关节镜下肩袖修复术后早期疼痛影响因素分析  

Analysis of influencing factors of early pain after arthroscopic rotator cuff repair

作　　者：张东芳 王丰坤 杨国栋 郭珈 张英泽 于腾波[2] 孙月荣[2] 戚超[2] 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)

机构地区：[1]青岛大学青岛医学院,山东青岛266073 [2]青岛大学附属医院运动医学科,山东青岛266103

出　　处：《中国修复重建外科杂志》2022年第3期284-290,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨关节镜下肩袖修复术后早期疼痛的影响因素。方法回顾分析2018年6月—2020年10月符合选择标准的592例接受关节镜下肩袖修复术患者临床资料。男239例,女353例;年龄32~81岁,平均58.1岁。术前及术后3 d、6周、3个月,采用疼痛视觉模拟评分(VAS)评估患者疼痛程度;并根据术后VAS评分将患者分为无痛或轻度疼痛组、中重度疼痛组。纳入术前及术中相关因素进行单因素分析,包括年龄、性别、身体质量指数、术前疼痛程度、肩周炎史、高血压史、糖尿病史、吸烟史、受累肌腱(冈上肌腱、冈下肌腱或肩胛下肌腱损伤)、有无冈上肌萎缩、有无脂肪浸润、手术时间、肩袖撕裂程度、使用锚钉数量、是否行肩峰成形术,初步筛选术后疼痛影响因素;进一步采用logistic回归进行多因素分析,筛选危险因素。结果术后3 d 440例(74.3%)患者发生中重度疼痛,6周382例(66.2%),3个月141例(23.8%)。多因素分析显示,术后3 d女性、非全层肩袖撕裂以及术中行肩峰成形术是疼痛危险因素(P<0.05);6周时,女性、合并脂肪浸润、非全层肩袖撕裂以及术中行肩峰成形术是疼痛危险因素(P<0.05);3个月时,女性、合并脂肪浸润以及非全层肩袖撕裂是疼痛危险因素(P<0.05)。结论接受关节镜下肩袖修复术患者中,女性、肩袖撕裂较小、合并脂肪浸润以及术中行肩峰成形术者在术后3个月内疼痛更严重,应重视此类患者术后镇痛管理,提供个性化康复方法,并进行更密切随访。Objective To evaluate the influencing factors that affect early pain after arthroscopic rotator cuff repair. Methods 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. Results 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(P<0.05);the women, combined with fatty infiltration, partial-thickness rotator cuff tear, and acromioplasty were the risk factors at 6 weeks(P<0.05);and the women, combined with fatty infiltration, and partial-thickness rotator cuff tear were risk factors at 3 months(P<0.05).Conclusion Among patients undergoing arthroscopic rotator cuff repair, women, those with smaller rotator cuff tears,combined with fatty infiltration, an

关 键 词：关节镜 肩袖撕裂 肩袖修复术 术后疼痛 疼痛视觉模拟评分 

分 类 号：R687.4[医药卫生—骨科学]