全膝关节置换术后发生疼痛灾难化的影响因素分析及风险评估模型的构建与评价

An analysis of influencing factors of pain catastrophizing after total knee arthroplasty and construction and evaluation of a risk assessment model

目的:分析全膝关节置换术(totalknee arthroplasty,TKA)后发生疼痛灾难化的影响因素,构建TKA后发生疼痛灾难化的风险评估模型并评价其应用价值。方法:共纳入采用TKA治疗的膝骨关节炎(knee osteoarthritis,KOA)患者180例,采用调查问卷、量表评价等方法收集患者的性别、年龄、膝关节疼痛时间、是否有固定照护者、是否发生疼痛灾难化等信息和抑郁、紧张、愤怒、疲劳、慌乱、精力、自尊感量表评分及美国膝关节协会(American knee society,AKS)疼痛评分、功能评分,采用电子VonFrey检测仪测定患者的疼痛阈值。根据是否发生疼痛灾难化将患者分为疼痛灾难化组和无疼痛灾难化组。先对2组患者的相关信息进行单因素对比分析,然后对其中组间差异有统计学意义的因素进行Logistic回归分析。建立TKA后发生疼痛灾难化的风险评估模型,计算该模型预测KOA患者TKA后发生疼痛灾难化风险的灵敏度、特异度和准确度,采用受试者操作特征(receiver operating characteristic,ROC)曲线分析评价该模型的应用价值。结果:问卷调查收回有效问卷178份,最终纳入KOA患者178例,其中疼痛灾难化组60例、无疼痛灾难化组118例。2组患者的性别、膝关节疼痛时间、固定照护者情况、疼痛阈值和抑郁、紧张、慌乱、精力、自尊感量表评分及AKS疼痛评分、功能评分的比较,组间差异均有统计学意义[χ^(2)=37.926,P=0.000;Z=-9.038,P=0.000;χ^(2)=59.699,P=0.000;(2.90±0.68)mA,(2.50±0.51)mA,t=4.437,P=0.000;(8.10±0.92)分,(6.11±1.42)分,t=-10.326,P=0.000;(7.52±0.51)分,(6.70±0.71)分,t=7.932,P=0.000;(8.00±1.82)分,(9.59±2.35)分,t=-3.443,P=0.001;(32.18±1.20)分,(34.76±1.72)分,t=-10.403,P=0.000;(41.05±1.14)分,(43.19±1.62)分,t=-9.166,P=0.000;(61.18±2.01)分,(65.57±2.61)分,t=-11.398,P=0.000;(53.88±5.29)分,(62.75±5.47)分,t=-10.336,P=0.000];年龄及愤怒、疲劳量表评分的比较,组间差异均无统计学意义[Z=-0.222,P=0.824;(18.92±3.94)分,(19.62±4.01)分,t=-1.111,P=0.268;(9.10±2.18)分,(9.30±2.38)分,t=-0.535,P=0.593]。Logistic回归分析结果显示,抑郁量表评分是KOA患者TKA后发生疼痛灾难化的危险因素(β=1.531,P=0.000,OR=4.624),AKS疼痛评分和疼痛阈值是其保护因素(β=-0.753,P=0.000,OR=0.471;β=-1.195,P=0.000,OR=3.303)。TKA后发生疼痛灾难化的风险评估模型为P=ex/(1+ex),其中x=1.531×抑郁量表评分-0.753×AKS疼痛评分-1.195×疼痛阈值。以发生疼痛灾难化的实际结果为标准,该模型预测TKA后发生疼痛灾难化风险的灵敏度为93.33%、特异度为97.46%、准确度为96.07%。ROC曲线分析结果显示,依据该模型预测TKA后发生疼痛灾难化风险的曲线下面积为0.993(P=0.000)。结论:抑郁量表评分是KOA患者TKA后发生疼痛灾难化的危险因素,AKS疼痛评分和疼痛阈值是其保护因素;构建的TKA后发生疼痛灾难化的风险评估模型具有较高的应用价值。

