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| 脊柱侧弯矫形术患者术后慢性疼痛的危险因素 |
| Risk factors for chronic post-surgical pain after scoliosis orthopaedics |
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| DOI：10.12089/jca.2022.09.010 |
| 中文关键词: 术后慢性疼痛 脊柱侧弯矫形术 危险因素 预测模型 |
| 英文关键词: Chronic post-surgical pain Scoliosis orthopedics Risk factors Prognostic model |
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| 中文摘要: |
目的 探讨脊柱侧弯矫形术患者术后慢性疼痛（CPSP）的危险因素，并建立预测模型。
方法 回顾性分析2017年1月至2020年9月择期行后入路脊柱侧弯矫形术206例患者资料，男88例，女118例，ASAⅠ—Ⅲ级，根据术后3个月是否发生CPSP将患者分为两组：CPSP组（n=76）和无CPSP组（n=130）。收集术前、术中和术后资料，并通过电话随访获取患者CPSP以及术后3个月并发症（如内固定松动、连接棒断裂、螺钉拔出等）的发生情况。采用多因素Logistic回归分析CPSP的危险因素并建立预测模型。
结果 有76例（36.9%）患者发生CPSP。多因素Logistic回归分析显示：术前VAS疼痛评分＞3分（OR=5.794，95%CI 2.224～15.097，P＜0.001）、融合椎体数增加（每增加1个单位，OR=1.525，95%CI 1.256～1.853，P＜0.001）、术后72 h VAS疼痛评分＞3分（OR=3.022，95%CI 1.360～6.715， P=0.007）以及术后3个月内有并发症（OR=5.424，95%CI 1.058～27.800， P=0.043）是CPSP的危险因素，预测模型的受试者工作特征（ROC）曲线下面积为0.873（95%CI 0.822～0.925，P＜0.001），敏感性85.5%，特异性79.2%。
结论 术前VAS疼痛评分＞3分、融合椎体数增加、术后72 h VAS疼痛评分＞3分以及术后3个月有并发症是脊柱侧弯矫形术患者发生CPSP的危险因素，建立的CPSP风险预测模型可以较好地预测脊柱侧弯患者矫形术CPSP发生的风险。 |
| 英文摘要: |
Objective To explore the risk factors of chronic post-surgical pain (CPSP) after scoliosis orthopedics and establish a predictive model.
Methods A total of 206 patients, 88 males and 118 females, ASA physical statusⅠ-Ⅲ, scheduled for posterior spinal fusion surgery from January 2017 to September 2020 were enrolled. The patients were divided into two groups according to whether they developed CPSP: CPSP group (n = 76) and no CPSP group (n = 130). The preoperative, intraoperative and postoperative data were collected, and the CPSP and postoperative complications (such as loosening of internal fixation, rod breakage, screw removal) were obtained through telephone follow-up. Risk factors of CPSP in patients after scoliosis orthopedics were evaluated using univariate and multiple Logistic regression analysis, and established predictive model.
Results Seventy-six (36.9%) patients developed CPSP. The results of multivariate Logistic regression indicates that the preoperative VAS score > 3 (OR = 5.794, 95% CI 2.224-15.097, P < 0.001), number of fused vertebrae (every 1 unit increased, OR = 1.525, 95% CI 1.256-1.853, P < 0.001), VAS score at 72 hours after operative > 3 (OR = 3.022, 95% CI 1.360-6.715, P = 0.007) and postoperative complications (OR = 5.424, 95% CI 1.058-27.800, P = 0.043) were risk factors of CPSP. The area under the receiver operating characteristic (ROC) curve was 0.873 (95% CI 0.822-0.925, P < 0.001). The predictive model had an ideal sensitivity (85.5%) and specificity (79.2%).
Conclusion Preoperative VAS score > 3, increased number of fused vertebrae, VAS score at 72 hours after operative > 3 and postoperative complications were the risk factors of CPSP in patients with scoliosis. The prognostic model established in our study could better predict the risk of CPSP in patients with scoliosis. |
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