股骨颈骨折患者术后爆发痛发生现状及影响因素分析

赵锋; 颜峰; 孟利锋; 吴巨生; 葛科梁; 王鹏宇; 冯智英

doi:10.16766/j.cnki.issn.1674-4152.002633

股骨颈骨折患者术后爆发痛发生现状及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002633

1.
诸暨市人民医院疼痛科，浙江杭州 311899
2.
台州市中医院骨科，浙江台州 318000
3.
诸暨市人民医院麻醉科

基金项目:

浙江省中医药科技计划项目 2022ZA183

详细信息

通讯作者:
冯智英, E-mail: hg841962@163.com

中图分类号: R683.42
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出版历程
- 收稿日期: 2022-03-18
- 网络出版日期: 2022-11-29

Current situation and influencing factors of postoperative explosive pain in patients with femoral neck fracture

1.
Department of Pain, Zhuji People's Hospital, Zhuji, Zhejiang 311899, China

摘要

摘要: 目的分析股骨颈骨折患者术后爆发痛发生现状及影响因素。方法选取2019年2月—2021年9月诸暨市人民医院骨科收治的200例股骨颈骨折患者，所有患者均于超声引导腰丛-坐骨神经阻滞麻醉下进行手术(加压空心螺钉固定术73例，人工股骨头置换术65例，人工全髋关节置换术62例)。术后12~24 h应用疼痛数字评分法(NRS)进行疼痛评估，统计爆发痛发生率；根据是否出现爆发痛将患者分成爆发痛组与非爆发痛组，比较2组患者相关资料(性别、年龄、民族、文化程度、体重指数、术前NRS评分、手术时间、麻醉时间、ASA分级、手术方式、麻醉方式、合并骨质疏松、术后并发症)，运用logistic回归分析探究爆发痛发生的危险因素。结果 200例患者术后12~24 h的NRS评分为(6.22±1.63)分，出现爆发痛131例，爆发痛发生率为65.50%。爆发痛组131例，非爆发痛组69例，2组患者年龄、术前NRS评分、手术时间、麻醉时间、麻醉方式、合并骨质疏松、术后并发症情况比较差异有统计学意义(均P＜0.05)；多因素logistic分析结果显示，年龄≥60岁是爆发痛发生的保护因素，术前NRS评分≥6分、手术时间≥126 min、麻醉时间≥135 min、单纯神经阻滞、合并骨质疏松、术后发生并发症是爆发痛发生的危险因素。结论股骨颈骨折患者术后爆发痛发生率较高，术前疼痛、手术时间长、麻醉时间长、单纯神经阻滞、合并骨质疏松、术后并发症均是其影响因素，应积极采取预防性干预措施，以降低术后爆发痛的发生风险。
- 股骨颈骨折 /
- 爆发痛 /
- 发生率 /
- 影响因素
Abstract: Objective To analyse the current situation and influencing factors of postoperative explosive pain in patients with femoral neck fracture. Methods A total of 200 patients with femoral neck fracture treated in the Department of Orthopaedics of Zhuji People's Hospital from February 2019 to September 2021 were selected. All patients underwent surgery under ultrasound-guided lumbar plexus sciatic nerve block anaesthesia (73 cases of compression cannulated screw fixation, 65 cases of artificial femoral head replacement, and 62 cases of artificial total hip arthroplasty). Pain was evaluated by digital pain score (NRS) 12 - 24 h after operation, and the incidence of explosive pain was counted. According to the occurrence of explosive pain, the patients were divided into explosive and non-explosive-pain groups. The differences in relevant data (gender, age, nationality, educational level, body mass index, preoperative NRS score, operation time, anaesthesia time, ASA grade, operation mode, anaesthesia mode, osteoporosis, and postoperative complications) between the two groups were compared. The risk factors of the incidence of explosive pain were analysed by logistic analysis. Results The NRS score of 200 patients 12 - 24 h after operation was (6.22±1.63) points, and 131 patients had explosive pain. The incidence of explosive pain was 65.50%. The explosive and non-explosive-pain group had 131 and 69 cases, respectively. The age, preoperative NRS score, operation time, anaesthesia time, anaesthesia mode, osteoporosis, and postoperative complications of the two groups were compared (all P < 0.05). Multivariate logistic analysis showed that age (≥60 years old) was the protective factor of the incidence of explosive pain. Preoperative NRS score (≥6 points), operation time (≥126 min), anaesthesia time (≥135 min), anaesthesia mode (simple nerve block), and osteoporosis (yes) and postoperative complications (yes) were the risk factors. Conclusion The incidence of postoperative explosive pain in patients with femoral neck fracture is high. Preoperative pain, long operation time, long anaesthesia time, simple nerve block, osteoporosis, and postoperative complications are the influencing factors. Preventive intervention measures should be actively taken to reduce the risk of postoperative explosive pain.
- Femoral neck fracture /
- Explosive pain /
- Incidence /
- Influence factor

