Yang Qiqi, Li Chunning, Ye Min, Zhou Xinhua, Li Weiran, Li Fei
Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China.
The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China.
Front Neurol. 2025 Jan 15;15:1509197. doi: 10.3389/fneur.2024.1509197. eCollection 2024.
Postoperative cognitive dysfunction (POCD) is a common complication after total knee arthroplasty (TKA), impacting recovery and quality of life. This study aims to investigate central sensitization (CS) as an independent risk factor for POCD to improve preoperative screening and postoperative interventions.
A retrospective analysis was conducted on 142 TKA patients from January 2020 to May 2024 across three hospitals. Data were collected at six time points: preoperatively (T0), intraoperatively (T1), and postoperatively on days 1 (T2), 3 (T3), 7 (T4), and 30 (T5). Patients were classified into CS (CSI ≥ 40) and non-CS (CSI < 40) groups according to Central Sensitization Inventory (CSI) score. Cognitive function and POCD incidence were assessed with the Mini-Mental State Examination (MMSE), and knee recovery with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Logistic regression was used to identified risk factors for POCD.
The overall incidence of POCD at T5 was 19.72%, with a significantly higher rate in CS group (30.91%) compared to non-CS group (12.64%) ( = 0.008). MMSE scores declined significantly in both groups at T2 and T3 compared to T0 ( < 0.05), with CS group showing consistently lower scores than non-CS group at T2-T5 ( < 0.05). KOOS scores revealed that CS group had worse pain and quality of life scores at T0, T4, and T5 compared with non-CS group ( < 0.05). Logistic regression revealed that CS, cerebrovascular disease, intraoperative hemorrhage, and preoperative MMSE were associated with the risk of POCD ( < 0.05).
CS is a significant risk factor for POCD following TKA, adversely affecting recovery in terms of pain and quality of life. Prospective studies are warranted to validate findings and develop targeted interventions.
术后认知功能障碍（POCD）是全膝关节置换术（TKA）后常见的并发症，影响患者的康复和生活质量。本研究旨在探讨中枢敏化（CS）作为POCD的独立危险因素，以改善术前筛查和术后干预措施。
对2020年1月至2024年5月期间三家医院的142例TKA患者进行回顾性分析。在六个时间点收集数据：术前（T0）、术中（T1）、术后第1天（T2）、第3天（T3）、第7天（T4）和第30天（T5）。根据中枢敏化量表（CSI）评分，将患者分为CS组（CSI≥40）和非CS组（CSI<40）。采用简易精神状态检查表（MMSE）评估认知功能和POCD发生率，采用膝关节损伤和骨关节炎疗效评分（KOOS）评估膝关节恢复情况。采用逻辑回归分析确定POCD的危险因素。
T5时POCD的总体发生率为19.72%，CS组（30.91%）显著高于非CS组（12.64%）（P = 0.008）。与T0相比，两组在T2和T3时MMSE评分均显著下降（P<0.05），在T2 - T5期间，CS组的评分始终低于非CS组（P<0.05）。KOOS评分显示，与非CS组相比，CS组在T0、T4和T5时的疼痛和生活质量评分更差（P<0.05）。逻辑回归分析显示，CS、脑血管疾病、术中出血和术前MMSE与POCD风险相关（P<0.05）。
CS是TKA术后发生POCD的重要危险因素，对疼痛和生活质量的恢复产生不利影响。有必要进行前瞻性研究以验证研究结果并制定针对性的干预措施。
