关节镜下肩袖修补术后I型复杂区域疼痛综合征的危险因素分析
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1.湖南省人民医院(湖南师范大学附属第一医院 )骨科;2.湖南省人民医院(湖南师范大学附属第一医院 ) 骨科;3.湖南省人民医院(湖南师范大学附属第一医院 ) 麻醉医学中心

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R686.1

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湖南省重点领域研发计划(No:2020SK2117)


Risk factor analysis of type 1 complex regional pain syndrome after arthroscopic rotator cuff repair
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    摘要:

    摘要:目的 研究关节镜下肩袖修补(ARCR)术后发生I型复杂区域疼痛综合征(CRPS 1)的危险因素。方法 收集2018年1月至2020年10月在湖南省人民医院关节外科因肩袖损伤行ARCR患者的临床资料。以术后发生CRPS 1的患者为CRPS 1组,未发生术后CRPS 1的患者为对照组。对患者的性别、术前视觉模拟疼痛(VAS)评分、Cofield肩袖损伤分型及缝合方式等资料进行单因素分析及多因素Logistic回归分析,以研究各危险因素与ARCR术后发生CRPS 1的关系。结果 纳入研究的346例患者中,32例术后发生CRPS 1(9.25%)。两组在性别、术前VAS评分、术前UCLA评分-疼痛部分、Cofield肩袖损伤分型及Goutallier肩袖肌肉脂肪浸润分型方面比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,性别为女性 [^ OR=3.653(95% CI: 1.200, 11.121)]、术前高VAS评分[^ OR=1.609 (95% CI: 1.115, 2.323)]均为ARCR术后发生CRPS 1的危险因素,而肩袖小撕裂[^ OR=0.177 (95% CI: 0.038, 0.825)] 是ARCR术后发生CRPS 1的保护因素(P<0.05)。结论 女性患者及术前疼痛度高的患者ARCR术后发生CRPS 1的风险较高,肩袖小撕裂的患者ARCR术后发生CRPS 1的风险较低。ARCR术前应评估上述因素,及早采取应对与干预措施。

    Abstract:

    Abstract: 【Objective】 To investigate the risk factors of type 1 complex regional pain syndrome (CRPS 1) after the arthroscopic rotator cuff repair (ARCR). 【Methods】 The clinical data of patients who had the ARCR due to the rotator cuff tear from January 2018 to October 2020 in the department of joint surgery of Hunan Provincial People’s Hospital was collected. Patients who had postoperative CRPS 1 were included in the CRPS 1 group, while patients without postoperative CRPS 1 were included in the control group. The data of patients, including the gender, the visual analogue score (VAS), the Cofield classification of rotator cuff tear, the method of suture and so on were analyzed by univariate analysis firstly and then the multivariate Logistic regression analysis to explore if these risk factors could affect the incidence of CRPS 1 after the ARCR.【Results】 Among all 346 patients who were included in the research, 32 patients were diagnosed with postoperative CRPS 1. The rate of incidence was 9.25%. These two groups had significant differences in the gender, the preoperative VAS, the preoperative pain section of the University of California at Los Angeles (UCLA) shoulder scale, the Cofield classification and the Goutallier classification (P<0.05). Multivariate Logistic regression analysis showed that the female patients [^ OR=3.653 (95% CI: 1.200, 11.121)] and the high preoperative VAS score [^ OR=1.609 (95% CI: 1.115, 2.323)] were risk factors for CRPS 1 after the ARCR (P<0.05). The small rotator cuff tear [^ OR=0.177 (95% CI: 0.038, 0.825)] was the protective factor for CRPS 1 after the ARCR (P<0.05). 【Conclusions】 The female patients and patients who have the high level of preoperative pain intensity have relatively high chance of developing CRPS 1 after the ARCR, while patients with the small rotator cuff tear are less prone to suffer CRPS 1 after the ARCR. It is recommended to evaluate the above factors before the surgery. Taking early response measures and intervention measures are also essential.

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  • 收稿日期:2021-07-08
  • 最后修改日期:2021-09-20
  • 录用日期:2021-10-08
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