Tian Meimei, Li Zihua, Chen Xujuan, Wu Qiting, Shi Huimin, Zhu Yuchang, Shi Yan
Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, People's Republic of China.
Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, People's Republic of China.
J Pain Res. 2022 Apr 15;15:1091-1105. doi: 10.2147/JPR.S345496. eCollection 2022.
Pain relief is the most important issue in the long-term outcome of arthroplasty surgery, with nearly one-third of patients still suffered persistent pain and caused dissatisfaction after the surgery.
A total of 713 patients underwent primary elective primary TKA and UKA were included consecutively between July 2018 and December 2019, using binary logistic method to analyze the data.
The prevalence of CPSP at rest and on movement at 2-year was 12.1% and 37.7% respectively after primary knee arthroplasty and CPSP at rest factors included: age above 80 (odds ratio [OR]= 6.72, 95% confidence interval [CI] 1.58 to 28.56), BMI above 30 (2.339, 1.02 to 5.383), and moderate to severe pain variables: preoperative pain, (1.95, 1.11 to 3.41); APSP on movement, 4.9 (2.31-10.6); and follow-up contralateral knee pain-at-rest scores (12.6, 5.5 to 28.5). Factors associated with presence of CPSP on movement included: no smoking (2.59, 1.07 to 6.26); and moderate to severe pain variables: preoperative pain, (1.57, 1.073 to 2.30); APSP at rest, (1.85, 1.13 to 3.02); APSP on movement, 6.11 (3.82 to 9.78); and follow-up contralateral knee pain-on-movement scores, 3.22 (2.08 to 5.00). Factors to occurrence of moderate to severe CPSP on movement include: presence of COPD (12.20, 2.19 to 67.98); and moderate to severe pain variables: preoperative pain (2.36, 1.32 to 4.23); APSP on movement (4.68, 1.95 to 11.25); and follow-up contralateral knee pain-on-movement scores (2.71, 1.66 to 4.42).
Prevention strategies should be targeted to different types of pain, and the comorbidity of COPD undergoing knee arthroplasty should receive early identification and attention.
疼痛缓解是关节置换手术长期疗效中最重要的问题,近三分之一的患者术后仍遭受持续性疼痛并导致不满。
2018年7月至2019年12月期间连续纳入713例行初次择期全膝关节置换术(TKA)和单髁膝关节置换术(UKA)的患者,采用二元逻辑回归方法分析数据。
初次膝关节置换术后2年静息时和活动时慢性术后疼痛(CPSP)的发生率分别为12.1%和37.7%,静息时CPSP的相关因素包括:年龄80岁以上(比值比[OR]=6.72,95%置信区间[CI]1.58至28.56)、体重指数(BMI)高于30(2.339,1.02至5.383),以及中度至重度疼痛变量:术前疼痛(1.95,1.11至3.41);活动时急性术后疼痛(APSP),4.9(2.31 - 10.6);以及随访时对侧膝关节静息疼痛评分(12.6,5.5至28.5)。与活动时CPSP存在相关的因素包括:不吸烟(2.59,1.07至6.26);以及中度至重度疼痛变量:术前疼痛(1.57,1.073至2.30);静息时APSP(1.85,1.13至3.02);活动时APSP,6.11(3.82至9.78);以及随访时对侧膝关节活动疼痛评分,3.22(2.08至5.00)。活动时中度至重度CPSP发生的相关因素包括:慢性阻塞性肺疾病(COPD)的存在(12.20,2.19至67.98);以及中度至重度疼痛变量:术前疼痛(2.36,1.32至4.23);活动时APSP(4.68,1.95至11.25);以及随访时对侧膝关节活动疼痛评分(2.71,1.66至4.42)。
预防策略应针对不同类型的疼痛,对接受膝关节置换术的COPD合并症患者应尽早识别并予以关注。