通过对四肢骨折患儿心理应激状态及影响因素分析，为儿童骨折后心理护理模式的制定提供临床依据。

采用偶遇抽样方法，选择2016年4月至8月，于上海交通大学医学院附属新华医院儿童骨科急诊收治的81例四肢骨折患儿为研究对象。采用本研究自行设计的《四肢骨折患儿一般资料调查表》，《四肢骨折患儿家长骨折知识调查问卷》，以及调查儿童创伤后心理应激状态常用的《儿童应激障碍检查表(CSDC)》，对患儿及其家长进行问卷调查，了解四肢骨折患儿急性反应、近期反应评分，以及患儿家长对骨折知识掌握情况，并进行统计学分析，找出可能影响骨折患儿心理应激状态的因素。本研究与所有受试者的监护人均签署临床研究知情同意书。

①本研究共计发放调查问卷81套，回收有效问卷81套，调查问卷的有效回收率为100%。②采用CSDC调查的结果显示，81例四肢骨折患儿CSDC中位总评分为7分(0～28分)，其中，急性反应中位评分为4分(1～9分)，近期反应中位评分为2分(0～23分)。③采用《四肢骨折患儿家长骨折知识调查问卷》调查的结果显示，7道骨折知识题目中，50.6%(41/81)四肢骨折患儿家长可正确回答3～4道题目，仅3.7%(3/81)家长可正确回答7道题目。④纳入研究的81例四肢骨折患儿中，>7～14岁患儿骨折后急性反应评分显著低于2～7岁患儿，二者比较，差异有统计学意义(Z＝－2.668，P＝0.008)。非独生子女患儿骨折后急性反应评分低于独生子女患儿，而近期反应中的再体验评分，则高于独生子女患儿，差异均有统计学意义(Z＝－2.049，P＝0.040；Z＝－2.295，P＝0.022)。家长骨折知识题目回答正确≥4道题目与<4道题目的患儿急性反应评分、近期反应总评分、CSDC总评分及近期反应中的再体验、回避、麻木与分离、警觉性增高、功能性损害评分分别比较，差异均无统计学意义(P>0.05)。

患儿年龄、是否为独生子女，为四肢骨折患儿心理应激状态的影响因素。家长骨折知识掌握情况，对四肢骨折患儿心理应激状态的影响，因本研究纳入样本量较小，仍需大样本、多中心随机对照研究证实。

To assess the stress disorders status and its influencing factors of children with limb fractures, to provide clinical evidence for laying down the post-fractured nursing mode.

From April to August 2016, a total of 81 cases of children with limb fractures who were treated in Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were recruited as research objects by accidental sampling method. The self-designed Basic Information Survey of Children With Limb Fractures and Fracture Knowledge Questionnaire for Parents, and the Child Stress Disorders Checklist (CSDC) which was used to investigate children′s post-traumatic psychological status were conducted among children and their parents, to get the data about limb fractured children′s immediate response scores and post-traumatic response scores, and fracture knowledge that the parents grasped. Through statistical analysis, finding out the influencing factors of limb fractured children′s stress disorders status. Informed consent was obtained from the guardians of each children.

①A total of 81 sets of questionnaires were handed out and 81 sets of valid questionnaires were collected, the feedback rate of valid questionnaires was 100%. ②According to the survey results of CDSC, the median score of CDSC was 7 scores (0-28 scores), and the median scores of immediate and post-traumatic response were 4 scores (1-9 scores) and 2 scores (0-23 scores), respectively. ③According to the survey results of self-designed Fracture Knowledge Questionnaire for Parents, 50.6% (41/81) parents could answer 3-4 questions correctly among 7 questions. However, only 3.7% (3/81) parents could answer all the fracture knowledge correctly. ④ Among those 81 cases of children with limb fracture, the immediate response score of limb fractured children who were >7-14 years old was lower than that of children who were 2-7 years old, and the difference was statistically significant (Z=-2.668, P=0.008). The immediate response score of children with siblings was lower than that of only-child children, meanwhile the score of re-experiencing of post-traumatic response was higher than that of only-child children, and both the differences were statistically significant (Z=-2.049, P=0.040; Z=-2.295, P=0.022). There were no statistical differences in the scores of immediate response, post-traumatic response, CSDC and scores of re-experience, avoidance, numbness and separation, increased alertness and functional lesion of post-traumatic response between the children whose parents could at least answer 4 questions correctly and the children whose parents could only answer less than 4 questions correctly (P>0.05).

The children′s age and only-child could influence the stress disorders status of children with limb fractures. As the sample size in this study is relatively small, the influences of fracture knowledge that the parents have grasped on stress disorders status of children with limb fractures still need large sample, multi-center randomized controlled study to confirm.