全膝关节置换术后患者长期全范围关节运动疼痛的预测因素研究

Predictive factors for long-term joint pain in patients with total knee arthroplasty

目的探讨人工全膝关节置换术（TKA）后患者长期全范围关节运动疼痛（ROMP）的发生特点和影响因素。方法以符合条件的138例TKA患者为研究对象。术前应用Hamilton抑郁量表和Hamilton焦虑量表评估抑郁、焦虑状态，应用视觉模拟量表（VAS）评估术前关节静息疼痛和ROMP程度。术后6个月再次评估ROMP程度。应用Logistic多元回归分析探讨术后中重度ROMP与术前各变量的关系。结果术后6个月时26例存在中重度ROMP。中重度ROMP组术前的ROMP评分、术前膝关节静息疼痛评分及抑郁、焦虑评分与非中重度ROMP组患者比较差异均有统计学意义。多因素分析发现，术前重度ROMP、焦虑水平是预测术后长期中重度ROMP的独立因素，OR值及95％C1分别为6．118（2．859～14．833）和1．337（1．172。4．789）。结论TKA患者存在长期ROMP，术前焦虑水平和重度ROMP与术后中重度ROMP密切相关，据此进行有效地术前沟通和干预将会增加TKA患者的满意度，改善手术效果。

Objective The study aimed to explore the characteristics of a long-term range-of-motion pain （ROMP） and influencing factors on ROMP in patients with total knee atthroplasty （TKA）. Methods 138 TKA patients meeting the criteria were included. Anxiety and depression levels were assessed with Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale before surgery. Visual Analogue Scale （VAS） was used to assess preoperative joint pain at rest and ROMP. ROMP was reevaluated with VAS at postoper- ative 6- month clinic visit. Logistic regression analysis was used to investigate the relationship between postoperative moderate to severe ROMP and preoperative variable. Results 26 cases showed moderate to severe ROMP at postoperative 6-month clinic visit. Patients with moderate to severe ROMP had a higher ROMP score,more severe resting pain and higher anxiety and depression levels compared with those non- moderate to severe ROMP. Multivariate analysis found that preoperative severe ROMP and anxiety level were independent factors for postoperative long-term moderate to severe ROMP. Conclusions TKA pa- tients show a long-term ROMP. Preoperative anxiety levels and severe ROMP are closely associated with moderate to severe postoperative ROMP. Based on these results, effective communication and intervention before surgery will increase satisfaction and improve surgical results in TKA patients.