老年患者行全膝关节置换术后慢性疼痛的危险因素及预测模型的建立  

Risk Factors and Predictive Model for Chronic Postoperative Pain in Elderly Patients Undergoing Total Knee Arthroplasty

作　　者：陈诚[1,2] 吴战坡 丁祖运 桂鉴超 CHEN Cheng;WU Zhanpo;DING Zuyun;GUI Jianchao(Department of Sports and Joint Surgery,The Affiliated Nanjing Hospital of Nanjing Medical University,Nanjing,Jiangsu 210006,China;Department of Orthopedics,Nanjing Lishui District People's Hospital,Nanjing,Jiangsu 211200,China)

机构地区：[1]南京医科大学附属南京医院运动关节科,江苏南京210006 [2]南京市溧水区人民医院骨科,江苏南京211200

出　　处：《转化医学杂志》2024年第11期1880-1884,共5页Translational Medicine Journal

基　　金：江苏省南京市卫生科技发展专项资金项目(ZKX21039)。

摘　　要：目的分析老年患者行全膝关节置换术(TKA)后慢性疼痛(CPSP)的危险因素,并建立预测模型。方法选取2022年1月至2024年3月江苏省南京市溧水区人民医院行TKA的154例老年患者为研究对象,根据是否发生CPSP将其分为CPSP组(n=57)和非CPSP组(n=97)。通过多因素Logistic回归分析老年患者TKA后CPSP的影响因素并建立预测模型,采用受试者工作特征曲线分析模型的预测价值。结果术前使用阿片类药物、术前睡眠障碍、术前焦虑、术前抑郁、术后24 h运动数字评价量表(NRS)评分增加和术后24 h C反应蛋白(CRP)升高为老年患者TKA后CPSP的独立危险因素(P均<0.05)。基于独立危险因素建立老年患者TKA后CPSP的预测模型,经霍斯默-莱梅肖检验拟合优度良好(P>0.05)。模型预测老年患者TKA后CPSP的曲线下面积为0.879,敏感度、特异度分别为0.684、0.928。结论使用阿片类药物、睡眠障碍、焦虑、抑郁、NRS评分、CRP为老年患者TKA后CPSP的独立危险因素,基于此建立的预测模型对老年患者TKA后CPSP具有较高的预测价值。Objective To analyze the risk factors for chronic postoperative pain(CPSP)in elderly patients undergoing total knee arthroplasty(TKA)and establish a predictive model.Methods A total of 154 elderly patients with knee osteoarthritis(KOA)who underwent TKA at Nanjing Lishui District People's Hospital from January 2022 to March 2024 were included.Patients were divided into a CPSP group(n=57)and a non-CPSP group(n=97)based on the presence of CPSP.Multivariate logistic regression was used to identify factors influencing CPSP and construct a predictive model.The predictive value of the model was evaluated using the receiver operating characteristic(ROC)curve.Results Preoperative opioid use,sleep disturbances,anxiety,depression,increased 24-hour postoperative numeric rating scale(NRS)pain scores,and elevated 24-hour postoperative C-reactive protein(CRP)levels were identified as independent risk factors for CPSP after TKA in elderly patients(all P<0.05).A predictive model based on these independent risk factors was developed,with the Hosmer-Lemeshow test showing good calibration(P>0.05).The area under the curve(AUC)of the model was 0.879,with a sensitivity of 0.684 and specificity of 0.928.Conclusions Preoperative opioid use,sleep disturbances,anxiety,depression,NRS pain scores,and CRP levels are independent risk factors for CPSP in elderly patients after TKA.The predictive model based on these factors has high predictive value for CPSP in this population.

关 键 词：膝骨关节炎 老年 全膝关节置换术 慢性术后疼痛 危险因素 

分 类 号：R687.4[医药卫生—骨科学]