半月板损伤膝关节镜术后疼痛程度及影响因素分析

Postoperative Pain Intensity and Its Possible Risk Factors Following Knee Arthroscopy in Patients with Meniscus Injury

目的分析半月板损伤膝关节镜术后疼痛程度并探索其可能的影响因素。方法纳入2014年1月至2015年6月在四川大学华西医院因半月板损伤行膝关节镜手术的患者167例,收集患者的年龄、性别、术前麻醉风险评估(ASA)分级、体重指数(BMI)、手术侧别及类型等资料,并在术前、术后4d及术后1年采用数字化模拟评分法(numerous rating scale,NRS)对患者膝关节静息痛及行走痛进行评估,分析膝关节镜术后疼痛程度及可能的影响因素。结果膝关节镜术前、术后4d及术后1年平均静息NRS评分分别为(3.14±1.85)、(2.89±1.80)、(1.59±1.10)分,其中中重度静息痛(NRS≥4分)发生率分别为43.71%、36.53%及2.99%;患者平均行走NRS评分分别为(4.89±1.84)、(4.10±1.78)、(1.93±1.14)分,其中中重度行走痛发生率分别为71.26%、61.08%及7.19%。BMI与膝关节镜术前、术后4d及术后1年行走NRS评分呈正相关(P<0.01),是各时间点行走NRS评分的主要影响因素(P<0.01)。结论半月板损伤膝关节镜术后静息痛及行走痛均较术前逐渐降低,BMI是膝关节镜术后行走痛的危险因素,控制体重对减轻膝关节镜术后疼痛具有重要意义。

Objectives To analyze the postoperative pain intensity and explore its possible risk factors following knee arthroscopy in patients with meniscus injury. Methods A total of 167 patients with meniscus injury undergoing knee arthroscopy in West China Hospital of Sichuan University from January 2014 to June 2015 were enrolled in this study. The data including age, gender, ASA grade, body mass index （BMI）, surgical side and type were collected. The resting and walking pain of the knee joint was assessed using the numerical rating scale （NRS） at 24 h before surgery, 4 clays and 1 year after surgery. The pain intensity and its possible risk factors following knee arthroscopy were analyzed. Results The average resting NRS scores at 24 h before surgery, 4 clays and 1 year after surgery were （3.14 ± 1.85）, （2.89 ±1.80） and （1.59 ± 1.10）, respectively. The incidences of moderate to severe resting pain （NRS ≥ 4） were 43.81%, 36.53% and 2.99% respectively. Meanwhile, the average walking NRS scores were （4.89 ± 1.84）, （4.10 ± 1.78） and （1.93 ± 1.14） , respectively. The incidences of moderate to severe walking pain were 71.26% , 61.08% and 7.19 % respectively. There were significantly positive correlation between BMI and walking NRS scores at 24 h before knee arthroscopy, and 4 clays and 1 year after knee arthroscopy （P〈0.01）, and the BMI was the main risk factor of walking NRS score at each time point （P〈0.01）. Conclusion The resting and walking pain of the knee joint progressively reduced after knee arthroscopy, and BMI is an risk factor for postoperative pain and it appears reasonable that weight control is important to reduce the postoperative pain following knee arthroscopy in patients with meniscus injury.