Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor.
Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor.
JAMA Netw Open. 2020 Dec 1;3(12):e2028929. doi: 10.1001/jamanetworkopen.2020.28929.
Despite appropriate treatment, many patients who sustain distal radius fractures (DRFs) report persistent wrist pain. Chronic musculoskeletal pain is among the leading health problems in the elderly population associated with significant personal and societal burden.
To identify modifiable preoperative factors that are significantly associated with developing chronic pain.
DESIGN, SETTING, AND PARTICIPANTS: This is a secondary analysis of the Wrist and Radius Injury Surgical Trial (WRIST), a randomized multicenter clinical trial of 24 study sites in the United States, Canada, and Singapore that enrolled patients from April 10, 2012, to December 31, 2016. Adults older than 60 years who sustained closed extra-articular DRFs, were treated operatively, and completed 12-month Michigan Hand Outcomes Questionnaires (MHQs) were included in this study. Analysis was conducted from September to December 2019.
Volar locking plate internal fixation, external fixation, or percutaneous pinning.
12-month MHQ pain domain score. Inverse probability weighted logistic regression was used to identify factors associated with of chronic pain.
A total of 146 patients with DRF who were treated operatively and had 12-month MHQ scores met inclusion criteria. The mean (SD) patient age was 68.9 (7.2) years, 128 (87.6%) were women, and 93 (63.7%) were retired. Chronic pain was present in 87 patients (59.6%) and absent in 59 patients (40.4%) at 1-year follow-up. A 1-week delay in surgery was associated with more than triple the odds of developing chronic pain (odds ratio [OR], 3.65; 95% CI, 1.48-9.00), and each 10-point increase in preoperative pain was associated with a 17% increase in the odds of experiencing chronic pain (OR, 1.17; 95% CI, 1.02-1.34). Internal fixation was associated with decreased odds of developing chronic pain compared with the other 2 procedures (OR, 0.29; 95% CI, 0.10-0.90).
In this study, preoperative pain, time to surgery, and procedure type were modifiable factors associated with chronic pain 1 year after DRF treated with surgery. Adequate pain control in patients with acute DRFs even before definitive surgical management and earlier fixation for patients requiring surgery may decrease the risk of developing chronic pain. Internal fixation may decrease the risk of chronic pain after DRF surgery, compared with percutaneous pinning or external fixation.
ClinicalTrials.gov Identifier: NCT01589692.
尽管进行了适当的治疗，许多患有桡骨远端骨折（DRF）的患者仍报告手腕持续疼痛。慢性肌肉骨骼疼痛是老年人中导致严重个人和社会负担的主要健康问题之一。
确定与慢性疼痛发生显著相关的可改变的术前因素。
设计、地点和参与者：这是 Wrist and Radius Injury Surgical Trial（WRIST）的二次分析，这是一项在美国、加拿大和新加坡的 24 个研究地点进行的随机多中心临床试验，纳入了 2012 年 4 月 10 日至 2016 年 12 月 31 日期间接受手术治疗且完成 12 个月密歇根手部结果问卷（MHQ）的年龄超过 60 岁的闭合性关节外 DRF 患者。本研究纳入了 146 名接受手术治疗且有 12 个月 MHQ 疼痛域评分的 DRF 患者。采用逆概率加权逻辑回归分析确定与慢性疼痛相关的因素。
掌侧锁定钢板内固定、外固定或经皮克氏针固定。
12 个月 MHQ 疼痛域评分。
共有 146 名接受手术治疗且有 12 个月 MHQ 评分的 DRF 患者符合纳入标准。患者的平均（SD）年龄为 68.9（7.2）岁，128 名（87.6%）为女性，93 名（63.7%）已退休。在 1 年随访时，87 名患者（59.6%）存在慢性疼痛，59 名患者（40.4%）不存在慢性疼痛。手术延迟 1 周与发生慢性疼痛的几率增加三倍以上相关（比值比[OR]，3.65；95%置信区间[CI]，1.48-9.00），术前疼痛每增加 10 分，发生慢性疼痛的几率就会增加 17%（OR，1.17；95% CI，1.02-1.34）。与其他两种手术方式相比，内固定与发生慢性疼痛的几率降低相关（OR，0.29；95% CI，0.10-0.90）。
在这项研究中，术前疼痛、手术时间和手术方式是与桡骨远端骨折术后 1 年慢性疼痛相关的可改变因素。在接受手术治疗的急性 DRF 患者中，即使在进行确定性手术治疗之前，也要充分控制疼痛，对于需要手术的患者，尽早固定，可能会降低发生慢性疼痛的风险。与经皮克氏针固定或外固定相比，内固定可能会降低桡骨远端骨折手术后发生慢性疼痛的风险。
ClinicalTrials.gov 标识符：NCT01589692。
