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[1]汪賀軒,劉壘,文啟,等.全膝關(guān)節(jié)置換術(shù)后發(fā)生疼痛災(zāi)難化的影響因素分析及風(fēng)險評估模型的構(gòu)建與評價[J].中醫(yī)正骨,2023,35(04):7-11.
　WANG Hexuan,LIU Lei,WEN Qi,et al.An analysis of influencing factors of pain catastrophizing after total knee arthroplasty and construction and evaluation of a risk assessment model[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(04):7-11.
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全膝關(guān)節(jié)置換術(shù)后發(fā)生疼痛災(zāi)難化的影響因素分析及風(fēng)險評估模型的構(gòu)建與評價()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年04期
頁碼:
7-11
欄目:
臨床研究
出版日期:
2023-04-20

文章信息/Info

Title:
An analysis of influencing factors of pain catastrophizing after total knee arthroplasty and construction and evaluation of a risk assessment model
作者:
汪賀軒1; 劉壘1; 文啟1; 金鑫2
(1.鄭州市第七人民醫(yī)院,河南 鄭州 450016; 2.鄭州市第二人民醫(yī)院,河南 鄭州 450006)
Author(s):
WANG Hexuan1; LIU Lei1; WEN Qi1; JIN Xin2
1.The 7th People's Hospital of Zhengzhou,Zhengzhou 450016,Henan,China 2.Zhengzhou Second Hospital,Zhengzhou 450006,Henan,China
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  關(guān)節(jié)成形術(shù); 置換; 膝;  疼痛; 手術(shù)后;  災(zāi)難傾向;  Logistic模型;  危險因素;  因素分析; 統(tǒng)計學(xué);  ROC曲線
Keywords:
osteoarthritis; knee;  arthroplasty; replacement; knee;  pain; postoperative;  catastrophization;  Logistic models;  risk factors;  factor analysis;  statistical;  ROC curve
摘要:
目的:分析全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)后發(fā)生疼痛災(zāi)難化的影響因素,構(gòu)建TKA后發(fā)生疼痛災(zāi)難化的風(fēng)險評估模型并評價其應(yīng)用價值。方法:共納入采用TKA治療的膝骨關(guān)節(jié)炎(knee osteoarthritis,KOA)患者180例,采用調(diào)查問卷、量表評價等方法收集患者的性別、年齡、膝關(guān)節(jié)疼痛時間、是否有固定照護者、是否發(fā)生疼痛災(zāi)難化等信息和抑郁、緊張、憤怒、疲勞、慌亂、精力、自尊感量表評分及美國膝關(guān)節(jié)協(xié)會(American knee society,AKS)疼痛評分、功能評分,采用電子Von Frey檢測儀測定患者的疼痛閾值。根據(jù)是否發(fā)生疼痛災(zāi)難化將患者分為疼痛災(zāi)難化組和無疼痛災(zāi)難化組。先對2組患者的相關(guān)信息進行單因素對比分析,然后對其中組間差異有統(tǒng)計學(xué)意義的因素進行Logistic回歸分析。建立TKA后發(fā)生疼痛災(zāi)難化的風(fēng)險評估模型,計算該模型預(yù)測KOA患者TKA后發(fā)生疼痛災(zāi)難化風(fēng)險的靈敏度、特異度和準確度,采用受試者操作特征(receiver operating characteristic,ROC)曲線分析評價該模型的應(yīng)用價值。結(jié)果:問卷調(diào)查收回有效問卷178份,最終納入KOA患者178例,其中疼痛災(zāi)難化組60例、無疼痛災(zāi)難化組118例。2組患者的性別、膝關(guān)節(jié)疼痛時間、固定照護者情況、疼痛閾值和抑郁、緊張、慌亂、精力、自尊感量表評分及AKS疼痛評分、功能評分的比較,組間差異均有統(tǒng)計學(xué)意義[χ2=37.926,P=0.000; Z=-9.038,P=0.000; χ2=59.699,P=0.000;(2.90±0.68)mA,(2.50±0.51)mA,t=4.437,P=0.000;(8.10±0.92)分,(6.11±1.42)分,t=-10.326,P=0.000;(7.52±0.51)分,(6.70±0.71)分,t=7.932,P=0.000;(8.00±1.82)分,(9.59±2.35)分,t=-3.443,P=0.001;(32.18±1.20)分,(34.76±1.72)分,t=-10.403,P=0.000;(41.05±1.14)分,(43.19±1.62)分,t=-9.166,P=0.000;(61.18±2.01)分,(65.57±2.61)分,t=-11.398,P=0.000;(53.88±5.29)分,(62.75±5.47)分,t=-10.336,P=0.000]; 年齡及憤怒、疲勞量表評分的比較,組間差異均無統(tǒng)計學(xué)意義[Z=-0.222,P=0.824;(18.92±3.94)分,(19.62±4.01)分,t=-1.111,P=0.268;(9.10±2.18)分,(9.30±2.38)分,t=-0.535,P=0.593]。Logistic回歸分析結(jié)果顯示,抑郁量表評分是KOA患者TKA后發(fā)生疼痛災(zāi)難化的危險因素(β=1.531,P=0.000,OR=4.624),AKS疼痛評分和疼痛閾值是其保護因素(β=-0.753,P=0.000,OR=0.471; β=-1.195,P=0.000,OR=3.303)。TKA后發(fā)生疼痛災(zāi)難化的風(fēng)險評估模型為P=ex/(1+ex),其中x=1.531×抑郁量表評分-0.753×AKS疼痛評分-1.195×疼痛閾值。以發(fā)生疼痛災(zāi)難化的實際結(jié)果為標準,該模型預(yù)測TKA后發(fā)生疼痛災(zāi)難化風(fēng)險的靈敏度為93.33%、特異度為97.46%、準確度為96.07%。ROC曲線分析結(jié)果顯示,依據(jù)該模型預(yù)測TKA后發(fā)生疼痛災(zāi)難化風(fēng)險的曲線下面積為0.993(P=0.000)。結(jié)論:抑郁量表評分是KOA患者TKA后發(fā)生疼痛災(zāi)難化的危險因素,AKS疼痛評分和疼痛閾值是其保護因素; 構(gòu)建的TKA后發(fā)生疼痛災(zāi)難化的風(fēng)險評估模型具有較高的應(yīng)用價值。
Abstract:
