Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK.
BMJ Open. 2017 Nov 3;7(11):e018105. doi: 10.1136/bmjopen-2017-018105.
To identify postoperative patient-related risk factors for chronic pain after total knee replacement (TKR).
The systematic review protocol was registered on the International Prospective Register of Systematic Reviews (CRD42016041374). MEDLINE, Embase and PsycINFO were searched from inception to October 2016 with no language restrictions. Key articles were also tracked in the Institute for Scientific Information (ISI) Web of Science. Cohort studies evaluating the association between patient-related factors in the first 3 months postoperatively and pain at 6 months or longer after primary TKR surgery were included. Screening, data extraction and assessment of methodological quality were undertaken by two reviewers. The primary outcome was pain severity in the replaced knee measured with a patient-reported outcome measure at 6 months or longer after TKR. Secondary outcomes included adverse events and other aspects of pain recommended by the core outcome set for chronic pain after TKR.
After removal of duplicates, 16 430 articles were screened, of which 805 were considered potentially relevant. After detailed evaluation of full-text articles, 14 studies with data from 1168 participants were included. Postoperative patient-related factors included acute pain (eight studies), function (five studies) and psychosocial factors (four studies). The included studies had diverse methods for assessment of potential risk factors and outcomes, and therefore narrative synthesis was conducted. For all postoperative factors, there was insufficient evidence to draw firm conclusions about the association with chronic pain after TKR. Selection bias was a potential risk for all studies, as none were reported to be conducted at multiple centres.
This systematic review found insufficient evidence to draw firm conclusions about the association between any postoperative patient-related factors and chronic pain after TKR. Further high-quality research is required to provide a robust evidence base on postoperative risk factors, and inform the development and evaluation of targeted interventions to optimise patients' outcomes after TKR.
确定全膝关节置换术后慢性疼痛的患者相关术后风险因素。
本系统评价方案已在国际前瞻性系统评价注册库（CRD42016041374）中注册。检索了 MEDLINE、Embase 和 PsycINFO 数据库，检索时间截至 2016 年 10 月，未对语言进行限制。还在科学信息研究所（ISI）Web of Science 中跟踪了关键文章。纳入了评估患者相关因素在术后 3 个月内与初次 TKR 术后 6 个月或更长时间疼痛之间关联的队列研究。两名审查员进行了筛选、数据提取和方法学质量评估。主要结局是使用患者报告的 TKR 术后 6 个月或更长时间的膝关节疼痛严重程度的测量结果。次要结局包括 TKR 后慢性疼痛的核心结局集推荐的不良事件和疼痛的其他方面。
去除重复项后，共筛选出 16430 篇文章，其中 805 篇被认为具有潜在相关性。在详细评估全文文章后，纳入了 14 项研究，共纳入 1168 名参与者。术后患者相关因素包括急性疼痛（8 项研究）、功能（5 项研究）和心理社会因素（4 项研究）。纳入的研究在评估潜在风险因素和结局的方法上存在差异，因此进行了叙述性综合分析。对于所有术后因素，由于没有研究报告在多个中心进行，因此没有足够的证据得出与 TKR 后慢性疼痛相关的明确结论。选择偏倚是所有研究的潜在风险，因为没有研究报告在多个中心进行。
本系统评价发现，没有足够的证据得出任何术后患者相关因素与 TKR 后慢性疼痛之间存在关联的明确结论。需要进一步进行高质量的研究，为术后风险因素提供可靠的证据基础，并为优化 TKR 后患者结局的靶向干预措施的制定和评估提供信息。
