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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参考文献(21)

[1]	SORT R, BRORSON S, GÖGENUR I, et al. Peripheral nerve block anaesthesia and postoperative pain in acute ankle fracture surgery: The AnAnkle randomised trial[J]. Br J Anaesth, 2021, 126(4): 881-888. doi: 10.1016/j.bja.2020.12.037
[2]	李林锋, 郑传东, 李强, 等. 超声引导髂筋膜间隙阻滞联合骶丛神经阻滞复合喉罩全麻在老年髋关节置换术中的应用[J]. 实用医院临床杂志, 2020, 17(4): 57-59. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC202004018.htm LI L F, ZHENG C D, LI Q, et al. Application of ultrasound-guided iliac fascia compartment block and sacral plexus block combined with laryngeal mask general anesthesia in elderly patients undergoing hip replacement[J]. Practical Journal of Clinical Medicine, 2020, 17(4): 57-59. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC202004018.htm
[3]	苏孟勤, 钟巍, 安静, 等. 超声引导下神经阻滞对老年骨质流失性骨折患者应激反应和镇痛效果的影响[J]. 安徽医学, 2021, 42(6): 643-647. doi: 10.3969/j.issn.1000-0399.2021.06.014 SU M Q, ZHONG W, AN J, et al. Effect of ultrasound-guided nerve block on stress response and analgesia in elderly patients with bone loss fracture[J]. Anhui Medical Journal, 2021, 42(6): 643-647. doi: 10.3969/j.issn.1000-0399.2021.06.014
[4]	张灿华, 钱金桥. 超声引导下外周神经阻滞麻醉对老年人下肢骨科术后功能恢复的影响[J]. 昆明医科大学学报, 2017, 38(2): 54-57. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX201702012.htm ZHANG C H, QIAN J Q. The effect of peripheral nervous block anesthesia guided by ultrasound on the functional recovery after senile lower extremity surgery[J]. Journal of Kunming Medical University, 2017, 38(2): 54-57. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX201702012.htm
[5]	郑兰兰, 王仿, 吴献伟, 等. 喉罩全麻联合超声引导下神经阻滞在老年患者下肢骨折手术中的应用[J]. 陕西医学杂志, 2017, 46(2): 214-215. doi: 10.3969/j.issn.1000-7377.2017.02.032 ZHENG L L, WANG F, WU X W, et al. Application of laryngeal mask anesthesia combined with ultrasound-guided nerve block in the operation of lower extremity fracture in elderly patients[J]. Shaanxi Medical Journal, 2017, 46(2): 214-215. doi: 10.3969/j.issn.1000-7377.2017.02.032
[6]	施芸岑, 方婕, 仓静, 等. 超声引导下周围神经阻滞后暴发痛的临床特征及影响因素分析[J]. 中国临床医学, 2019, 26(3): 420-424. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX201903019.htm SHI Y C, FANG J, CANG J, et al. Clinical characteristics and influencing factors of rebound pain following ultrasound-guided peripheral nerve block[J]. Chinese Journal of Clinical Medicine, 2019, 26(3): 420-424. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX201903019.htm
[7]	程峰, 张蓉, 谢海燕, 等. 程控硬膜外间歇脉冲注入技术联合患者自控镇痛对初产妇爆发痛及分娩结局的影响[J]. 广西医学, 2020, 42(3): 273-276, 289. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX202003010.htm CHENG F, ZHANG R, XIE H Y, et al. Effect of programmed intermittent epidural bolus combined with patient-controll edepidural analgesia on breakthrough pain and delivery outcome in primiparas[J]. Guangxi Medical Journal, 2020, 42(3): 273-276, 289. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX202003010.htm
[8]	马婧, 陈爱华, 郑晨果, 等. 复方中药熏洗配合中医护理干预对肛裂术后患者伤口愈合情况以及NRS评分的影响[J]. 中华全科医学, 2018, 16(10): 1766-1768. doi: 10.16766/j.cnki.issn.1674-4152.000480 MA J, CHEN A H, ZHENG C G, et al. Effect of compound traditional Chinese medicine fumigation and washing combined with traditional Chinese medicine nursing intervention on wound healing and NRS score of patients after anal fissure surgery[J]. Chinese Journal of General Practice, 2018, 16(10): 1766-1768. doi: 10.16766/j.cnki.issn.1674-4152.000480
[9]	张菁, 袁岩. 超声引导下股神经-坐骨神经阻滞复合全麻及术后镇痛在全膝关节置换术中的应用[J]. 实用临床医药杂志, 2017, 21(7): 188-190. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201707065.htm ZHANG J, YUAN Y. Application of ultrasound-guided femoral-sciatic nerve block combined with general anesthesia and postoperative analgesia in total knee arthroplasty[J]. Journal of Clinical Medicine in Practice, 2017, 21(7): 188-190. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201707065.htm
[10]	安小凤, 方良勤, 吴丹. 超声引导下腰骶丛神经阻滞联合全麻在高龄患者髋关节置换术中的临床应用[J]. 中华全科医学, 2021, 19(2): 186-188, 311. doi: 10.16766/j.cnki.issn.1674-4152.001763 AN X F, FANG L Q, WU D. Clinical application of ultrasound-guided low sacral plexus nerve block combined with general anesthesia in hip replacement for elderly patients[J]. Chinese Journal of General Practice, 2021, 19(2): 186-188, 311. doi: 10.16766/j.cnki.issn.1674-4152.001763
