摘要
目的 探讨影响全膝关节置换术(total knee replacement,TKA)患者术后慢性疼痛的高危因素及对应预防策略。方法回顾性选取2020年3月至2023年9月于新乡市中心医院行TKA治疗的258例患者,于术后随访3个月,其中存在慢性疼痛71例患者作为慢性疼痛组,另外187例不存在慢性疼痛患者作为未发生慢性疼痛组。予以单因素和多因素logistic回归分析TKA患者术后慢性疼痛的高危因素。结果慢性疼痛组较未发生慢性疼痛组相比,在年龄、性别、术前抑郁评分、术后24 h疼痛数字等级评定量表(numerical rating scale,NRS)评分、术后3个月美国特种外科医院(Hospital for Special Surgery,HSS)膝关节功能评分、术前应对方式为逃避疼痛、术后3个月应对方式为勇敢面对方面,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,术后24 h NRS评分显示有疼痛、术前应对方式为逃避疼痛、术前抑郁评分升高、术后3个月HSS膝关节功能评分降低是影响TKA患者术后慢性疼痛的高危因素(OR=1.570、1.486、1.432、1.499,P<0.05),术后3个月应对方式为勇敢面对则是影响TKA患者术后慢性疼痛的保护因素(OR=0.660,P<0.05)。结论影响TKA患者术后慢性疼痛的高危因素包括术后24 h NRS评分显示有疼痛、术后3个月HSS膝关节功能评分的降低、术前抑郁评分的升高、术前应对方式为逃避疼痛,影响TKA患者术后慢性疼痛的保护因素则为术后3个月应对方式为勇敢面对,临床可据此进行早期预警并予以针对性的干预方法,从而减少术后慢性疼痛情况的出现。
Objective To explore the high risk factors of chronic pain after total knee replacement(TKA)and the corresponding preventive strategies.Methods Totally 258 patients who underwent TKA in the Xinxiang Central Hospital from March 2020 to September 2023 were selected retrospectively,and were followed up for 3 months after operation.Among them,71 patients with chronic pain served as the chronic pain group,and 187 patients without chronic pain served as the non-chronic pain group.The high risk factors of chronic pain after TKA were analyzed by univariate and multivariate logistic regression.Results Comparing the chronic pain group with the non-chronic pain group,there were differences in age,gender,preoperative depression score,postoperative 24 h pain numerical rating scale(NRS)score,knee joint function score of American Hospital for Special Surgery(HSS)three months after operation,the coping style before operation was to avoid pain and the coping style 3 months after the operation was to face it bravely three months after operation,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that the score of NRS at 24 h after operation showed pain,the coping style before operation was to avoid pain,preoperative depression score increased,and HsS knee function score decressed at 3 months after operation,which were the high risk factors for chronic pain after TKA(OR=1.570,1.486,1.432,1.499,P<0.05).Coping style of bravely facing tthhee ssiittuuaattiioonn 33 mmoonntthhssu aafftter operation wraass tthhee pprrootteeccttivivee ffaaccttor of chronic pain in TKA patients(OR=0.660,P<0.05).Conclusion The high-risk factors affecting chronic pain of TKA patients includes NRS score at 24 h after operation showed pain,lower HSS knee function score at 3 months after operation,higher preoperative depression score,and preoperative coping style was to avoid pain.The protective factor affecting chronic pain of TKA patients is courage to face it 3 months after operation,which can be used for early warning and targeted intervention in clinic to reduce the occurrence of chronic pain after operation.
作者
贾瑞平
杨卫可
田致忠
郭新军
王琳
崔利敏
JIA Rui-ping;YANG Wei-ke;TIAN Zhi-zhong;GUO Xin-jun;WANG Lin;CUI Li-min(Department of Orthopedics,Xinxiang Central Hospital,the Fourth Clinical College of Xinxiang Medical University,Xinxiang,Henan 453500,China)
出处
《医药论坛杂志》
2025年第14期1490-1495,共6页
Journal of Medical Forum
基金
河南省医学科技攻关计划联合共建项目(LHGJ20191326)。
关键词
全膝关节置换术
慢性疼痛
高危因素
预防策略
Total knee replacement
Chronic pain
High risk factors
Preventive strategy
