膝骨关节炎患者术前广泛疼痛与全膝关节置换术后慢性疼痛的关系

Relationship between preoperative widespread pain and chronic post-surgical pain following total knee arthroplasty in patients with knee osteoarthritis

目的评价膝骨关节炎患者术前广泛疼痛与全膝关节置换术(TKA)后慢性疼痛(CPSP)的关系。方法择期首次全麻下行TKA的单侧原发性膝骨关节炎患者200例,ASA分级Ⅰ~Ⅲ级,年龄40~70岁,术前1 d记录广泛疼痛指数(WPI)评分、VAS评分、医院焦虑抑郁量表(HAD)评分和中枢敏化问卷(CSI)评分。根据术后6个月VAS评分,分为CPSP阳性组和CPSP阴性组。采用logistic回归分析CPSP的危险因素。结果logistic回归分析显示:术前WPI评分、CSI评分和HAD评分升高、女性患者为TKA后发生CPSP的危险因素(P<0.1)。结论膝骨关节炎患者术前广泛疼痛是TKA后发生CPSP的危险因素。

Objective To evaluate the relationship between preoperative widespread pain and chronic post-surgical pain(CPSP)following total knee arthroplasty(TKA)in the patients with knee osteoarthritis.Methods Two hundred American Society of Anesthesiologists physical statusⅠ-Ⅲpatients with knee osteoarthritis,aged 40-70 yr,undergoing elective the first unilateral primary TKA under general anesthesia,were enrolled.The widespread pain index,visual analogue scale score,Hospital Anxiety and Depression Scale and Central Sensitization Inventory scores were recorded at 1 day before surgery.The patients were divided into CPSP-positive group and CPSP-negative group according to visual analogue scale score at 6 months after surgery.Risk factors for CPSP were analyzed by logistic regression.Results The results of logistic regression analysis showed that increased preoperative widespread pain index score,Central Sensitization Inventory score and Hospital Anxiety and Depression Scale score and female were risk factors for CPSP after TKA.Conclusions Preoperative widespread pain is a risk factor for CPSP following TKA in the patients with knee osteoarthritis.