| Objectives:1.Analyze the overall psychological profile,personality and quality of life of patients with scoliosis;2.To identify the relationship between the main cobb Angle,duration of disease,age,gender,quality of life and preoperative psychological status of patients with scoliosis;3.Psychological parameters were compared before and after surgery and surgery+psychological intervention to explore the psychological impact of surgery on patients with scoliosis and the effectiveness of psychological intervention;Methods:A total of 96 patients diagnosed with AIS and EOS had been admitted to the Department of Orthopedics of The Second Affiliated Hospital of Kunming Medical University from November 2019 to August 2020 were collected.Among them,75 patients who volunteered to participate in this study and had complete follow-up records were included in this study.Among the 75 patients,9 cases(AIS7 cases,EOS2 cases)received non-surgical treatment,and 66 cases(AIS38 cases,EOS28 cases)received surgical treatment.The patients treated by surgery were randomly divided into two groups according to whether they received short-term psychological therapy intervention,the control group and the psychological intervention group;In AIS,there were 16 cases in psychological intervention group and 22 cases in control group.In EOS,10 cases were in the psychological intervention group and 18 cases were in the control group.Gender,age,duration of disease progression,preoperative and 6-month post-operative Cobb Angle of the main curve were collected.Psychological score and quality of life score were performed for all patients with scoliosis included in the study at admission and 6 months after surgery.The psychological score of AIS using SCL-90,EOS was filled out by parents with Achenbach Chdd Behavior Checklist,and quality of life was scored using simplified Chinese SRS-22 scale.PHQ-9 and GAD-7 questionnaires were used to evaluate the short-term psychological efficacy of patients in the psychological intervention group before and after the intervention,and SPSS 20.0 was used for data analysis.Results:Psychological characteristics of patients with scoliosis:(1)AIS patients:compared with the norm average score of Chinese young people,the psychological status of AIS patients was different from that of normal people,mainly represented by somatization factor,anxiety factor,fear factor,psychotic factor and positive items,which were significantly higher than the norm average score of Chinese young people,with statistical significance(P<0.05).(2)EOS Children:Compared with normal children,the scores of CBCL behavior scale in EOS children were basically normal.Among the 30 children involved in the study,the scores were higher than the normal value:Depression factor 1(3.33%),social withdrawal factor 1(3.33.14%),hyperactivity factor 1(3.33%)and cruelty factor 1(3.33%)were found in female children,and only 2(6.67%)of the total scores were above the normal value.Male bad communication factor 2(6.67%),the total score over the normal value of 1(3.33%).2.Correlation analysis of gender,age,Cobb Angle,course of disease with preoperative psychological characteristics and quality of life of patients with scoliosis:(1)AIS patients:there was no statistically significant difference between female patients and male patients in various scores of psychological status SCL-90(P>0.05),but there was statistically significant difference between female patients and male patients in total score,score of pain and average score of activity ability in terms of quality of life SRS-22(P<0.05),the femal scores was significantly lower than that of male patients.There was no correlation between age and psychological status and quality of life(P>0.05).Cobb Angle had no correlation with total score of SCL-90(P>0.05),but was significantly positively correlated with relationships、diet factors factor of SCL-90,and significantly negatively correlated with total score of SRS-22,average score of activity ability and average score of self-image(P<0.05).The duration of disease was not correlated with the total score of SCL-90(P>0.05),but was significantly positively correlated with the somatization factor of SCL-90,and significantly negatively correlated with the total score of SRS-22,average score of activity ability and average score of self-image(P<0.05).(2)EOS children:there was no significant difference in the total score of CBCL in psychological status between male and female EOS children(P>0.05);There was no correlation between age and psychological status and quality of life(P>0.05).The psychologic score of SRS-22 in children with EOS was significantly negatively correlated with the size of Cobb Angle and the length of disease course(P<0.05),and the total score of CBCL was significantly positively correlated with the size of Cobb Angle and the length of disease course(P<0.05).3.Relationship between quality of life and psychological symptoms in patients with scoliosis:(1)AIS patients:There was a significant negative correlation between total score of SRS-22,average score of psychological state and total score of SCL-90(P<0.05),and there was a significant negative correlation between total score of SRS-22,average score of pain,average score of psychological state and somatization factor and depression factor of SCL-90(P<0.05).The average score of SRS-22 was significantly negatively correlated with SCL-90 anxiety factor and psychotic factor(P<0.05),and the total score of SRS-22 was significantly negatively correlated with SCL-90 dietary factor(P<0.05).(2)EOS children,there was no significant correlation between each item of SRS-22 and the total score of CBCL(P>0.05).4,After short-term Mindfulness-based Cognitive Therapy(MBCT)psychological intervention,the psychological status and quality of life of patients in the intervention group and the control group were compared vertically and horizontally before and after 6 months:There were no significant differences between the intervention group and the control group in gender,age,Cobb Angle,progression time,PHQ-9,GAD-7,SCL-90,SRS-22 and other aspects at admission(P>0.05).(1)AIS patients:The Cobb Angle of the intervention group and the control group decreased significantly after operation(P<0.05).The change of Cobb Angle in the intervention group and the control group was significantly negatively correlated with the change of the total score of SRS 22(P<0.05).With the decrease of Cobb Angle,the quality of life improved.The total score of SRS-22 in the intervention group and the control group was significantly different after surgery(P<0.05),the quality of life score was significantly higher than that before surgery.6 months later the total score of SCL-90 in the control group was not significantly different from that before surgery(P>0.05).However,there were significant differences in the total score of SCL-90,mean score of depression,mean score of anxiety and mean score of psychosis in the intervention group(P<0.05),and the score was significantly lower than that before the operation,and the psychological status was improved after the intervention.In terms of psychological status,the total score of SCL-90 and all the factors(somatization,compulsion,interpersonal relationship,depression,anxiety,hostility,fear,psychosis,diet)in the intervention group were better than the operation control group in each average score.In terms of quality of life,the intervention group was superior to the control group in terms of total score,activity ability,self-image,psychological status and so on.(2)EOS children:longitudinal comparison between the control group and the intervention group before and after 6 months:there was a statistically significant difference in the total CBCL score of the female children in the intervention group(P<0.05),which was significantly lower than that before the operation,and only the psychological status of the female children was significantly improved after the intervention.The total score of CBCL in the intervention group was significantly lower than that before surgery 6 months later,and the difference was statistically significant(P<0.05).The total score of SRS-22 in the control group compared with that before operation,the score was increasedand,the difference was statistically significant(P<0.05),compared with preoperative,surgery improved quality of life of children.after psychological intervention,psychological situation improves,witch were more pronounced among girls.Horizontal comparison was made between the control group and the intervention group 6 months after operation:there was no statistically significant difference between intervention group and control group in the score of life quality SRS-22,;In psychological behavior assessment CBCL,the score of the intervention group was significantly lower than that of the operation control group(P<0.05).5.Influence of short-term psychological intervention on short-term anxiety and depression symptoms in AIS and EOS patients:After the intervention,there were statistically significant differences in PHQ-9 and GAD-7 scores of AIS and EOS patients(P<0.05),which were significantly lower than those before the intervention.Psychological intervention can improve anxiety,depression and other emotions of patients in the short term.Conclusions:1.Patients with scoliosis have abnormal psychological symptoms such as somatization,anxiety and fear before surgery,especially in AIS,which need to be paid more attention.2.Cobb Angle and course of disease were positively correlated with the severity of psychological symptoms,but negatively correlated with quality of life;3.The quality of life of patients with scoliosis can be improved after effective surgical correction.If short-term MBCT psychological intervention is added,patients can get more psychological improvement. |
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