Influencing factors for pain after total knee arthroplasty

doi:10.3969/j.issn.2095-4344.2017.07.002

Abstract

Abstract:

BACKGROUND: Pain is the main reason for the recovery of knee function after total knee arthroplasty.

OBJECTIVE: To explore and analyze the influencing factors of pain after total knee arthroplasty.

METHODS: 160 patients with knee osteoarthritis underwent total knee arthroplasty. At 12, 24 and 48 hours after total knee arthroplasty, patients were evaluated with visual analogue scale (VAS) and knee function was assessed with KSS score preoperatively and 90 days postoperatively. Factors, including operation time, age, gender, body mass index, anesthesia method, and preoperative score of KSS were analyzed by Pearson correlation and multiple linear regression. These statistics method also was used to analyze the relationship between the postoperative 90 days score of KSS and postoperative VAS score at each time point.

RESULTS AND CONCLUSION: (1) Pearson correlation analysis and multiple linear regression analysis showed that operation time, gender, and body mass index had been correlated positively with VAS score at 12, 24 and 48 hours postoperatively. (2) Patient age had been correlated negatively with VAS score at 12, 24 and 48 hours postoperatively. (3) VAS score at 12, 24 and 48 hours postoperatively had been correlated negatively with KSS score at 90 days postoperatively. (4) Gender, operation time, body mass index and age are all the influencing factors of the pain after total knee arthroplasty. Pain after total knee arthroplasty affects the recovery of knee function.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Knee, Arthroplasty, Replacement, Knee, Pain, Tissue Engineering

CLC Number:

R318

Shi Bin, An Jing, Chen Long-gang, Zhang Nan, Tian Ye . Influencing factors for pain after total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 993-997.

Figures/Tables 2

2.1 参与者数量分析纳入患者160例，按意向性处理分析，全部进入结果分析。 2.2 影响关节置换后疼痛的因素分别以置换后各时间点(12，24，48 h)VAS评分为因变量，置换前膝关节KSS评分、性别、年龄、体质量指数、置换中所用手术时间、麻醉方式为自变量，分别行相关分析结果见表1，表明手术时间、性别、体质量指数与置换后各时间点(12，24， 48 h)VAS评分呈正相关，年龄与置换后各时间点(12，24，48 h)VAS评分呈负相关。分别以术后各时间点(12，24，48 h)VAS评分为因变量，其他因素为自变量的完全进入的多元回归分析结果见表2，结果表明手术时间、性别、体质量指数与关节置换后各时间点(12，24，48 h)VAS评分呈正相关，年龄与置换后各时间点(12，24，48 h)VAS评分呈负相关。采用P < 0.05为选入，P > 0.10为移出标准的逐步多元回归分析结果见表3。表明有手术时间、年龄、性别、体质量指数入选，根据标准回归系数的绝对值大小排序，其中关节置换后12 h VAS评分对应变量的作用排序为手术时间(0.492)>年龄(0.306)>体质量指数(0.240)>性别(0.184)；置换后24 h VAS评分对应变量的作用排序为手术时间(0.517)>体质量指数(0.247)>年龄(0.237)>性别(0.185)；置换后48 hVAS评分对应变量的作用排序为手术时间(0.472)>体质量指数(0.267)>性别(0.239)>年龄(0.122)；提示手术时间、年龄、性别、体质量指数是影响置换后各时间点(12，24，48 h)VAS评分的主要因素。 2.3 关节置换后疼痛对于膝关节功能恢复的影响以关节置换后90 d膝关节KSS评分为因变量，置换后各时间点(12，24，48 h)VAS评分为自变量，行相关分析结果见表4，表明置换后各时间点(12，24，48 h)VAS评分与置换后90 d 膝关节KSS评分呈负相关。"

References

[1] Tian Y, Xu Y, Fu Q, et al. Notch inhibits chondrogenic differentiation of mesenchymal progenitor cells by targeting Twist1. Mol Cell Endocrinol.2015; 403:30-38.

[2] Richman JM, Liu SS, Courpas G, et al . Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis.Anesth Analg.2006;102:248-257.

[3] Insall JN,Dorr LD,Scott RD,et al.Rationale of the Knee Society clinical rating system.Clin Orthop Relat Res. 1989; (248) : 13-14.

[4] Kurtz SM,Ong KL,Lau E,et al.International survey of primary and revision total knee replacemen.Int Orthop.2011;35(12): 1783-1789.

[5] Buckland J.Osteoarthritis: Targeting cartilage erosion in OA. Nature Reviews Rheumatology.2010;6(2): 62-64.

[6] 童培建,何帮剑,黄余亮. 中医药疗法在全膝关节置换术围手术期的干预作用[J]. 中医正骨,2013,25(1): 8-10.

[7] Bourne RB,Chesworth BM,Davis AM,et al.Patient satisfaction after total knee arthroplasty:who is satisfied and who is not. Clin Orthop Relat Res.2010;468(1):57-63.

[8] Skinner HB,Shintani EY. Results of a multimodal analgesic trial involving patients with total hip or total knee arthroplasty. Am J Orthop ( Belle Mead NJ). 2004;33(2) :85-92.

[9] Horlocker TT,Hebl JR,Kinney MA,et al.Opioid-free analgesia following total knee arthroplasty-a multimodal approach using continuous lumbar plexus (psoas compartment ) block, acetaminophen, and ketorolac. Reg Anesth Pain Med.2002; 27:105-108.

[10] 符培亮,吴宇黎,吴海山,等. 全膝置换术后关节内注射鸡尾酒式镇痛混合剂对镇痛效果的评价[J]. 中华骨科杂志,2008,28(7): 541-545.

[11] 王锦琰.超前镇痛面临的挑战[J].中国疼痛医学杂志,2005,11(6): 321-322.

[12] Mandalia V,Eyres K,Schranz P,et al. Evaluation of patients with a painful total knee replacement.J Bone Joint Surg Br. 2008,90:265-271.

[13] 计忠伟,包倪荣,赵建宁. 人工全膝关节置换术后疼痛原因分析[J]. 中国骨伤,2014,11(27):970-974.

[14] 黎笔熙,郭文军,崔桂林,等.不同止血带压力对血流动力学和代谢及再灌注损伤的影响[J].华南国防医学杂志, 2008,22(4): 883-888.

[15] 马卫华,张树栋,王诗军,等.止血带的使用方式对膝关节置换术失血量和手术时间影响[J].中华关节外科:电子版,2011,5(6):9-13.

[16] Singh JA,Gabriel S,Lewallen D. The impact of gender,age,and preoperative pain severity on pain after TKA.Clin Orthop Relat Res.2008;466(11):2717-2723.

[17] Ritter MA,Wing JT,Berend ME,et al.The clinical effect of gender on outcome of total knee arthroplasty. J Arthroplasty. 2008;23(3):331-336.

[18] 吴晓燕, 陈淑琼, 胡欣. Logistic回归评估膝关节置换术后发生中重度疼痛的影响因素[J]. 浙江临床医学,2015,17(8): 1412-1413.

[19] Lingard EA,Riddle DL. Impact of psychological distress on pain and function following knee arthroplasty.J Bone Joint Surg Am.2007;89(6):1161-1169.

[20] 肖军,严格,罗裕强,等. 疼痛对人工膝关节表面置换术后功能康复的影响[J/CD]. 中华关节外科杂志: 电子版,2014,8(2) : 160-165.