关节镜治疗肩关节疾病术后疼痛危险因素分析

Analysis of Risk Factors for Postoperative Pain Following Arthroscopic Treatment of Shoulder Joint Diseases

目的探讨关节镜治疗肩关节疾病术后疼痛的危险因素。方法选取2020年9月至2023年1月在空军军医大学第二附属医院骨科行肩关节镜手术治疗的268例患者资料,其中男122例,女146例;年龄38~86岁,平均(56.20±8.88)岁。术后3 d、3个月采用疼痛数字评分(numeric rating scale,NRS)评估患者疼痛程度,并将NRS≥4分的患者纳入术后疼痛组、NRS<4分的患者纳入术后无痛组。比较两组术后3 d和3个月疼痛的影响因素,而后行多因素Logistic回归分析筛查能够导致术后疼痛的独立危险因素。术后3个月采用Constant-Murley肩关节功能评分评定术后疗效并分析两组差异。结果术后268例患者均随访3个月。术后3 d,198例(73.88%)患者发生中重度疼痛;女性、伴有焦虑、术前中重度疼痛是肩关节镜术后3 d疼痛的危险因素(P<0.05)。术后3个月,66例(24.63%)患者发生中重度疼痛;女性、伴有焦虑、睡眠障碍、较小的肩袖撕裂是肩关节镜术后3个月疼痛的危险因素(P<0.05)。术后3个月,无痛组Constant-Murley肩关节功能评分92.74(92.00,92.48)分高于疼痛组90.65(88.98,92.32)分,差异有统计学意义(P<0.05)。结论女性、伴有焦虑、睡眠障碍、较小肩袖撕裂的患者术后3个月内疼痛更加严重,应加强对此类患者术前、术后的镇痛及心理疏导,制定个性化镇痛和康复计划,以降低术后中重度疼痛发生率。

Objective To investigate the risk factors for postoperative pain following arthroscopic treatment of shoulder joint diseases.Methods Data from 268 patients who underwent elective shoulder arthroscopy surgeries at the Second Affiliated Hospital of Air Force Medical University,spanning from September 2020 to January 2023,were selected.This cohort comprised 122 males and 146 females,with ages varying between 38 and 86 years,yielding an average age of(56.20±8.88)years.Pain levels were assessed using the numeric rating scale(NRS)on the 3rd day and 3 months post-surgery,with patients scoring NRS≥4 being categorized into the postoperative pain group and those scoring NRS<4 into the postoperative pain-free group.The influencing factors of pain at 3 days and 3 months post-surgery were compared between the two groups,followed by multivariate logistic regression analysis to screen for independent risk factors leading to postoperative pain.The Constant-Murley shoulder function score was used to evaluate the postoperative efficacy at 3 months,and differences between the two groups were analyzed.Results All 268 patients underwent follow-up assessments for three months post-surgery.On the third day post-operation,198 patients(73.88%)reported experiencing moderate to severe pain.The study identified being female,having accompanying anxiety,and preoperative moderate to severe pain as significant risk factors for postoperative pain following shoulder arthroscopy(P<0.05).At the three-month follow-up,66 patients(24.63%)still experienced moderate to severe pain,with female gender,coexisting anxiety,sleep disorders,and smaller rotator cuff tears emerging as risk factors for pain at this time point(P<0.05).Notably,the Constant-Murley shoulder function score at three months for the pain-free group was significantly higher,at 92.74(92.00,92.48),compared to 90.65(88.98,92.32)for the pain group(P<0.05).Conclusion Patients who are female,accompanied by anxiety,sleep disorders,and smaller rotator cuff tears experience more severe pain within 3 months post-surgery.It is recommended to strengthen preoperative and postoperative analgesia and psychological counseling for such patients,and to develop personalized analgesia and rehabilitation plans to reduce the incidence of moderate to severe postoperative pain.