全膝关节置换术后慢性疼痛危险因素的Meta分析

Meta-analysis of risk factors for chronicpain after total knee arthroplasty

目的系统评价全膝关节置换术后慢性疼痛相关危险因素,为更好地预防和管理全膝置换术后疼痛提供循证证据。方法计算机检索中国知网、万方数据库、维普网、PubMed、Embase、Cochrane Library、Web of Science等数据库,收集有关全膝关节置换术后慢性疼痛危险因素的队列或病例对照研究,检索时限均为建库起至2023年6月。根据纳排标准,筛选并提取纳入文献的基本信息,予以质量评估并偏倚分析。采用RevMan 5.4软件对数据进行Meta分析。结果最终纳入文献11篇,中文文献4篇,英文文献7篇,包括患者2669例,实验组816例,对照组1853例。Meta分析的结果显示,性别、教育水平、种族、特质焦虑、WOMAC骨性关节炎指数、NRS疼痛评分是全膝关节置换术后慢性疼痛的高危因素(P<0.05)。结论性别、教育水平、种族、特质焦虑指数、术前WOMAC评分、术前NRS评分为全膝关节置换术后慢性疼痛的独立危险因素,临床医师可重点识别并针对性控制高危因素,并对可干预因素予以针对性控制,以预防或减少人工全膝关节置换术后慢性疼痛的发生。

Objective To systematically evaluate the risk factors for chronic pain after total knee arthroplasty(TKA),and to provide evidence-based evidence for better prevention and management of pain after TKA.Methods Cohort or case-control studies on risk factors for chronic pain after TKA published before June 2023 were collected by online searching from CNKI,Wanfang Database,VIP,PubMed,Embase,Cochrane Library,Web of Science and other databases.According to the inclusion and exclusion criteria,the basic information of the included literature was screened and extracted to evaluate the quality and analyze the bias.Meta-analysis was performed using RevMan5.4 software.Results A total of 11 eligible literatures were included,involving 4 published in Chinese language and 7 in English language.A total of 2669 patientswith chronic pain after TKA were included,involving 816 in the experimental group and 1853 in the control group.The results of meta-analysis showed that gender,education level,race,trait anxiety,the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)and the Numerical Rating Scale(NRS)score were risk factors for chronic pain after TKA(P<0.05).Conclusion Gender,education level,race,trait anxiety index,preoperative WOMAC score and preoperative NRS score are independent risk factors for chronic pain after TKA.Clinicians can focus on identifying and controlling risk factors,and control intervention factors,aiming to prevent or reduce the occurrence of chronic pain after TKA.