Boyer Elizabeth R, Novaczyk Zachary B, Novacheck Tom F, Symons Frank J, Burkitt Chantel C
Gillette Children's Specialty Healthcare St. Paul MN USA.
Department of Orthopedic Surgery University of Minnesota Minneapolis MN USA.
Paediatr Neonatal Pain. 2021 Dec 18;4(1):44-52. doi: 10.1002/pne2.12067. eCollection 2022 Mar.
While children with cerebral palsy (CP) may undergo 8-22 orthopedic surgeries in their lifetime, little is known about the associated pain. We aimed to assess the pain presence before and one year after lower extremity orthopedic surgery, predictors of pain presence at follow-up, and the association between pain and orthopedic outcomes related to surgery. This retrospective study included 86 children with CP (M age = 10.0 years, SD = 3.2; range = 4.1-17.3 years, Gross Motor Functional Classification System (GMFCS) level I-III) who underwent orthopedic surgery and had completed questionnaires at gait analyses before (M = 2.7 months; range = 0.0-5.7) and after surgery (M = 11.8 months; range = 9.0-14.9). Pain presence, location, and Pediatric Outcomes Data Collection Instrument (PODCI) scores were documented before and after surgery at gait analyses. Pain prevalence was 60% at baseline and 56% at follow-up. Significant predictors of pain presence at follow-up included (1) pain presence at baseline (range of odds ratios [OR] across any/all locations = 3.22 to 15.54), (2) older age (range of OR for any pain, back, knee, and foot pain = 1.24-1.26), (3) female sex (decreased OR for males for ankle pain = 0.12), (4) having hip surgery (decreased OR for foot pain = 0.20), and (5) lower GMFCS level (OR for foot pain = 0.41). Changes in PODCI Sports and Physical Function scores were associated with changes in hip and knee pain ( < .03); PODCI scores worsened for patients who had pain at both time points and improved for patients who had pain at baseline but not follow-up. Pain was present for over half of the participants before and after orthopedic surgery. Pain presence at follow-up was predicted by pain presence at baseline. Pain and functional outcomes were correlated at follow-up. Prospective studies examining perioperative pain experience and factors predicting pain outcomes are warranted.
虽然脑瘫（CP）患儿一生中可能要接受8至22次骨科手术，但对于相关疼痛却知之甚少。我们旨在评估下肢骨科手术前及术后一年的疼痛情况、随访时疼痛存在的预测因素，以及疼痛与手术相关骨科结局之间的关联。这项回顾性研究纳入了86例接受骨科手术且在步态分析前（中位数 = 2.7个月；范围 = 0.0至5.7个月）和术后（中位数 = 11.8个月；范围 = 9.0至14.9个月）完成问卷调查的CP患儿（年龄中位数 = 10.0岁，标准差 = 3.2；范围 = 4.1至17.3岁，粗大运动功能分级系统（GMFCS）I至III级）。在步态分析时记录手术前后的疼痛情况、疼痛部位以及儿童结局数据收集工具（PODCI）评分。基线时疼痛患病率为60%，随访时为56%。随访时疼痛存在的显著预测因素包括：（1）基线时疼痛存在（所有部位的优势比[OR]范围 = 3.22至15.54），（2）年龄较大（任何疼痛、背部、膝盖和足部疼痛的OR范围 = 1.24至1.26），（3）女性（男性脚踝疼痛的OR降低 = 0.12），（4）接受髋关节手术（足部疼痛的OR降低 = 0.20），以及（5）较低的GMFCS级别（足部疼痛的OR = 0.41）。PODCI运动和身体功能评分的变化与髋部和膝盖疼痛的变化相关（P <.03）；在两个时间点都有疼痛的患者PODCI评分恶化，而在基线时有疼痛但随访时没有疼痛的患者评分改善。超过一半的参与者在骨科手术前后都有疼痛。随访时疼痛的存在可由基线时疼痛的存在来预测。随访时疼痛与功能结局相关。有必要进行前瞻性研究以检查围手术期疼痛经历及预测疼痛结局的因素。
