《中国康复理论与实践》

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (3): 364-372.doi: 10.3969/j.issn.1006-9771.2026.03.013

• 康复伦理 • 上一篇    

全膝关节置换术后患者疼痛、运动恐惧、社会参与与膝关节功能的关系：基于伦理公平性视角下的网络分析

王志伟1,2,3, 孟丽君4, 武雨1,2, 刘健1,2, 达朝锦1,2, 延泽萍5, 吴世彩4()   

  1. 1 山东大学护理与康复学院， 山东济南市 250012
    2 康复大学， 山东青岛市 266113
    3 山东大学齐鲁医院， 山东济南市 250012
    4 中国康复研究中心北京博爱医院， 北京市 100068
    5 山东第一医科大学附属省立医院护理部， 山东济南市 250021
  • 收稿日期:2026-01-04 出版日期:2026-03-25 发布日期:2026-04-01
  • 通讯作者: 吴世彩(1966-)，男，汉族，山东高密市人，博士，研究员，博士研究生导师，主要研究方向：马克思主义哲学、医学哲学和医史文献，E-mail：wscai66@163.com。
  • 作者简介:王志伟(1997-)，男，汉族，山东济南市人，博士研究生，主要研究方向：康复伦理、康复护理
  • 基金资助:
    国家重点研发计划项目(2022YFC3600305)

Network analysis of pain, kinesiophobia, social participation and knee function in patients after total knee arthroplasty from an ethical equity perspective

WANG Zhiwei1,2,3, MENG Lijun4, WU Yu1,2, LIU Jian1,2, DA Zhaojin1,2, YAN Zeping5, WU Shicai4()   

  1. 1 School of Nursing and Rehabilitation, University of Shandong, Ji'nan, Shandong 250012, China
    2 University of Health and Rehabilitation Sciences, Qingdao, Shandong 266113, China
    3 Qilu Hospital of Shandong University, Ji'nan, Shandong 250012, China
    4 Beijing Bo'ai Hospital, China Rehabilitation Research Centre, Beijing 100068, China
    5 Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong 250021, China
  • Received:2026-01-04 Published:2026-03-25 Online:2026-04-01
  • Contact: WU Shicai, E-mail: wscai66@163.com
  • Supported by:
    National Key R&D Program of China(2022YFC3600305)

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摘要：

目的 探讨全膝关节置换术后患者疼痛、运动恐惧、社会参与与膝关节功能之间的复杂网络关系，从伦理公平性视角分析不同社会结构性因素对康复网络的调节作用。

方法 采用方便抽样法，选取2023年5月至7月山东大学齐鲁医院全膝关节置换术后患者291例。采用疼痛数字评定量表、中文简版运动恐惧量表、自主参与问卷和美国特种外科医院膝关节评分进行评估。采用图形最小绝对收缩与选择算子构建疼痛、运动恐惧、社会参与与膝关节功能的偏相关网络，通过强度中心性与桥中心性识别核心变量，并运用网络比较检验分析不同社会结构亚组间网络差异。

结果 网络模型中强度中心性最高的节点为室内参与、活动行为和活动痛；桥中心性分析显示活动痛、膝关节功能、室内参与和活动认知是关键桥梁节点。网络比较检验发现，不同居住地、受教育程度和付费方式亚组在网络整体结构和全局强度上无显著性差异(P > 0.05)，但在活动认知-活动行为、膝关节功能-室内参与等具体边上存在权重差异(P < 0.05)。

结论 全膝关节置换术后患者疼痛、运动恐惧、社会参与与膝关节功能间存在网络化交互关系，室内参与、活动痛等节点在康复过程中发挥关键作用。尽管不同社会结构群体的康复网络整体相似，但在农村、低教育水平和自费患者中部分关联路径存在差异。提示临床康复干预应聚焦核心节点，并针对不同社会结构性弱势群体实施精准化支持策略，以促进康复公平。

关键词: 全膝关节置换术, 膝关节功能, 疼痛, 运动恐惧, 社会参与, 伦理公平性, 网络分析

Abstract:

Objective To explore the complex network relationships among pain, kinesiophobia, social participation and knee function in patients after total knee arthroplasty (TKA), and to analyze the moderating effects of different socio-structural factors on the rehabilitation network from an ethical equity perspective.

Methods A convenience sampling method was used to select 291 patients who underwent TKA in Qilu Hospital of Shandong University from May to July, 2023. Pain was assessed using Numerical Rating Scale, kinesiophobia with Chinese short version of the Tampa Scale for Kinesiophobia, social participation with Impact on Participation and Autonomy Questionnaire, and knee function with Hospital for Special Surgery Knee Score. A partial correlation network among pain, kinesiophobia, social participation and knee function was constructed using Graphical Least Absolute Shrinkage and Selection Operator. Key variables were identified through node centrality and bridge centrality analysis. Network Comparison Tests (NCT) were used to analyze network differences among subgroups based on different socio-structural characteristics.

Results In the network model, the nodes with the highest strength centrality were indoor participation, activity behavior and activity pain. Bridge centrality analysis indicated that activity pain, knee function, indoor participation and activity cognition were key bridge nodes. NCT revealed no significant differences in overall network structure or global strength among subgroups based on residence, education level or payment method (P> 0.05). However, significant differences in edge weights were found for specific edges such as activity cognition-activity behavior and knee function-indoor participation (P < 0.05).

Conclusion There is a network of interactions among pain, kinesiophobia, social participation and knee function in patients after TKA, with nodes such as indoor participation and activity pain playing key roles in the rehabilitation process. Although the overall rehabilitation network is similar across different socio-structural groups, variations exist in specific relational pathways among patients from rural areas, those with lower education levels, and those with out-of-pocket payment. This suggests that clinical rehabilitation interventions should focus on these core nodes and implement targeted support strategies for socio-structurally disadvantaged groups to promote rehabilitation equity.

Key words: total knee arthroplasty, knee function, pain, kinesiophobia, social participation, ethical equity, network analysis

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