[11]	林良山. 神经刺激仪辅助下腰丛联合坐骨神经阻滞麻醉在老年股骨颈骨折患者髋关节置换术中的应用效果[J]. 中国民康医学, 2020, 32(7): 35-37. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMYX202007015.htm LIN L S. Application effect of nerve stimulator assisted low back plexus combined with sciatic nerve block anesthesia in hip arthroplasty in elderly patients with femoral neck fracture[J]. Medical Journal of Chinese People's Health, 2020, 32(7): 35-37. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMYX202007015.htm
[12]	王菁, 陈晨, 孙啸云, 等. 程控间歇脉冲输注联合硬膜外分娩镇痛时产妇爆发痛的相关因素分析[J]. 临床麻醉学杂志, 2021, 37(12): 1250-1253. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ202112004.htm WANG J, CHEN C, SUN X Y, et al. Relevant factors of breakthrough pain during labor analgesia of programmed intermittent epidural bolus combined with patient controlled epidural analgesia[J]. Journal of Clinical Anesthesiology, 2021, 37(12): 1250-1253. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ202112004.htm
[13]	谢雨逸孜, 王江玲, 蔡昀方, 等. 盐酸羟考酮防治瑞芬太尼全身麻醉爆发痛的临床观察[J]. 中国现代医生, 2018, 56(20): 131-134. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS201820037.htm XIE Y Y Z, WANG J L, CAI Y F, et al. Clinical effect of oxycodone hydrochloride in the prevention and treatment of breakthrough pian after general anesthesia using remifentanil[J]. China Modern Doctor, 2018, 56(20): 131-134. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS201820037.htm
[14]	符紫艺, 高泉. 对骨科手术患者行超声引导下神经阻滞复合全身麻醉对其血流动力学指标及术后爆发痛的影响[J]. 当代医药论丛, 2022, 20(4): 103-106. FU Z Y, GOA Q. Effect of ultrasound-guided nerve block combined with general anesthesia on hemodynamic parameters and postoperative burst pain in patients undergoing orthopedic surgery[J]. Contemporary Medical Symposium, 2022, 20(4): 103-106.
[15]	张理, 蒋涛, 席小燕. 系统疼痛管理对老年髋部骨折手术患者应激反应及疼痛阈值的影响[J]. 创伤外科杂志, 2019, 21(8): 595-600. https://www.cnki.com.cn/Article/CJFDTOTAL-CXWK201908009.htm ZHANG L, JIANG T, XI X Y. Effect of the system pain management on stress response, pain threshold in elderly patients undergoing hip fracture operation[J]. Journal of Traumatic Surgery, 2019, 21(8): 595-600. https://www.cnki.com.cn/Article/CJFDTOTAL-CXWK201908009.htm
[16]	冯康平, 张新建, 张春艳. 骨科手术后慢性疼痛发生的危险因素分析及预测模型构建[J]. 职业与健康, 2017, 33(20): 2877-2880. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJK201720038.htm FENG K P, ZHANG X J, ZHANG C Y. Study on risk factors of chronic post-surgical pain in patients undergoing orthopedic surgery and prediction model establishment[J]. Occupation and Health, 2017, 33(20): 2877-2880. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJK201720038.htm
[17]	段宝霖, 刘美义, 马涛, 等. 四肢骨折矫形术后患者慢性手术后疼痛的发生率及其危险因素分析[J]. 现代生物医学进展, 2018, 18(20): 3976-3979, 4000. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX201820040.htm DUAN B L, LIU M Y, MA T, et al. Analysis of incidence and risk factors of postoperative chronic pain after orthopedic surgery for limbs fractures[J]. Progress in Modern Biomedicine, 2018, 18(20): 3976-3979, 4000. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX201820040.htm
[18]	周超, 徐斌, 涂俊. 关节镜治疗膝关节外侧盘状半月板损伤的临床疗效及术后疼痛的危险因素[J]. 中国运动医学杂志, 2019, 38(11): 930-937. https://www.cnki.com.cn/Article/CJFDTOTAL-YDYX201911002.htm ZHOU C, XU B, TU J. The clinical efficacy of arthroscopy in the treatment of lateral discoid meniscus injury of knee joint and the risk factors of postoperative pain[J]. Chinese Journal of Sports Medicine, 2019, 38(11): 930-937. https://www.cnki.com.cn/Article/CJFDTOTAL-YDYX201911002.htm
[19]	赵海军, 崔庆达, 任玮. 影响膝关节盘状半月板损伤患者关节镜术后疼痛的相关因素分析[J]. 中国中医骨伤科杂志, 2020, 28(7): 72-74. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZG202007019.htm ZHAO H J, CUI Q D, REN W. Analysis of related factors affecting pain after arthroscopy in patients with disc meniscus injury of knee joint[J]. Chinese Journal of Traditional Medical Traumatology & Orthopedics, 2020, 28(7): 72-74. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZG202007019.htm
[20]	张克民, 孙保国, 李伟. 四肢骨折矫形术后患者慢性手术后疼痛发生危险因素分析[J]. 中国公共卫生, 2016, 32(10): 1415-1417. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201610031.htm ZHANG K M, SUN B G, LI W. Risk factors of chronic post-surgical pain after orthopedic surgery in patients with extremity fracture[J]. Chinese Journal of Public Health, 2016, 32(10): 1415-1417. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201610031.htm
[21]	王佳倩, 赵万燕, 马鹏芳, 等. 中老年人骨质疏松的影响因素[J]. 甘肃科技, 2019, 35(18): 153-154. https://www.cnki.com.cn/Article/CJFDTOTAL-GSKJ201918054.htm WANG J Q, ZHAO W Y, MA P F, et al. Influencing factors of osteoporosis in middle-aged and elderly people[J]. Gansu Science and Technology, 2019, 35(18): 153-154. https://www.cnki.com.cn/Article/CJFDTOTAL-GSKJ201918054.htm