Predicting total knee replacement pain
Predicting total knee replacement pain
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DOI：
10.1097/01.blo.0000092983.12414.e9
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发表时间：
2003-11-01
影响因子：
4.2
通讯作者：
Houle, T
中科院分区：
文献类型：
--
作者：
Brander, VA;Stulberg, SD;Houle, T
为了描述全膝关节置换术后疼痛的自然史，并确定预测术后过度疼痛的因素，我们采用了一项前瞻性观察性研究，评估术前和膝关节置换术后1、3、6和12个月的临床和影像学变量。数据来源包括视觉模拟疼痛量表和患者健康、心理状态和组件可靠性的其他测量。进行回归分析以确定预测术后疼痛的特定因素，控制变量的不平等，并使用回归诊断进行确认。116例患者（149例膝关节;平均年龄66岁; 55.2%为女性）分别报告了72.3%、44.4%、22.6%、18.4%和13.1%的显著疼痛。麻醉、体重、年龄或性别不存在组间差异。术前疼痛较大的患者术后疼痛更多，使用更多的家庭治疗和术后操作。术前抑郁和焦虑与1年时疼痛加剧相关。膝关节置换术后疼痛迅速消退，3个月时降至约（1）/（2）。然而，八分之一的患者在手术后1年报告中度至重度疼痛，尽管没有临床或放射学异常。为这些患者开发基于办公室的术前筛查工具和干预措施可能会降低术后成本并改善患者感知的结果。
To describe the natural history of pain after total knee arthroplasty and to identify factors predicting excessive postoperative pain, we used a prospective, observational study assessing clinical and radiographic variables preoperatively and at 1, 3, 6, and 12 months after knee replacement. Data sources included the visual analog pain scale and other measures of patient health, psychologic state, and component reliability. Regression analyses were conducted to identify specific factors predictive of postoperative pain, controlling for inequality of variables, and confirmed using regression diagnostics. For 116 patients (149 knees; mean age, 66 years; 55.2% women), significant pain was reported by 72.3%, 44.4%, 22.6%, 18.4%, and 13.1%, respectively. No intergroup differences existed for anesthesia, weight, age, or gender. Patients with greater preoperative pain had more postoperative pain, used more home therapy, and postoperative manipulations. Preoperative depression and anxiety were associated with heightened pain at 1 year. Pain after knee replacement resolves quickly, declining to approximately (1)/(2) by 3 months. However, one in eight patients report moderate to severe pain 1 year after surgery despite an absence of clinical or radiographic abnormalities. Development of office-based preoperative screening tools and interventions for these patients may reduce postoperative costs and improve patient-perceived outcomes.