血脂异常对老年股骨颈骨折行单侧全髋关节置换术患者术后慢性非恶性疼痛的影响

Effects of dyslipidemia on chronic non-malignant pain in elderly patients with femoral neck fractures undergoing unilateral total hip arthroplasty

目的 评估血脂异常对单侧股骨颈骨折行全髋关节置换术的老年患者术后慢性非恶性疼痛(CNP)的影响。方法 选择因单侧股骨颈骨折在静吸复合全麻联合神经阻滞下择期行全髋关节置换术的患者176例,年龄≥60岁。根据血脂水平分为血脂异常组(D组)和血脂正常组(C组),记录两组患者一般资料,并用NRS量表评估术后24 h疼痛评分;随访6个月,应用NRS量表评价术后6个月的疼痛情况,比较两组术后慢性非恶性疼痛的发生率;并对疼痛组和非疼痛组血脂指标进行比较,采用多因素Logistic回归分析CNP相关的血脂指标因素。结果 最终有140例患者完成随访并纳入分析,血脂异常组(D组)46例,对照组(C组)94例。两组一般资料比较差异均无统计学意义(P>0.05),术后慢性疼痛患者44例,发生率为31.43%,其中D组21例(45.65),C组23例(24.74),术后慢性疼痛发生率的比较差异有统计学意义(χ2=6.43,P<0.05);疼痛组与非疼痛组总胆固醇[(4.97±1.15)vs(4.55±1.01)]、甘油三酯[(1.90±0.94)vs(1.48±1.10)]、LDL-C[(3.12±0.93)vs(2.80±0.87)]指标相比差异有统计学意义(P<0.05);多因素Logistic回归分析结果提示总胆固醇、甘油三酯、LDL-C的OR值均>1,但差异无统计学意义(P>0.05)。结论 血脂异常可能会增加老年股骨颈骨折全髋关节置换术后慢性疼痛的发生率,血脂水平的调控可能预防术后慢性疼痛。

Objective To evaluate the effect of dyslipidemia on postoperative chronic non-malignant pain(CNP) in elderly patients with unilateral femoral neck fracture who underwent total hip arthroplasty. Methods A total of 176 patients were selected,aged ≥ 60 years. According to blood lipid levels,they were divided into the dyslipidemia group(group D)and the normal blood lipid group(group C). The general data of the two groups of patients were recorded,and the NRS scale was used to evaluate the pain score at 24 hours after the operation. After 6 months of follow-up,the NRS scale was used to evaluate the pain situation at 6 months after the operation. The postoperative chronic non-malignant pain between the two groups was compared. The incidence was compared;and the blood lipid indexes in the pain group and the non-pain group were compared,and the CNP-related blood lipid index factors were analyzed by multivariate Logistic regression. Results A total of 140 patients were included in the final analysis. There were 46 patients in the group D and 94 patients in the group C. There was no statistical difference in general data between the two groups. There were 44 patients with postoperative chronic pain,with an incidence of 31.43%,including 21 patients in group D(45.65%)and 23 patients in group C(24.74%),with a statistically significant difference(χ2=6.43,P<0.05). The total cholesterol,triglyceride and LDL-C in the pain group were significantly higher than those in the non-pain group,and the difference was statistically significant(P<0.05). The results of multivariate Logistic regression analysis showed that the OR values of total cholesterol,triglyceride and LDL-C were more than 1,but the difference was not statistically significant(P>0.05). Conclusion Dyslipidemia may increase the incidence of chronic pain after total hip arthroplasty in elderly patients with femoral neck fractures,and the regulation of blood lipid levels may prevent postoperative chronic pain.