全膝关节置换前股四头肌超声定量分析对置换后慢性疼痛的预测价值  

Ontario and McMaster University,WOMAC Value of preoperative quantitative ultrasound analysis of quadriceps femoris in predicting chronic post-surgical pain after total knee arthroplasty

作　　者：李孝强 陈唯 李明樾 单天驰 申文 Li Xiaoqiang;Chen Wei;Li Mingyue;Shan Tianchi;Shen Wen(Department of Anesthesiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Department of Pain,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏省徐州市221000 [2]徐州医科大学附属医院疼痛科,江苏省徐州市221000

出　　处：《中国组织工程研究》2024年第9期1388-1393,共6页Chinese Journal of Tissue Engineering Research

基　　金：江苏省高校自然科学研究重大项目(16KJA320002),项目负责人:申文;徐州市重点研发计划(社会发展)-医药卫生面上项目(KC22235),项目负责人:申文。

摘　　要：背景:全膝关节置换是治疗终末期膝骨关节炎的有效手段之一,但术后仍有一部分患者经历着慢性疼痛的折磨,寻找术后慢性疼痛发生的影响因素意义重大。人口学因素、社会心理因素和围术期疼痛是以往研究的重点,然而与膝骨关节炎发生发展密切相关的肌肉因素,却鲜有研究报道。目的:评估置换前股四头肌超声定量分析预测全膝关节置换后慢性疼痛的价值。方法:选择2022年1-8月于徐州医科大学附属医院择期全麻下行首次单侧全膝关节置换的膝骨关节炎患者250例,所有患者麻醉方法和手术方式相同。于置换前收集患者一般资料,并使用超声测量患者术侧股四头肌的厚度和回声强度,以此量化肌肉萎缩程度。采用多因素Logistic回归分析置换后慢性疼痛发生的独立影响因素,并用受试者工作特征曲线评估预测价值。结果与结论:①250例受试者进入结果分析,其中91例发生术后慢性疼痛,发生率为36.4%;②慢性疼痛组及非慢性疼痛组患者的置换前运动时疼痛评分、骨关节炎指数评分、焦虑抑郁量表评分、股四头肌厚度、回声强度及置换后急性疼痛评分相比,差异有显著性意义(P<0.05);③多因素回归分析显示,置换前股四头肌厚度是置换后慢性疼痛发生的独立保护因素,置换前运动时膝关节疼痛评分是置换后慢性疼痛发生的独立危险因素;④受试者工作特征曲线分析示,置换前股四头肌厚度的曲线下面积为0.625(95%CI:0.555-0.695),临界值为2.78 cm,敏感性为0.802,特异性为0.415;⑤结果显示,膝骨关节炎患者全膝关节置换前股四头肌厚度是置换后慢性疼痛发生的独立保护因素,但其预测效能低,在临床应用中仍有待进一步验证或改良。BACKGROUND:Total knee arthroplasty is one of the effective methods to treat end-stage knee osteoarthritis.However,some patients still experience chronic post-surgical pain.It is significant to find out the influencing factors of chronic post-surgical pain.Demographic factors,social psychological factors and perioperative pain were the focus of previous studies,but muscle factors closely related to the occurrence and development of knee osteoarthritis were rarely reported.OBJECTIVE:To evaluate the value of preoperative quantitative ultrasound analysis of quadriceps femoris in predicting chronic post-surgical pain after total knee arthroplasty.METHODS:A total of 250 patients with knee osteoarthritis who underwent the first unilateral total knee arthroplasty under elective general anesthesia from January to August 2022 in the Affiliated Hospital of Xuzhou Medical University were selected.All patients were treated with the same anesthesia and operative methods.Before the surgery,clinical data were recorded,and the thickness and echo intensity of quadriceps femoris on the operated side were measured by ultrasound imaging,which could quantify the degree of quadriceps femoris atrophy.Multivariate logistic regression was used to analyze the independent factors affecting the occurrence of chronic post-surgical pain,and receiver operating characteristic curves were used to evaluate its predictive value.RESULTS AND CONCLUSION:(1)250 subjects were involved in the result analysis,and 91 of them had chronic post-surgical pain,with an incidence of 36.4%.(2)There were significant differences between the chronic pain and non-chronic pain groups in preoperative pain score during movement,preoperative Western Ontario and McMaster University Osteoarthritis Index,preoperative anxiety and depression scale score,preoperative muscle thickness and echo intensity of quadriceps femoris,and postoperative acute pain score(P<0.05).(3)Multivariate logistic regression analysis showed that preoperative thickness of quadriceps femoris was an inde

关 键 词：股四头肌 超声 定量分析技术 全膝关节置换 术后慢性疼痛 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R441.1