四肢骨折矫形术后患者慢性手术后疼痛发生危险因素分析

Risk factors of chronic post-surgical pain after orthopedic surgery in patients with extremity fracture

目的了解四肢骨折矫形术后患者慢性手术后疼痛(CPSP)发生的危险因素,为临床骨折患者术后康复提供参考依据。方法收集2011年1月—2015年1月在山东省滨州市中心医院实施四肢骨折矫形手术治疗的389例患者病历资料、手术资料及术后随访资料进行CPSP危险因素分析。结果 389例四肢骨折矫形术后患者中,发生CPSP者109例,CPSP发生率为28.02%;多因素非条件logistic回归分析结果显示,高能量致伤、下肢骨折、开放性骨折、二次手术、合并骨质疏松、全麻和臂丛麻醉是四肢骨折矫形术后患者发生CPSP的危险因素。结论致伤原因、受伤部位、骨折类型、麻醉方式以及是否二次手术和合并骨质疏松与四肢骨折矫形术后患者发生CPSP有关。

Objective To investigate influencing factors of chronic post-surgical pain （CPSP）in patients with extremity fracture after orthopedic surgery and to provide references for postoperative rehabilitation of the patients. Methods Totally 389 extremity fracture patients with orthopedics from January 2011 to January 2015 at Binzhou Central Hospital were recruited and assigned into a case group （109 with CPSP） and a control group （280 without CPSP）. Medical records and follow-up information of all the patients were collected and analyzed. Results The incidence of CPSP among all the patients was 28.02%. Unconditional multivariate logistic regression revealed that major risk factors of CPSP included high energy injury （ odds ratio [ OR] = 1. 567） ,lower limb fracture （ OR = 1. 896） ,open fracture （ OR = 1. 930）, with a second operation （ OR = 1. 302 ）, complicated with osteoporosis （ OR = 1. 628 ）, and with general anesthesia （ OR = 1. 309） or brachial plexus anesthesia （ OR = 1. 295 ） among the patients. Conclusion The occurrence of chronic post-surgical pain is associated with injury cause, injury site, fracture type, anesthesia method, whether with a secondary surgery, and whether complicated with osteoporosis among patients with extremity fracture after orthopedic surgery.