腰椎间盘突出症患者术后运动恐惧的潜在类别、影响因素与护理对策 [中文引用][英文引用]

目的  探索接受单侧双通道髓核摘除术（unilateral biportal endoscopic discectomy，UBED）的腰椎间盘突出症（lumbar disc herniation，LDH）患者术后运动恐惧的潜在类别，并分析其影响因素，为 LDH 患者术后康复护理提供依据。方法  采用便利抽样法，选取 2022 年 7 月— 2024 年 7 月本院接受 UBED 治疗的 230 例 LDH 患者为研究对象，采用一般资料调查表、Tampa 运动恐惧量表（Tampa scale of kinesiophobia-17，TSK-17）、视觉模拟评分法（visual analogue scale，VAS）、社会支持评定量表（social support rating scale，SSRS）和医院焦虑抑郁量表（hospital anxiety and depression scale，HADS）进行调查。采用潜在剖面分析（latent profile analysis，LPA）识别 LDH 患者术后运动恐惧的潜在类别，并采用多分类 Logistic 回归分析其影响因素。结果  230 例 LDH 患者完成研究。患者术后 TSK-17 得分为（42.13±13.24）分，128 例患者 TSK-17 得分 >37 分，运动恐惧检出率为 55.65%，共识别出低运动恐惧组 51 例（22.17%）、中运动恐惧组 80 例（34.78%）和高运动恐惧组 99 例（43.04%）3 个潜在类别。多分类 Logistic 回归分析显示，年龄、性别、疼痛、社会支持和焦虑、抑郁是 LDH 患者术后运动恐惧潜在类别的影响因素（均 P<0.05）。年龄 >64 岁、女性、疼痛水平较高、焦虑抑郁水平较高及社会支持水平较低的患者更易出现高水平运动恐惧。结论  接受 UBED 治疗的 LDH 患者术后运动恐惧检出率较高，且存在明显群体异质性。护理人员应在术后早期开展运动恐惧筛查，重点关注高危患者，并结合患者年龄、疼痛程度、心理状态及社会支持情况，实施分层康复宣教、个体化疼痛管理、心理疏导及家属参与式护理干预，以降低患者运动恐惧水平，促进术后功能康复。

Objective To explore the potential profile of kinesiophobia in lumbar disc herniation（LDH）patients undergoing unilateral biportal endoscopic discectomy（UBED）and to analyse its influencing factors，thereby providing guidance for postoperative rehabilitation and nursing care. Methods A convenience sample of 230 LDH patients who underwent UBED at Suqian Hospital， Nanjing Drum Tower Hospital Group were recruited from July 2022 to July 2024. A general information questionnaire，the Tampa scale of kinesiophobia-17（TSK-17），visual analogue scale（VAS），social support rating scale（SSRS），and hospital anxiety and depression scale（HADS）were used to investigate. Latent profile analysis（LPA）was performed to identify potential profiles of postoperative kinesiophobia. Multinomial logistic regression was used to analyses the influencing factors. Results A total of 230 LDH patients finished the study. The mean postoperative TSK-17 score was 42.13±13.24. 128 patients had a TSK-17 score >37，indicating a prevalence of kinesiophobia of 55.65%. LPA identified three latent profiles of kinesiophobia: low group with 51 patients（22.17%），moderate group with 80 patients（34.78%）and high group with 99 patients（43.04%）. Multinomial logistic regression analysis showed that age，gender，pain， social support，depression and anxiety were significant factors influencing the latent profiles of postoperative kinesiophobia（all P<0.05）. Patients aged >64 years，female，those with higher pain intensity，higher anxiety and depression，and lower social support were more likely to have high-level kinesiophobia. Conclusion LDH patients undergoing UBED have a high prevalence of postoperative kinesiophobia and exhibit significant group heterogeneity. Nurses should conduct early postoperative screening for kinesiophobia，pay particular attention to high-risk patients，and implement stratified rehabilitation education，individualised pain management，psychological counseling and family-involved nursing interventions based on the age，pain intensity，psychological status and social support of the patients，to reduce kinesiophobia and promote postoperative functional recovery.