Objective:To analyze the influencing factors of pain catastrophiring afer total knee arthroplasty(TKA),construct a risk asessment model of pain cat astrophizing after TKA,and evaluate its application value.Methods:A total of 180 knee ostearthritis(K0A)patients treated with TKA were included,and information on gender,age,duration of knee joint pain,presence of a fixed caregiver,and 0-currence of pain cat astrophizing,as well as depression,anxiety,anger,fatigue,furry,vigor,self-estem scale scores,American Knee Society(AKS)pain scores and functional scores,were ollcted using survey questionnaires,scale evaluation,and other methods.The pain threshold o the palienta W meaured uaing a eloctronie Von Frey derice.The patients wae divided into a pain cahatrophizing group and a non-pain eatatrophicing group baed on wthether they erperieneed pain aastrophing.First,a univariale analyais performed to compare and malyze the relrant indormatin of patiens in the tuo groupe.Subeaquenly,Lagitie regression analysis condueted on the factors that showed sinifint diferenees betheen the te goup.A rial amcsmert mdel for pain eatatrophizing sfher TKA wa etblished,and the senstinity,perdeitry,and scemey of the model in prdieing the riak of pain eraropizingg afer TKA in KOA paiens were caluluted.The reeiver eperating charerenmie(ROC)eure analyis a perdormed to eraluae the aplisatin wvlue d the mode.Reults:A bond of 178 valid questionnaires were oled in the survey,and fnally 178 KOA pains were enolled,ineluding 60 in the pain eatrophiring goup and 118 in the nm pain edarophizing goup There were igificant diferences in gender,dumation of knee joint pin,presene of a firced earegiver,pain threshld,depremion,anoiey,flumy,rigor,elfeteem scake sores,AKS pain soore and funetional some between the ho groupe(χ^(2)=37.926,P=0.000;Z=-9.038,P=0.000;χ^(2)=59.699,P=0.00;2.9±0.68vs2.50±0.51 mA,t=4.437,P=0.000;8.10±0.92vs6.11±1.42 peings,t=-10.326,P=0.000;7.52±0.51 vs6.70±0.71 pints,t=7.932,P=000;8.00±1.82vs9.59±2.35 poins,t=-3.443,P=0.001;32.18±1.20vs34.76±1.72 poins,t=-10.403,P=0.000;41.05±1.14vs43.19±1.62 points,t=-9.16,P0.00;61.18±2.01 vs 65.57±2.61 poite,t=-11.398,P=0.000;53.815.29 vs 62.75±5.47 peinst,t=-10.336,P=0.00).There were no signdient dferenes in was and anger and frige seak seones betneen the two goupe(Z=-0.222,P=0.824;18.92±3.94vs19.62±4.01 pints,t=-1.111,P=0.268;9.10±2.18 vs 9.30±2.38 points,t=-0.535,P=0.593).Lqgitie regreaion anaysis shomed that the depreaion scale seore was a riak fectar for pain aatrophizing aler IKA in KOA paients(β=1.531,P=0.000,OR=4.624),ahile the AKS pain seoare and pain theshold were praecive fecors(β=-0.753,P=0.000,0R=0.471;β=-1.195,P=0.000,OR=3.303).The is acsmen model for the oceumrance of pain catastrophing afer TKA is P=ex/(1+ex),where X=1.531a(depresaion seale seore)-0.753b(AKS pain seore)-1.195e(pain thre-shold).Uaing the seciual oceurence of pain etrophiring s the sandard,the senitiny peifeing,and secumey of the mdel in padie-ting the ril of pain estrophizing after TKA were 93.33%3,97.07%,and repecivel The ROC eurne analysis reula shomed thut the arca under eure of the model for prediesing the nink of pain estropising ather TKA was 0.993(P=0.00).Concdusiom:The depresaion scale sorei a riak feter for the oceumence of pain catrophizing sfher TKA in KOA patiens,while AKS pain seore and pain threshold are proetive facors.The conaneted risk amecament medel for the oceurence d pain eatrophiring ster TKA has a high practical value.