目的 探究全膝关节置换术（total knee arthroplasty，TKA）后疼痛灾难化水平、自我效能感与膝关节功能恢复的相关性。 方法 回顾性收集2021年1月至2025年6月安徽医科大学第一附属医院收治的124例TKA患者的临床资料，包括一般资料、术后疼痛灾难化量表得分、康复自我效能感量表得分及膝关节功能，采用Pearson相关分析法分析TKA术后疼痛灾难化水平、康复自我效能感与膝关节功能恢复的关系，使用结构方程模型分析康复自我效能感在患者疼痛灾难化和膝关节功能恢复之间的中介效应。按术后膝关节功能恢复情况分为恢复良好组与恢复不良组，比较两组临床资料及各量表调查结果，采用多因素logistic回归分析术后膝关节功能恢复的影响因素。 结果 124例患者术后疼痛灾难化量表（PCS）总分为（31.74 ± 4.90）分，康复自我效能感量表（SER）总分为（81.03 ± 10.86）分，美国特种外科医院膝关节功能评分（HSS）总分为（77.32 ± 6.81）分；TKA术后患者PCS表夸大、无助、反复思考及总分均与SER表各维度得分、总分，HSS表总分呈负相关（P < 0.05），SER表各维度得分、总分与HSS表总分呈正相关（P < 0.05），PCS各维度得分、SER表各维度得分彼此呈正相关（P < 0.05）；PCS得分对HSS得分有直接负向影响（β = -0.762，95%CI：-1.230 ~ -0.392，P < 0.05），PCS通过SER对HSS得分有间接负向影响（β = -0.199，95%CI：-0.393 ~ -0.020，P < 0.05），具体路径：PCS得分升高显著降低SER得分，而SER得分升高显著提升HSS得分（β = 0.194，95%CI：0.037 ~ 0.351，P < 0.05），PCS对HSS的总负向效应显著（P < 0.05），在PCS对HSS的总负向影响中，有21.90%通过降低SER这一中介路径实现，SER在PCS、HSS间发挥部分中介作用；124例患者术后4周恢复良好86例（69.35%），恢复不良38例（30.65%），恢复不良组年龄> 60岁、丧偶、自费占比高于恢复良好组（P < 0.05），PCS得分高于恢复良好组，SER得分低于恢复良好组（P < 0.05）；年龄> 60岁、高PCS得分为TKA术后患者膝关节功能不良的危险因素（P < 0.05），高SER得分为保护因素（P < 0.05）。 结论 TKA术后患者疼痛灾难化水平较高、康复自我效能水平中等，两者均与术后膝关节功能恢复有关，疼痛灾难化水平可影响TKA术后患者膝关节功能恢复，也可通过康复自我效能中介作用间接影响术后膝关节功能恢复；高龄、高PCS得分为TKA术后患者膝关节功能恢复不良的危险因素，高SER得分为保护因素。

Objective To explore the correlation between the level of pain catastrophizing and self-efficacy and the recovery of knee function after total knee arthroplasty （TKA）. Methods The clinical data of 124 patients who underwent TKA at the First Affiliated Hospital of Anhui Medical University from January 2021 to June 2025 were retrospectively collected. These data included general information， postoperative pain catastrophizing scale scores， rehabilitation self-efficacy scale scores， and knee joint function. Pearson correlation analysis was conducted to analyze the relationships between the levels of pain catastrophizing and rehabilitation self-efficacy and the recovery of knee joint function after TKA. Structural equation modeling was utilized to examine the mediating effect of rehabilitation self-efficacy between patients' pain catastrophizing and the recovery of knee joint function. Based on the recovery of knee joint function after surgery， the patients were divided into the good recovery group and the poor recovery group. The clinical data and the results of various scales were compared between the two groups. Multivariate logistic regression analysis was applied to screen the influencing factors of knee joint function recovery after surgery. Results The total score of the postoperative Pain Catastrophizing Scale （PCS） for 124 patients was （31.74 ± 4.90） points. The total score of the Self-Efficacy for Rehabilitation Scale （SER） was （81.03 ± 10.86） points， and the total score of the Hospital for Special Surgery Knee Score （HSS） was （77.32 ± 6.81） points. In TKA patients， the postoperative PCS scores， including those for exaggeration， helplessness， rumination， and the overall score， were negatively correlated with the scores of each dimension and the total score of the SER scale， as well as the total score of the HSS scale （P < 0.05）. The scores of each dimension and the total score of the SER scale were positively correlated with the total score of the HSS scale （P < 0.05）. The scores of each dimension of the PCS were positively correlated with the scores of each dimension of the SER scale （P < 0.05）. The PCS score had a direct negative impact on the HSS score （β = -0.762， 95%CI： -1.230 ? -0.392， P < 0.05）， and the PCS had an indirect negative impact on the HSS score through the SER （β = -0.199， 95%CI： -0.393 ? -0.020， P < 0.05）. The specific pathway： A significant increase in the PCS score led to a notable reduction in the SER score. Conversely， a significant increase in the SER score substantially enhanced the HSS score （β = 0.194， 95%CI： 0.037 ? 0.351， P < 0.05）. The overall negative effect of PCS on HSS was significant （P < 0.05）. Among the total negative impact of PCS on HSS， 21.90% was realized through the mediating pathway of reducing SER， and SER played a partial mediating role between PCS and HSS. Out of the 124 patients， 86 cases （69.35%） exhibited good recovery 4 weeks after surgery， whereas 38 cases （30.65%） showed poor recovery. The poor-recovery group had a higher proportion of patients who were over 60 years old， widowed， and self-funded compared to the good-recovery group （P < 0.05）. The PCS score in the poor-recovery group was higher， while the SER score was lower （P < 0.05）. Being over 60 years old and having a PCS score ≥ 30 points were risk factors for poor knee joint function in patients after TKA （P < 0.05）， while high SER scores were a protective factor （P < 0.05）. Conclusions Patients who have undergone TKA exhibit a relatively high level of postoperative pain catastrophizing and a moderate level of rehabilitation self-efficacy. Both of these factors are associated with the recovery of knee joint function after surgery. The level of pain catastrophizing can directly influence the recovery of knee joint function in TKA patients and can also indirectly impact it through the mediating effect of rehabilitation self-efficacy. Being over 60 years old and having high PCS scores are risk factors for poor knee joint function recovery after TKA， whereas high SER scores are protective factors.