[1]汪贺轩,刘垒,文启,等.全膝关节置换术后发生疼痛灾难化的影响因素分析及风险评估模型的构建与评价[J].中医正骨,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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全膝关节置换术后发生疼痛灾难化的影响因素分析及风险评估模型的构建与评价()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年04期
页码:
7-11
栏目:
临床研究
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:
汪贺轩1; 刘垒1; 文启1; 金鑫2
(1.郑州市第七人民医院,河南 郑州 450016; 2.郑州市第二人民医院,河南 郑州 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
关键词:
骨关节炎; 膝;  关节成形术; 置换; 膝;  疼痛; 手术后;  灾难倾向;  Logistic模型;  危险因素;  因素分析; 统计学;  ROC曲线
Keywords:
osteoarthritis; knee;  arthroplasty; replacement; knee;  pain; postoperative;  catastrophization;  Logistic models;  risk factors;  factor analysis;  statistical;  ROC curve
摘要:
目的:分析全膝关节置换术(total knee arthroplasty,TKA)后发生疼痛灾难化的影响因素,构建TKA后发生疼痛灾难化的风险评估模型并评价其应用价值。方法:共纳入采用TKA治疗的膝骨关节炎(knee osteoarthritis,KOA)患者180例,采用调查问卷、量表评价等方法收集患者的性别、年龄、膝关节疼痛时间、是否有固定照护者、是否发生疼痛灾难化等信息和抑郁、紧张、愤怒、疲劳、慌乱、精力、自尊感量表评分及美国膝关节协会(American knee society,AKS)疼痛评分、功能评分,采用电子Von Frey检测仪测定患者的疼痛阈值。根据是否发生疼痛灾难化将患者分为疼痛灾难化组和无疼痛灾难化组。先对2组患者的相关信息进行单因素对比分析,然后对其中组间差异有统计学意义的因素进行Logistic回归分析。建立TKA后发生疼痛灾难化的风险评估模型,计算该模型预测KOA患者TKA后发生疼痛灾难化风险的灵敏度、特异度和准确度,采用受试者操作特征(receiver operating characteristic,ROC)曲线分析评价该模型的应用价值。结果:问卷调查收回有效问卷178份,最终纳入KOA患者178例,其中疼痛灾难化组60例、无疼痛灾难化组118例。2组患者的性别、膝关节疼痛时间、固定照护者情况、疼痛阈值和抑郁、紧张、慌乱、精力、自尊感量表评分及AKS疼痛评分、功能评分的比较,组间差异均有统计学意义[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]; 年龄及愤怒、疲劳量表评分的比较,组间差异均无统计学意义[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回归分析结果显示,抑郁量表评分是KOA患者TKA后发生疼痛灾难化的危险因素(β=1.531,P=0.000,OR=4.624),AKS疼痛评分和疼痛阈值是其保护因素(β=-0.753,P=0.000,OR=0.471; β=-1.195,P=0.000,OR=3.303)。TKA后发生疼痛灾难化的风险评估模型为P=ex/(1+ex),其中x=1.531×抑郁量表评分-0.753×AKS疼痛评分-1.195×疼痛阈值。以发生疼痛灾难化的实际结果为标准,该模型预测TKA后发生疼痛灾难化风险的灵敏度为93.33%、特异度为97.46%、准确度为96.07%。ROC曲线分析结果显示,依据该模型预测TKA后发生疼痛灾难化风险的曲线下面积为0.993(P=0.000)。结论:抑郁量表评分是KOA患者TKA后发生疼痛灾难化的危险因素,AKS疼痛评分和疼痛阈值是其保护因素; 构建的TKA后发生疼痛灾难化的风险评估模型具有较高的应用价值。
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 本文编辑:吕宁)

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