肩关节镜下肩袖修复术后I型复杂区域疼痛综合征的危险因素分析

Risk factor analysis of type I complex regional pain syndrome after arthroscopic rotator cuff repair

摘要:

目的 探讨肩关节镜下肩袖修复术后发生I型复杂区域疼痛综合征的危险因素。方法 选取2018年1月—2020年10月在湖南省人民医院骨科因肩袖损伤行肩关节镜下肩袖修复术的346例患者，术后发生I型复杂区域疼痛综合征的32例患者为观察组，未发生的314例患者为对照组。比较两组患者的性别构成、年龄、优势侧、冠心病、高血压、糖尿病、颈椎病、高血脂、损伤原因、美国加州大学（UCLA）肩关节评分、视觉模拟评分法（VAS）、Goutallier肩袖肌肉脂肪浸润分型、关节各方向主动活动度和被动活动度、手术时间、住院时间、麻醉方式、撕裂肌腱类型、缝合方式、钙化性肌腱炎、肩峰下滑膜清理、肩峰成型、肱二头肌长头腱切断、Cofield肩袖损伤分型、锚钉数量及缝合肌腱数量；采用多因素Logistic回归分析肩关节镜下肩袖修复术后发生I型复杂区域疼痛综合征的危险因素。结果 两组的性别构成、术前VAS评分、术前UCLA肩关节评分（疼痛部分）、Cofield肩袖损伤分型及Goutallier肩袖肌肉脂肪浸润分型比较，差异有统计学意义（P <0.05）。多因素Logistic回归分析显示，女性［O^R=3.653（95% CI：1.200，11.121）］、术前高VAS评分［O^R=1.609（95% CI：1.115，2.323）］均为肩关节镜下肩袖修复术后发生I型复杂区域疼痛综合征的危险因素（P <0.05）；肩袖小撕裂［O^R=0.177（95% CI：0.038，0.825）］是肩关节镜下肩袖修复术后发生I型复杂区域疼痛综合征的保护因素（P <0.05）。结论 女性患者及术前疼痛度高的患者肩关节镜下肩袖修复术后发生I型复杂区域疼痛综合征的风险较高，肩袖小撕裂的患者肩关节镜下肩袖修复术后发生I型复杂区域疼痛综合征的风险较低。肩关节镜下肩袖修复术前应评估上述因素，及早采取应对与干预措施。

关键词:肩袖损伤;肩袖修复术;肩关节镜;复杂区域疼痛综合征;危险因素

Abstract:

Objective To investigate the risk factors of type 1 complex regional pain syndrome after the arthroscopic rotator cuff repair (ARCR).Methods The clinical data of patients who had the arthroscopic rotator cuff repair 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 type 1 complex regional pain syndrome were included in the observation group, while patients without postoperative type 1 complex regional pain syndrome 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 type 1 complex regional pain syndrome after the arthroscopic rotator cuff repair.Results 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 [O^R = 3.653 (95% CI: 1.200, 11.121)] and the high preoperative VAS score [O^R = 1.609 (95% CI: 1.115, 2.323)] were risk factors for type 1 complex regional pain syndrome after the arthroscopic rotator cuff repair (P < 0.05). The small rotator cuff tear [O^R = 0.177 (95% CI: 0.038, 0.825)] was the protective factor for type 1 complex regional pain syndrome after the arthroscopic rotator cuff repair (P < 0.05).Conclusions The female patients and patients who have the high level of preoperative pain intensity have relatively high chance of developing type 1 complex regional pain syndrome after the arthroscopic rotator cuff repair, while patients with the small rotator cuff tear are less prone to suffer type 1 complex regional pain syndrome after the arthroscopic rotator cuff repair. It is recommended to evaluate the above factors before the surgery. Taking early response measures and intervention measures are also essential.

Key words:rotator cuff injuries;rotator cuff repair;shoulder arthroscopy;complex regional pain syndrome;risk factors