肩袖损伤关节镜修复术后慢性疼痛的危险因素  

Risk factors of chronic post-surgery pain after arthroscopic rotator cuff repair

作　　者：谢羽婕 季玉秀 吴胜健 王双 义雪莲 蒋佩伶 张驰 XIE Yujie;JI Yuxiu;WU Shengjian;WANG Shuang;YI Xuelian;JIANG Peiling;ZHANG Chi(Department Rehabilitation Medicine,the Affiliated Hospital,Southwest Medical University,Luzhou 646000,China;Department of Rehabilitation Medicine.Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院康复医学科,泸州646000 [2]西南医科大学康复医学系,泸州646000

出　　处：《西南医科大学学报》2023年第6期517-523,共7页Journal of Southwest Medical University

基　　金：四川省科技厅重点研发项目(2021YFS0070);泸州市科技局-西南医科大学应用基础研究(2020LZXNYDJ10,2020LZXNYDJ14);西南医科大学应用基础研究(2021371)。

摘　　要：目的探究肩袖损伤关节镜修复术(arthroscopic rotator cuff repair,ARCR)后慢性疼痛(chronic post-surgical pain,CPSP)的危险因素,以期为ARCR术后疼痛管理提供新的临床依据。方法根据纳排标准,对西南医科大学附属医院骨与关节外科、康复医学科于2021年01月01日至2022年09月30日行ARCR的患者进行初步筛选。术后3个月通过疼痛视觉模拟评分(visual analogue scale,VAS)进行随访,根据术后3个月患侧肩膀是否存在疼痛将纳入病例分为疼痛组和无痛组。收集纳入患者的流行病学资料、围手术期临床资料、术后临床资料。纳入相关因素进行单因素分析初步筛选CPSP的影响因素;进一步采用logistic回归进行多因素分析,筛选危险因素。结果符合纳入标准病例共153例,7例脱落,最终纳入146例,其中疼痛组83例,无痛组63例。单因素分析显示女性、绝经、全层撕裂、肩袖撕裂手术方式、术后疼痛程度、焦虑、睡眠障碍是CPSP的影响因素(P<0.05)。女性(OR=2.75,95%CI 1.35,5.59)、全层撕裂(OR=2.37,95%CI 1.09,5.14)、睡眠障碍(OR=2.84,95%CI 1.22,6.60)、肩袖撕裂手术方式(单排固定缝合OR=3.30,95%CI 1.29,8.44;双排固定缝合OR=3.02,95%CI 1.339,6.82)、肩袖小撕裂(OR=3.48,95%CI 0.14,10.68)是ARCR术后CPSP发生的危险因素。结论女性、全层撕裂、肩袖撕裂手术方式、睡眠障碍、肩袖小撕裂可能会导致ARCR术后CPSP的发生,应重视此类患者术后疼痛的管理,开展个性化康复训练。Objective To investigate the risk factors of chronic post-surgery pain(CPSP)after arthroscopic rotator cuff injury repair(ARCR)for clinical practice.Methods According to the inclusion and exclusion criteria,patients who undergone ARCR were screened from January 1,2021 to September 30,2022 in the Department of Bone and Joint Surgery and Rehabilitation Medicine,Affiliated Hospital of Southwest Medical University.Epidemiological factors,perioperative factors,surgical factors and postoperative factors were collected.Patients were followed up by visual analogue scale(VAS)score after 3 months.According to the VAS scores after surgery,patients were divided into pain group and control non-pain group.Related factors were included in the univariate analysis.Logistic regression was used for multivariate analysis to screen risk factors.Results A total of 153 cases met the inclusion criteria,7 cases fell off,and 146 cases were finally included.This study included 83 cases in the pain group and 63 cases in the non-pain group.Univariate analysis showed that female,menopause,full-thickness tears,rotator cuff tear surgery ways,degree of postoperative pain,anxiety,sleep disturbance were the influencing factors of CPSP(P<0.05).Female(OR=2.75,95%CI 1.35,5.59),full-thickness tear(OR=2.37,95%CI 1.09,5.14),sleep disturbance(OR=2.84,95%CI 1.22,6.60),rotator cuff tear surgical ways(single row fixation OR=3.30,95%CI 1.29,8.44;double rows fixation OR=3.02,95%CI 1.339,6.82),smaller rotator cuff tears(OR=3.48,95%CI 0.14,10.68)were risk factors for CPSP after ARCR.Conclusion Female,full-thickness tear,sleep disturbance,rotator cuff tear surgical ways,and small-size rotator cuff tears could cause CPSP after ARCR.Attention should be paid to postoperative analgesia management and individualized rehabilitation.

关 键 词：关节镜 肩袖修复术 危险因素 慢性术后疼痛 

分 类 号：R687.4[医药卫生—骨科学]