全膝关节置换术后疼痛原因分析及疼痛预测模型的研究进展  

Research progress of pain cause analysis and pain prediction models after total knee arthroplasty

作　　者：沈松坡[1] 翁习生[2] 冯宾[2] Shen Songpo;Weng Xisheng;Feng Bin(Department of Orthopaedics,Capital Medical University Beijing Tongren Hospital,Beijing 100730,China;Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences ＆ Peking Union Medical College,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院骨科,100730 [2]中国医学科学院北京协和医学院北京协和医院骨科,100730

出　　处：《中华骨科杂志》2018年第17期1082-1088,共7页Chinese Journal of Orthopaedics

基　　金：国家高技术研究发展计划（863）计划（2015AA033601）

摘　　要：疼痛是全膝关节置换（total knee arthroplastv，TKA）术后最常见的症状，也是导致患者对手术疗效不满意的最主要的原因。既往医生判断疼痛原因时，多关注感染、假体松动、假体位置不良等手术相关因素，对原因不明的疼痛认识不足。2016年Williams和Craig对疼痛的定义进行了更新，强调了疼痛是患者的主观感受，与其认知水平和一些社会因素也有关系。这种新的定义提示要以一种新的思路来分析TKA术后疼痛的原因。国际疼痛学会（International Association forthe Study of Pain，IASP）将慢性疼痛分为伤害感受性疼痛及非伤害感受性疼痛；围术期疼痛、急性感染、假体松动等因素多属于前者；而神经病理性疼痛和特发性疼痛，又称精神心理性疼痛，多为慢性疼痛，属于后者。依照这种思路，重新归纳分析现有文献中可能导致TKA术后疼痛的原因，尤其是以往难以解释原因的疼痛。这种疼痛与患者自身原因，如性别、精神心理因素、睡眠等也有一定的关系。近年来国外的研究者更加关注患者报告的结果（patient—reportedoutcomemea—sures，PROMs），已有研究依据PROMs建立了一些TKA术后结果的预测模型，并获得了初步验证。目前国内对TKA术后疼痛的患者自身因素关注不足，不能在术前对患者术后是否疼痛及满意做出预测，迫切需要建立适合我国患者情况的疼痛预测模型。Pain is the most common symptom after total knee arthroplasty （TKA） and is also the most cause of unsatisfacto- ry. When surgeons judged the cause of pain, they paid more attention to the surgery related factors such as infection, prosthesis loosening and improper location of prosthesis, but without sufficient understanding of some causes of pain. In 2016, William and Craig updated the definition of pain, stressing that pain is the subjective feeling of patient, as well as the cognitive level and some social factors. International Association for the Study of Pain （IASP） divided chronic pain into nociceptive pain and non-nocicep- tive pain. Perioperative pain, acute infection and prosthesis loosening mostly belong to the former, neuropathic pain and idiopathic （psychogenic） pain, mostly as chronic pain, belongs to the latter. According to the criteria, we re-analyzed the potential causes of postoperative pain after TKA, especially the unexplained pain. We found that some of the factors, such as gender, psychosocial sta- tus, sleep et al, also have certain relationships with the postoperative pain. In recent years, researchers abroad have paid more at- tention to the patient-reported outcome measures （PROMs）. Foreign studies have established some postoperative outcome predic- tion models after TKA based on PROMs and obtained preliminary verification. However, domestic studies have not paid enough at- tention to self-factors of patients with postoperative pain. Therefore, it is difficult to predict whether patients would feel pain after TKA. The purpose of the present review is to comprehensively summarize the causes of postoperative pain in TKA patients in a new viewpoint, and to summarize the progress of prediction models of postoperative pain for patients after TKA. Ultimately, the present review is to provide certain references for surgeons to re-understand the causes of postoperative pain in TKA patients and to establish a pain nrediction model suitable for Chinese patients.

关 键 词：全膝关节置换 术后疼痛 预测模型 原因分 WILLIAMS 精神心理因素 神经病理性疼痛 假体松动 

分 类 号：R687.4[医药卫生—骨科学]