中枢敏化是初次全膝关节置换术后伤口并发症的一个风险因素。
Central sensitization is a risk factor for wound complications after primary total knee arthroplasty.
机构信息
Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea.
Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2018 Nov;26(11):3419-3428. doi: 10.1007/s00167-018-4914-6. Epub 2018 Mar 24.
PURPOSE
Postoperative wound complication is a significant risk factor for subsequent deep periprosthetic joint infection after total knee arthroplasty (TKA). Central sensitization is an abnormal enhancement of pain mechanism involving the central nervous system. Although psychological disorder is widely considered as a risk factor, the relationship between central sensitization and wound complication is currently unclear. Therefore, the purpose of this study was to investigate whether central sensitization was associated with high wound complication rate after primary TKA.
MATERIALS AND METHODS
Between January and June 2016, 161 patients undergoing unilateral TKA were prospectively divided into two groups based on central sensitization inventory score of 40 points after excluding cases with known risk factors such as physical comorbidities, health-related behaviors, and psychological disorders. Group 1 consisted of 112 patients (112 knees) whose central sensitization inventory score was < 40 points and group 2 consisted of 49 patients (49 knees) whose central sensitization inventory score was ≥ 40 points. Wound complications were defined as wound dehiscence, suture granuloma, prolonged wound oozing after postoperative day 5, significant hematoma formation, or surgical site infection recorded during the initial 90-day postoperative period. Demographic data, visual analog scale (VAS), central sensitization inventory score, and wound complications were compared between the two groups.
RESULTS
Wound complications developed in 3 (2.7%) knees in group 1 and 14 (28.6%) knees in group 2 (p < 0.001). Multivariate logistic regression analysis showed that the odds of postoperative wound complications were increased 15.7 times in patients with central sensitization inventory score ≥ 40 (95% CI 4.1-60.0, p < 0.001).
CONCLUSION
Central sensitization is a risk factor for the development of postoperative wound complication after primary TKA.
LEVEL OF EVIDENCE
II.
目的
术后伤口并发症是全膝关节置换术（TKA）后深部假体周围关节感染的重要危险因素。中枢敏化是一种涉及中枢神经系统的异常疼痛机制增强。尽管心理障碍被广泛认为是一个危险因素，但中枢敏化与伤口并发症之间的关系尚不清楚。因此，本研究旨在探讨中枢敏化是否与初次 TKA 后高伤口并发症发生率有关。
材料与方法
2016 年 1 月至 6 月，161 例单侧 TKA 患者前瞻性地根据排除身体合并症、健康相关行为和心理障碍等已知危险因素后中枢敏化量表评分 40 分分为两组。组 1 包括 112 例（112 膝）中枢敏化量表评分<40 分，组 2 包括 49 例（49 膝）中枢敏化量表评分≥40 分。伤口并发症定义为术后 5 天内出现伤口裂开、缝线肉芽肿、伤口持续渗血、明显血肿形成或手术部位感染。比较两组患者的人口统计学数据、视觉模拟评分（VAS）、中枢敏化量表评分和伤口并发症。
结果
组 1 中有 3 例（2.7%）膝关节和组 2 中有 14 例（28.6%）膝关节发生伤口并发症（p<0.001）。多变量 logistic 回归分析显示，中枢敏化量表评分≥40 分的患者术后伤口并发症的可能性增加 15.7 倍（95%CI 4.1-60.0，p<0.001）。
结论
中枢敏化是初次 TKA 后术后伤口并发症的危险因素。
证据等级
II 级。
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