Objective:To analyze the influencing factors of pain catastrophizing after total knee arthroplasty(TKA),construct a risk assessment model of pain catastrophizing after TKA,and evaluate its application value.Methods:A total of 180 knee osteoarthritis(KOA)patients treated with TKA were included,and information on gender,age,duration of knee joint pain,presence of a fixed caregiver,and occurrence of pain catastrophizing,as well as depression,anxiety,anger,fatigue,flurry,vigor,self-esteem scale scores,American Knee Society(AKS)pain scores and functional scores,were collected using survey questionnaires,scale evaluation,and other methods.The pain threshold of the patients was measured using an electronic Von Frey device.The patients were divided into a pain catastrophizing group and a non-pain catastrophizing group based on whether they experienced pain catastrophizing.First,a univariate analysis was performed to compare and analyze the relevant information of patients in the two groups.Subsequently,Logistic regression analysis was conducted on the factors that showed significant differences between the two groups.A risk assessment model for pain catastrophizing after TKA was established,and the sensitivity,specificity,and accuracy of the model in predicting the risk of pain catastrophizing after TKA in KOA patients were calculated.The receiver operating characteristic(ROC)curve analysis was performed to evaluate the application value of the model.Results:A total of 178 valid questionnaires were collected in the survey,and finally 178 KOA patients were enrolled,including 60 in the pain catastrophizing group and 118 in the non-pain catastrophizing group.There were significant differences in gender,duration of knee joint pain,presence of a fixed caregiver,pain threshold,depression,anxiety,flurry,vigor,self-esteem scale scores,AKS pain score and functional score between the two groups(χ2=37.926,P=0.000; Z=-9.038,P=0.000; χ2=59.699,P=0.000; 2.90±0.68 vs 2.50±0.51 mA,t=4.437,P=0.000; 8.10±0.92 vs 6.11±1.42 points,t=-10.326,P=0.000; 7.52±0.51 vs 6.70±0.71 points,t=7.932,P=0.000; 8.00±1.82 vs 9.59±2.35 points,t=-3.443,P=0.001; 32.18±1.20 vs 34.76±1.72 points,t=-10.403,P=0.000; 41.05±1.14 vs 43.19±1.62 points,t=-9.166,P=0.000; 61.18±2.01 vs 65.57±2.61 points,t=-11.398,P=0.000; 53.88±5.29 vs 62.75±5.47 points,t=-10.336,P=0.000).There were no significant differences in age and anger and fatigue scale scores between the two groups(Z=-0.222,P=0.824; 18.92±3.94 vs 19.62±4.01 points,t=-1.111,P=0.268; 9.10±2.18 vs 9.30±2.38 points,t=-0.535,P=0.593).Logistic regression analysis showed that the depression scale score was a risk factor for pain catastrophizing after TKA in KOA patients(β=1.531,P=0.000,OR=4.624),while the AKS pain score and pain threshold were protective factors(β=-0.753,P=0.000,OR=0.471; β=-1.195,P=0.000,OR=3.303).The risk assessment model for the occurrence of pain catastrophizing after TKA is P=ex/(1+ex),where X=1.531a(depression scale score)-0.753b(AKS pain score)-1.195c(pain thre-shold).Using the actual occurrence of pain catastrophizing as the standard,the sensitivity,specificity,and accuracy of the model in predicting the risk of pain catastrophizing after TKA were 93.33%,97.46%,and 96.07%,respectively.The ROC curve analysis results showed that the area under curve of the model for predicting the risk of pain catastrophizing after TKA was 0.993(P=0.000).Conclusion:The depression scale score is a risk factor for the occurrence of pain catastrophizing after TKA in KOA patients,while AKS pain score and pain threshold are protective factors.The constructed risk assessment model for the occurrence of pain catastrophizing after TKA has a high practical value.

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(收稿日期:2022-10-18 本文編輯:呂寧)

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更新日期/Last Update: 1900-01-01