疼痛灾难化对膝关节置换术后疗效的影响

Relationship between pain catastrophizing and outcomes of total knee arthroplasty

目的分析疼痛灾难化对全膝关节置换(TKA)术后疗效的影响。方法对连续77例因骨关节炎(OA)行TKA术的患者进行分析。术前进行美国特种外科医院膝关节评分系统(HSS评分)及疼痛灾难化量表(PCS)评分检查。术后1年时,进行HSS评分检查及慢性疼痛分析。对术前HSS评分和术前PCS评分,术前HSS和术后HSS评分,术前PCS评分和术后HSS评分进行线性相关检验,对存在慢性疼痛和不存在慢性疼痛的患者进行非配对t检验。结果患者术前HSS评分与术前PCS评分存在中度负相关关系(r=-0.6939,P<0.01)。患者术前HSS评分与术后HSS评分存在高度正相关关系(r=0.8132,P<0.01)。患者术前PCS评分与术后HSS评分存在中度负相关关系(r=-0.7143,P<0.01)。术后1年发生慢性疼痛患者8例,无慢性疼痛患者66例。术后慢性疼痛患者与无术后慢性疼痛患者的术前HSS评分(t=2.029,P<0.05)和术前PCS评分(t=6.215,P<0.01),存在统计学差异。结论拟行TKA的换患者存在明显的疼痛灾难化现象,并会对术后慢性疼痛的及关节功能产生影响。

Objective To analyze the effects of pain catastrophizing on the postoperative effects of total knee arthroplasty（TKA）.Methods Seventy-seven patients undergoing TKA because of osteoarthritis were studied.The preoperative scores of the hospital for special surgery（HSS） and pain catastrophizing scale（PCS） were evaluated as well as the postoperative HSS and chronic pain analyzing（one year after the operation）.Linear correlation tests of the preoperative HSS and the preoperative PCS,the preoperative HSS and the postoperative HSS,the preoperative PCS and the postoperative HSS were carried out.Unpaired t tests of the patients with and without chronic pain were also performed.Results The results showed that the preoperative HSS and the preoperative PCS were moderately negative correlation（r =-0.6939,P〈0.01）,the preoperative HSS and the postoperative HSS were highly positive correlation（r = 0.8132,P〈0.01）,while the preoperative PCS and the postoperative HSS were moderately negative correlation（r =-0.7143,P〈0.01）.One year after the operation,eight patients suffered the chronic pain while 66 patients did not.The preoperative HSS（t = 2.029,P〈0.05） and the preoperative PCS（t = 6.215,P〈0.01） of the patients with and without chronic pain were obviously different.Conclusion Pain catastrophizing is remarkable in the patients who accept TKA,which will affect the postoperative chronic pain and the joint functions.