Rbia Nadia, van der Vlies Cornelis H, Cleffken Berry I, Selles Ruud W, Hovius Steven E R, Nijhuis Tim H J
1 Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
2 Department of Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
Foot Ankle Int. 2017 Sep;38(9):987-996. doi: 10.1177/1071100717712432. Epub 2017 Jul 1.
Unstable ankle fractures require treatment with open reduction and internal fixation (ORIF). Long-term functional outcome is satisfying in most patients; however, a number of patients have persistent complaints. Superficial nerve complications following ankle surgery may be the cause of chronic pain and disability.
In this observational retrospective survey, a cohort of 527 women and men, who underwent ORIF in the period from January 2007 to January 2014, were invited to an online questionnaire. Pain symptoms were assessed using the McGill Pain Questionnaire (MPQ) and the Douleur Neuropathic en 4 Questions (DN4) Questionnaire. Descriptive statistics were used to present patient characteristics; a logistic regression model was used to analyze prognostic factors of neuropathic pain. A total of 271 patients completed the questionnaire. Mean follow-up period was 5.8 years (±1.9).
Persistent neuropathic pain symptoms were present in 61 of all patients, and 51 of these patients reported an impaired quality of life caused by their symptoms. In univariate analysis, the following parameters were associated with neuropathic pain: age, hypertension, a thyroid disorder, lower back pain, fracture dislocations, and late complications such as nonunion, posttraumatic arthritis, or osteochondral injury. In multivariate analysis, an age between 40 and 60 years was found to be a significant predictor of neuropathic pain. Hypertension, dislocation, and late complications were significant predictors of persistent pain without neuropathic characteristics.
The present study demonstrated a prevalence of persistent neuropathic pain symptoms after ORIF for ankle fractures in 23% of the respondents, which caused an impaired health-related quality of life. We identified 4 significant predictors of chronic and neuropathic pain after ORIF. This knowledge may aid the treating surgeon to identify patients who are at increased risk of persistent postoperative neuropathic pain and may affect the treatment of pain in these patients.
Level IV, retrospective case series.
不稳定型踝关节骨折需要切开复位内固定术（ORIF）治疗。大多数患者的长期功能预后令人满意；然而，仍有一些患者存在持续不适。踝关节手术后的浅表神经并发症可能是慢性疼痛和残疾的原因。
在这项观察性回顾性调查中，邀请了2007年1月至2014年1月期间接受ORIF治疗的527名男女参与在线问卷调查。使用麦吉尔疼痛问卷（MPQ）和四问题神经病理性疼痛问卷（DN4）评估疼痛症状。采用描述性统计呈现患者特征；使用逻辑回归模型分析神经性疼痛的预后因素。共有271名患者完成了问卷。平均随访期为5.8年（±1.9）。
所有患者中有61例存在持续性神经性疼痛症状，其中51例患者报告其症状导致生活质量受损。单因素分析中，以下参数与神经性疼痛相关：年龄、高血压、甲状腺疾病、下背部疼痛、骨折脱位以及诸如骨不连、创伤后关节炎或骨软骨损伤等晚期并发症。多因素分析中，40至60岁的年龄被发现是神经性疼痛的显著预测因素。高血压、脱位和晚期并发症是无神经性特征的持续性疼痛的显著预测因素。
本研究表明，踝关节骨折ORIF术后有23%的受访者存在持续性神经性疼痛症状，这导致与健康相关的生活质量受损。我们确定了ORIF术后慢性和神经性疼痛的4个显著预测因素。这些知识可能有助于治疗外科医生识别术后持续性神经性疼痛风险增加的患者，并可能影响这些患者的疼痛治疗。
IV级，回顾性病例系列。
