关节镜下半月板成形术治疗盘状半月板的术后疼痛研究

Study on postoperative pain of arthroscopic meniscectomy for discoid meniscus

目的探究关节镜下半月板缝合成型术治疗盘状半月板的术后疼痛对短期内膝关节功能和软骨代谢指标的影响及其危险因素分析。方法选取2017年1月至2018年12月山东大学齐鲁医院运动医学科收治的152例膝关节外侧盘状半月板患者,均接受关节镜下半月板缝合成型术,术后3个月VAS疼痛评分≥1者纳入疼痛组(n=43)、其余患者纳入无痛组(n=109)。采用Lysholm膝关节评分量表(LKSS)、膝关节特种外科医院评分(HSS)评估两组治疗前后的膝关节功能,以酶联免疫吸附法检测并比较两组关节液中软骨代谢指标,并对影响患者术后疼痛的危险因素进行多因素logistic回归分析。结果两组术后3个月的LKSS、HSS评分较术前均明显升高(均为P<0.01),且疼痛组显著低于无痛组(t=12.217,5.928;均为P<0.01)。术后两组关节液中血清基质金属蛋白酶(MMP-1、MMP-3)和金属蛋白酶组织抑制剂(TIMP-1)水平较术前均明显降低(均为P<0.01),且无痛组显著低于疼痛组(t=7.230,12.411,11.504;均为P<0.01)。多因素logistic回归分析结果显示,年龄、关节软骨损伤、负重时间≥1周均为术后疼痛的独立危险因素(OR=5.068,7.893,8.142;P<0.05),术后冷敷为保护因素(OR=0.150,P<0.05)。结论关节镜下半月板缝合成型术治疗盘状半月板在短期内可获得较好的膝关节功能且能改善关节内环境,术后疼痛的发生会产生消极的影响且危险因素多,临床中需予以关注和预防。

Objective To explore the influence of postoperative pain of discoid meniscus under arthroscopy on knee function and cartilage metabolism in the short term and to analyze its risk factors.Methods From January 2017 to December 2018,152 patients with lateral discoid meniscus of knee joint admitted to the Department of Sports Medicine,Qilu Hospital,Shandong University were all treated with arthroscopic meniscus suture.Those with VAS pain score≥1 three months after operation were included in pain group(n=43),and the rest were included in painless group(n=109).The Lysholm knee score scale(LKSS)and Hospital of Special Surgery(HSS)knee score were used to evaluate the knee function of the two groups before and after treatment.Enzyme-linked immunosorbent assay(ELISA)was used to detect and compare cartilage metabolism indexes in joint fluid of the two groups,and multivariate logistic regression analysis was conducted to analyze the risk factors of postoperative pain.Results LKSS and HSS scores of both groups were significantly higher in three months after the surgery than those before the surgery(all P<0.01),and the pain group were significantly lower than the painless group(t=12.217,5.928,both P<0.01).Serum metalloproteinase(MMP)-1,MMP-3 and tissue inhibitor of metalloproteinase-1(TIMP-1)levels in the two groups of joint fluid were significantly lower than those before surgery(all P<0.01),and the levels of the painless group were significantly lower than those of the pain group(t=7.230,12.411,11.504,all P<0.01).Multivariate logistic regression analysis showed that age,articular cartilage injury and loading time≥one week were independent risk factors for postoperative pain(OR=5.068,7.893,8.142,P<0.05),postoperative cold compress as a protective factor(OR=0.150,P<0.05).Conclusions The treatment of discoid meniscus by arthroscopic meniscus suture and plasty can achieve better knee function and improve the intra-articular environment in the short term.Postoperative pain will have a negative impact and there are many risk factors,which should be paid attention to and prevented in clinical practice.