Wylde V, Dieppe P, Hewlett S, Learmonth I D
University of Bristol, Department of Orthopaedic Surgery, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.
Knee. 2007 Dec;14(6):417-23. doi: 10.1016/j.knee.2007.06.001. Epub 2007 Jun 26.
Total knee replacement (TKR) is considered an effective intervention for the treatment of chronic knee pain and disability. Yet there is increasing evidence, based on research using patient-based outcome measures, that a significant proportion of patients experience chronic knee pain, functional disability, a poor quality of life and dissatisfaction after TKR. Although some poor outcomes after TKR are due to surgical technique and implant factors, much of the pain and disability after surgery is medically unexplained. A range of possible patient factors could contribute to a poor outcome after TKR. Socio-demographic factors that have been found to correlate with a poor outcome after TKR include female gender, older age and low socio-economical status. Medical factors that are highly predictive of pain and disability after TKR are a greater number of co-morbidities and a worse pre-operative status. A range of psychological factors could be predictive of a poor outcome after surgery including depression, low self-efficacy, poor pain coping strategies, somatization, low social support and patient expectations. It is also proposed that a biological explanation for continuing pain after TKR could involve central sensitisation, a dysfunction of pain modulation by the central nervous system. To improve patient selection for TKR, future research needs to focus on developing a pre-operative screening protocol to identify those patients at risk of medically unexplained pain and disability after TKR.
全膝关节置换术（TKR）被认为是治疗慢性膝关节疼痛和残疾的有效干预措施。然而，越来越多基于以患者为基础的结局指标的研究证据表明，相当一部分患者在全膝关节置换术后仍经历慢性膝关节疼痛、功能残疾、生活质量差和不满意。虽然全膝关节置换术后的一些不良结局归因于手术技术和植入物因素，但术后的许多疼痛和残疾在医学上无法解释。一系列可能的患者因素可能导致全膝关节置换术后结局不佳。已发现与全膝关节置换术后不良结局相关的社会人口统计学因素包括女性、老年和社会经济地位低。全膝关节置换术后疼痛和残疾的高度预测性医学因素是更多的合并症和更差的术前状态。一系列心理因素可能预示术后结局不佳，包括抑郁、自我效能感低、疼痛应对策略差、躯体化、社会支持低和患者期望。也有人提出，全膝关节置换术后持续疼痛的生物学解释可能涉及中枢敏化，即中枢神经系统疼痛调节功能障碍。为了改善全膝关节置换术的患者选择，未来的研究需要专注于制定术前筛查方案，以识别那些在全膝关节置换术后有医学上无法解释的疼痛和残疾风险的患者。
