四肢骨折矫形术后慢性疼痛的危险因素分析

Risk factors of chronic pain after extremities fractures orthomorphia

目的系统回顾研究四肢骨折矫形术后患者出现慢性疼痛(CPSP)的危险因素及其相关性。方法选取我院2007年四肢骨折矫形术患者284例,复习病历以了解患者基本情况、术前疼痛情况、麻醉情况、手术情况及术后情况;根据简明疼痛问卷和VRS评分对患者慢性手术后疼痛情况进行电话回访。对可能与CPSP发生相关的因素做Logistic回归分析。结果最终完成调查患者共计228例,CPSP的发病例数为98例(42.98%),其中切口愈合部位针刺样疼痛30例(30.61%)、烧灼样疼痛27例(27.55%)及胀痛41例(41.84%);其中局部皮肤敏感33例(33.67%)。疼痛症状持续和(或)间断出现1年57例,2年29例,3年12例。二次手术、术前疼痛程度、术后3 d疼痛程度、麻醉方式、手术时间、无术后镇痛是CPSP发生的危险因素(P<0.05)。结论本研究显示手术时间、术前疼痛程度和术后3 d疼痛程度是导致CPSP的危险因素。

Objective To study the incidence and risk factors of chronic post-surgical pain(CPSP)after extremities fractures orthomorphia.Methods A questionnaire was sent to 284 patients underwent extremities fractures orthomorphia.Data of basic situation,preoperative pain,anesthesia conditions,surgical conditions,postoperative situation,and chronic pain were collected and VRS scoring was performed on the phone.Results 228 cases were included in the study.Incidence of CPSP was 42.98%.needle-like pain 30 cases(30.61%),burning pain 27 cases(27.55%)and acid-like pain 41 cases(41.84%),and 33 cases(33.67%)associated with local skin sensitivity.Pain duration of symptoms and/or interruption,occurred as long as one year in 57 cases,2 years in 29 cases,3 years in 12 cases.There was a significant positive correlation between CPSP and second surgery,preoperative pain,the 3 postoperative days pain,anesthesia,operative time and analgesia of surgery.There was a significant negative correlation between CPSP and analgesia after operation.Conclusions The risk factors for developing CPSP after extremities fractures orthomorphia are operation time,preoperative pain and pain levels of the 3 postoperative days.