初次单侧全膝关节置换术后慢性疼痛围术期危险因素分析

Perioperative Risk Factors for Chronic Pain after Primary Unilateral Total Knee Arthroplasty

【目的】探讨初次单侧全膝关节置换术(TKA)术后慢性疼痛(CPSP)的发生率、严重程度和性质,拟寻找导致TKA后CPSP发生的非手术因素。【方法】选择近两年本中心符合条件的接受初次单侧TKA患者380名。回顾性电话问卷,疼痛数字评分法(NRS)和ID pain评分量表法计算患者术后3个月的疼痛程度和性质,收集患者围术期相关信息。对相关信息采用二元Logistic回归分析,筛查TKA后CPSP可能的独立影响因素。【结果】最终纳入338例患者,失访率为11.05%。41.7%(141例)TKA患者术后3个月有CPSP。因CPSP日常活动受到影响的患者有25.1%(85例),导致睡眠障碍的有16.9%(57例)。15.4%患者(52例)疼痛性质为可疑神经病理性疼痛(NP)。围术期相关24项非手术因素中,术前术侧膝关节NRS评分高、自控镇痛泵有效按压率低、术后3个月术侧膝关节肿胀和术后3天C-反应蛋白(CRP)水平低是TKA后CPSP的独立危险因素,P<0.05。【结论】初次单侧TKA患者术后3个月的CPSP发生率仍较高,15.4%的有可疑的神经病理性疼痛。术前术侧NRS高、术后CRP水平低、术后术侧膝关节肿胀、自控镇痛泵有效按压率低是TKA后CPSP的独立危险因素。可通过进一步提高围术期疼痛管理来降低TKA后CPSP的发生。

【Objective】To investigate the incidence,severity and nature of chronic postoperative pain(CPSP)after primary unilateral total knee arthroplasty(TKA),and to screen the possible non-surgery factors leading to CPSP following TKA.【Methods】A total of 380 patients who received primary unilateral TKA in our center were selected.Retrospective telephone questionnaire,numeric rating scales(NRS)and ID pain subscale were used to calculate the degree and nature of pain 3 months after operation,and perioperative information was also collected.Binary logistic regression analysis was used to screen the possible independent risk factors for CPSP after TKA.【Results】A total of 338 patients were included(the lost follow-up rate=11.05%.).Among them,141 cases of TKA patients had experienced CPSP 3 months after operation(41.7%);85 cases of patients were affected by the daily activities of CPSP(25.1%),and 57 cases caused sleep disorders(16.9%).The nature of pain in patients(52 cases,15.4%)was suspected neuropathic pain(NP).Among the 24 nonoperative factors during perioperative period,high preoperative NRS score of knee joint,low effective compression rate of patient-controlled analgesia pump,swelling of knee joint 3 months after operation and low level of C-reactive protein(CRP)3 days after operation were independent risk factors for CPSP after TKA(P<0.05).【Conclusions】The incidence rate of CPSP in patients with primary unilateral TKA was still higher 3 months after operation,in which 15.4%of cases are suspected as neuropathic pain.High preoperative NRS,low postoperative CRP level,postoperative knee joint swelling and low effective compression rate of self-controlled analgesia pump are the independent risk factors for CPSP after TKA.Perioperative pain management should be further improved to reduce the incidence of CPSP after TKA.