家庭照顾者、家庭月收入、手术类型、骨质疏松程度、术后VAS评分、联合预测的受试者工作特征曲线下面积(AUC)分别为0.725、0.715、0.691、0.850、0.706、0.954，敏感度分别为0.765、0.552、0.725、0.412、0.627、0.804，特异度分别为0.686、0.824、0.657、0.905、0.886、0.943，表明联合多指标预测的效能最佳，且敏感度和特异度良好。结论：骨质疏松性胸腰椎骨折术后康复期恐动症的发生与无家庭照顾者、家庭月收入低、开放手术、重度骨质疏松及术后疼痛程度高密切相关，这些因素均为独立危险因素。联合多指标预测模型对术后康复期恐动症的预测效能最佳，可为临床早期识别和干预提供参考依据。

Objective: To analyze the influencing factors and risk prediction of kinesiophobia during the rehabilitation period after surgery for osteoporotic thoracolumbar fractures. Methods: A retrospective analysis was conducted on the clinical data of 156 patients with osteoporotic thoracolumbar fractures who underwent surgical treatment in our hospital from January 2020 to January 2024. Based on the Tampa Scale for Kinesiophobia(TSK) scores, the patients were divided into the kinesiophobia group(n=51, TSK>37) and the non-kinesiophobia group(n=105, TSK scores≤37 points). The clinical data of the patients between the two groups were compared. Binary logistic regression analysis was used to identify risk factors for kinesiophobia, and receiver operating characteristic(ROC) curve analysis was employed to assess the predictive efficacy of kinesiophobia. Results: There were no significant differences between the two groups in terms of age, gender, BMI, smoking history, alcohol history, number of comorbid chronic diseases, education level, marital status, living status, insurance type, cause of injury, and fracture type(P>0.05). The proportion of patients without family caregivers, with a monthly income of less than 3 000 yuan, undergoing open surgery, with severe osteoporosis, and with higher postoperative Visual Analog Scale(VAS)scores was higher in the kinesiophobia group than that in the non-kinesiophobia group(P<0.05). The absence of family caregivers, low family monthly income, open surgery, severe osteoporosis, and high postoperative VAS scores were identified as independent risk factors for kinesiophobia during the rehabilitation period after surgery for osteoporotic thoracolumbar fractures(P<0.05). The area under the receiver operating characteristic curve(AUC) values for family caregivers, family monthly income, surgical type, osteoporosis severity, postoperative VAS scores, and combined prediction were 0.725, 0.715, 0.691, 0.850, 0.706, and 0.954, respectively. The sensitivities were 0.765, 0.552, 0.725, 0.412, 0.627, and 0.804, respectively, and the specificities were 0.686, 0.824, 0.657, 0.905, 0.886, and 0.943, respectively. The combined multi-indicator prediction model showed the best predictive efficacy with good sensitivity and specificity. Conclusion: The occurrence of kinesiophobia during the rehabilitation period after surgery for osteoporotic thoracolumbar fractures is closely related to the absence of family caregivers, low family monthly income, open surgery, severe osteoporosis, and high postoperative pain levels, all of which are independent risk factors of kinesiophobia. The combined multi-indicator prediction model has the best predictive efficacy and can provide a reference for early identification and intervention in clinical practice.

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