关节镜治疗膝关节疾病的疗效及术后急性期疼痛危险因素分析

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Abstract Objective To investigate the clinical efficacy of arthroscopy in treating knee diseases and the risk factors leading to moderate and severe postoperative pain. Methods A total of 224 patients who underwent elective knee arthroscopic surgery in our department from September 2019 to January 2021，were selected to participate in the study.There were 119 males and 105 females，with an age distribution between 16 and 77 years，with a mean age (43.24±14.01)years.In this study，the numerical rating scale(NRS) of the above patients at 72h postoperatively were evaluated，and the patients with NRS≥4 were included in the postoperative pain group，and patients with NRS<4 were in the postoperative painless group.Factors that might influence postoperative pain were compared between the two groups.The data were then screened by multivariate Logistic regression analysis to effectively analyze the independent risk factors for postoperative pain.The Lysholm knee function score was used to determine the postoperative efficacy at three months after the operation，the occurrence of postoperative complications was recorded，and the differences in Lysholm score between the pain group and the painless group were analyzed.Results All 224 patients were followed up for 3 months postoperatively.88 patients(39.28%) were in the pain group in the acute postoperative phase(72 h postoperative time point) and 136 patients were in the pain free group after surgery.Overall，the Lysholm scale (82.84±5.72) scores of the patients at the 3 month postoperative point were significantly improved from the preoperative (43.82±11.24)scores(P＜0.05).The Lysholm scale (84.58±5.44)score at 3 months was higher in the no pain group than in the pain group (80.16±5.10) at the acute postoperative stage，and the difference was statistically significant(P＜0.05).For the results of univariate analysis of the risk factors associated with pain in the acute postoperative period，age，body mass index(BMI)，anxiety status，depression status，sleep quality，surgical procedures，and articular cartilage damage grade showed statistically significant differences(P＜0.05).Multivariate results analysis showed that advanced age，anxiety score≥9，depression score≥9，sleep quality score≥5，cruciate ligament reconstruction or intercondylar spine avulsion fracture reduction surgical approach，Outerbridge grade Ⅲ~Ⅳ，were independent risk factors for pain during the acute phase after knee arthroscopy.Conclusion Arthroscopic treatment of knee diseases is clinically effective，whereas pain in the acute postoperative period compromises early recovery of knee function.Advanced age，BMI≥24 kg/m²，comorbid anxiety，depression，sleep disturbance，severe articular cartilage damage，cruciate ligament reconstruction or reduction of an avulsed intercondylar spine fracture are risk factors for pain in the acute phase after knee arthroscopy.

Key words： arthroscopy postoperative pain acute phase risk factors

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