Zhang Dongfang, Wang Fengkun, Yang Guodong, Guo Jia, Zhang Yingze, Yu Tengbo, Sun Yuerong, Qi Chao
Qingdao College of Qingdao University, Qingdao Shandong, 266073, P. R. China.
Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Mar 15;36(3):284-290. doi: 10.7507/1002-1892.202111020.
To evaluate the influencing factors that affect early pain after arthroscopic rotator cuff repair.
A clinical data of 592 patients who met the selection criteria and underwent arthroscopic rotator cuff repair between June 2018 and October 2020 were retrospectively analyzed. There were 239 males and 353 females, with an average age of 58.1 years (range, 32-81 years). Before operation and at 3 days, 6 weeks, and 3 months after operation, the pain degree of patients was evaluated by visual analogue scale (VAS) score; and the patients were divided into no pain or mild pain group and moderate to severe pain group according to the postoperative VAS score. Preoperative and intraoperative related factors were included for univariate analysis, including age, gender, body mass index, preoperative VAS score, history of frozen shoulder, history of hypertension, history of diabetes, history of smoking, affected tendons (supraspinatus, infraspinatus, or subscapularis tendon injury), supraspinatus muscle atrophy, fatty infiltration, operation time, degree of rotator cuff tear, number of anchors, and whether to perform acromioplasty. The influencing factors of postoperative pain were screened; further logistic regression was used to conduct multivariate analysis to screen for risk factors.
Moderate to severe pain occurred in 440 patients (74.3%) at 3 days after operation, 382 patients (66.2%) at 6 weeks, and 141 patients (23.8%) at 3 months. Multivariate analysis showed that the women, partial-thickness rotator cuff tear, and acromioplasty were risk factors for pain at 3 days after operation ( <0.05); the women, combined with fatty infiltration, partial-thickness rotator cuff tear, and acromioplasty were the risk factors at 6 weeks ( <0.05); and the women, combined with fatty infiltration, and partial-thickness rotator cuff tear were risk factors at 3 months ( <0.05).
Among patients undergoing arthroscopic rotator cuff repair, women, those with smaller rotator cuff tears, combined with fatty infiltration, and acromioplasty have more severe pain within 3 months after operation, and attention should be paid to postoperative analgesia in these patients management, providing an individualized approach to rehabilitation, and closer follow-up.
评估影响关节镜下肩袖修补术后早期疼痛的相关因素。
回顾性分析2018年6月至2020年10月间592例符合入选标准并接受关节镜下肩袖修补术患者的临床资料。其中男性239例，女性353例，平均年龄58.1岁（范围32 - 81岁）。在术前以及术后3天、6周和3个月时，采用视觉模拟评分法（VAS）对患者疼痛程度进行评估；并根据术后VAS评分将患者分为无痛或轻度疼痛组和中度至重度疼痛组。纳入术前及术中相关因素进行单因素分析，包括年龄、性别、体重指数、术前VAS评分、肩周炎病史、高血压病史、糖尿病病史、吸烟史、患侧肌腱（冈上肌、冈下肌或肩胛下肌腱损伤）、冈上肌萎缩、脂肪浸润、手术时间、肩袖撕裂程度、锚钉数量以及是否行肩峰成形术。筛选术后疼痛的影响因素；进一步采用logistic回归进行多因素分析以筛选危险因素。
术后3天有440例患者（74.3%）出现中度至重度疼痛，术后6周有382例患者（66.2%），术后3个月有141例患者（23.8%）。多因素分析显示，女性、部分厚度肩袖撕裂和肩峰成形术是术后3天疼痛的危险因素（<0.05）；女性、合并脂肪浸润、部分厚度肩袖撕裂和肩峰成形术是术后6周的危险因素（<0.05）；女性、合并脂肪浸润和部分厚度肩袖撕裂是术后3个月的危险因素（<0.05）。
在接受关节镜下肩袖修补术的患者中，女性、肩袖撕裂较小、合并脂肪浸润以及行肩峰成形术的患者在术后3个月内疼痛更为严重，在这些患者的管理中应重视术后镇痛，提供个性化的康复方案，并密切随访。
