人工全关节置换术后慢性疼痛的相关影响因素及SII、NLR、PLR等炎症指标的预测价值

The Related Influencing Factors of Chronic Pain after Total Joint Arthroplasty Surgery and the Predictive Value of Inflammatory Indicators SII, NLR, and PLR

摘要:

【】目的 探究人工全关节置换术后慢性疼痛发生的相关影响因素,并探讨全身免疫炎症指数(systemic immune-inflammation index, SII)、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)、血小板与淋巴细胞比值(platelet to lymphocyte ratio, PLR)等炎症指标的预测价值。方法 纳入我院2023年12月-2024年6月择期行人工全关节置换术(total joint arthroplasty, TJA)患者478例,其中全膝关节置换术(total knee arthroplasty, TKA)332例,全髋关节置换术(total hip arthroplasty, THA)146例,根据术后3个月疼痛随访情况,将患者分为术后慢性疼痛(chronic postoperative pain,CPSP)组和非CPSP组。比较术前基线情况、术中及术后相关因素。将P<0.10的因素纳入二元Logistic回归分析,建立TKA和THA术后慢性疼痛的预测模型；采用受试者工作特征曲线(ROC)分析危险因素对CPSP的预测价值。结果 ①TKA患者中98例发生CPSP,发生率为29.5%；THA患者中26例发生CPSP,发生率为17.8%；②TKA患者两组间的术前NSIADs类药物服用>30d、术前PSQI>7分、术前及术后24hSII、NLR、PLR水平相比,差异有统计学意义(P<0.05)；THA患者两组间的术后第1d和3d运动时的NRS评分、术前PLR、术后24hSII及PLR水平相比,差异有统计学意义(P<0.05)。③多因素回归分析显示,术前PSQI>7分、术前NASIDs类药物服用>30d、术后24hSII水平是TKA术后慢性疼痛发生的独立危险因素；ROC曲线分析示,术后24hSII的曲线下面积为0.674(95%CI:0.614-0.734),临界值为1637.76,敏感性为0.673,特异性为0.598。④多因素回归分析显示,术后第3d运动时NRS评分是THA术后慢性疼痛发生的独立危险因素；ROC曲线分析示,术后第3d运动时NRS评分的曲线下面积为0.789(95%CI:0.686-0.892)临界值为6.50,敏感性为0.692,特异性为0.832。结论 术后24hSII水平是TKA术后慢性疼痛发生的独立危险因素,且具有一定的预测价值；术后第3d运动时NRS评分是THA术后慢性疼痛发生的独立危险因素。

Abstract:

【】 Objective To predict the risk factors for CPSP after total joint arthroplasty surgery and explore the predictive value of inflammatory markers systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR). Methods 478 patients who underwent elective total joint arthroplasty (TJA) in our hospital from December 2023 to June 2024 were included, including 332 cases of TKA and 146 cases of THA. According to the 3-month postoperative pain follow-up, they were divided into the non-CPSP group and the CPSP group. Compare preoperative baseline conditions, as well as intraoperative and postoperative factors. Incorporate factors with P<0.10 into binary logistic regression analysis to establish a predictive model for CPSP after TKA and THA surgery; Using Receiver Operating Characteristic (ROC) curve to analyze the predictive value of risk factors for postoperative chronic pain. Results ①Among TKA patients, 98 cases experienced CPSP, with an incidence rate of 29.5%; Among THA patients, 26 cases experienced CPSP, with an incidence rate of 17.8% ②There was a statistically significant difference (P<0.05) between the two groups of TKA patients in terms of preoperative use of NASIDs drugs >30 days, preoperative PSQI>7 points, and preoperative and postoperative 24-hour SII, NLR and PLR levels; There was a statistically significant difference (P<0.05) in NRS scores, preoperative PLR, 24-hour SII, and PLR levels between the two groups of THA patients on postoperative day 1 and 3 during exercise ③Multivariate regression analysis showed that preoperative PSQI score>7, preoperative use of NASIDs drugs>30 days, and postoperative 24-hour SII level were independent risk factors for chronic pain after TKA; The analysis of the ROC curves showed that the area under the curve of SII 24 hours after surgery was 0.674 (95% CI: 0.614-0.734), the critical value was 1637.76, the sensitivity was 0.673, and the specificity was 0.598 ④Multivariate regression analysis showed that the NRS score during the third day of postoperative exercise was an independent risk factor for chronic pain after THA surgery; The analysis of the ROC curves showed that the area under the NRS score curve on the third day after surgery was 0.789 (95% CI: 0.686-0.892). The critical value was 6.50, the sensitivity was 0.692, and the specificity was 0.832. Conclusion The postoperative 24-hour SII level is an independent risk factor for chronic pain after TKA and has certain predictive value; The NRS score during the third day of postoperative exercise is an independent risk factor for chronic pain after THA.