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表 1 爆发痛组与非爆发痛组患者相关资料比较

Table 1. Comparison of relevant data of patients with and without breakthrough pain group

项目	例数	爆发痛组(n=131)	非爆发痛组(n=69)	统计量	P值
性别[例(%)]				1.451^a	0.228
男性	113	70(53.44)	43(62.32)
女性	87	61(46.56)	26(37.68)
年龄(x±s，岁)		42.76±6.83	56.28±7.57	12.814^b	＜0.001
民族[例(%)]				0.189^a	0.664
汉族	191	124(94.66)	67(97.10)
少数民族	9	7(5.34)	2(2.90)
文化程度[例(%)]				0.116^a	0.944
小学及小学以下	55	36(27.48)	19(27.54)
初中与高中	121	80(61.07)	41(59.42)
大学及大学以上	24	15(11.45)	9(13.04)
体重指数(x±s)		23.25±2.03	23.68±2.25	1.371^b	0.172
术前NRS评分(x±s，分)		6.93±2.20	5.31±1.67	5.355^b	＜0.001
手术时间(x±s，min)		132.23±28.94	120.43±27.93	2.744^b	0.006
麻醉时间(x±s，min)		139.91±32.56	130.72±26.76	2.013^b	0.046
ASA分级[例(%)]				0.072^a	0.788
Ⅰ级	125	81(61.83)	44(63.77)
Ⅱ级	75	50(38.17)	25(36.23)
手术方式[例(%)]				0.205^a	0.903
加压空心螺钉固定术	73	47(35.88)	26(37.68)
人工股骨头置换术	65	44(33.59)	21(30.43)
人工全髋关节置换术	62	40(30.53)	22(31.88)
麻醉方式[例(%)]				4.730^a	0.030
单纯神经阻滞	60	46(35.11)	14(20.29)
神经阻滞联合全身麻醉	140	85(64.89)	55(79.71)
合并骨质疏松[例(%)]				4.464^a	0.035
是	43	34(25.95)	9(13.04)
否	157	97(74.05)	60(86.96)
术后并发症[例(%)]				4.194^a	0.041
是	39	31(23.66)	8(11.59)
否	161	100(76.34)	61(88.41)
注：^a为χ²值，^b为t值。

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表 2 变量赋值说明

Table 2. Description of variable assignment

变量	赋值方法
年龄	≥60岁=1；＜60岁=2
术前NRS评分	≥6分=1；＜6分=2
手术时间	≥126 min=1；＜126 min=2
麻醉时间	≥135 min=1；＜135 min=2
麻醉方式	单纯神经阻滞=1；神经阻滞联合全身麻醉=2
合并骨质疏松	是=1；否=2
术后并发症	是=1；否=2

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表 3 爆发痛发生的logistic回归分析

Table 3. Logistic regression analysis of the occurrence of breakthrough pain group

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄(≥60岁)	-0.140	0.031	20.840	< 0.001	0.869	0.818~0.923
术前NRS评分(≥6分)	0.349	0.146	5.739	0.017	1.418	1.066~1.887
手术时间(≥126 min)	0.639	0.272	5.525	0.019	1.894	1.112~3.226
麻醉时间(≥135 min)	0.303	0.109	7.752	0.007	1.354	1.094~1.676
麻醉方式(单纯神经阻滞)	0.226	0.108	4.356	0.037	1.254	1.014~1.551
合并骨质疏松(是)	0.512	0.259	3.903	0.048	1.668	1.004~2.771
术后并发症(是)	0.888	0.345	6.623	0.010	2.431	1.236~4.782

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