AIS患者术后急性疼痛控制与慢性术后疼痛发生及生活质量的关系研究-现代医学

AIS患者术后急性疼痛控制与慢性术后疼痛发生及生活质量的关系研究

单位：南京鼓楼医院脊柱外科10B, 江苏南京 210000

关键词：青少年特发性脊柱侧弯后路脊柱融合术慢性术后疼痛生活质量预测模型受试者工作特征曲线

分类号：R687.3

出版年·卷·期（页码）：2026·54·第七期（1097-1105）

摘要：

目的：探讨青少年特发性脊柱侧弯(AIS)后路脊柱融合术后急性疼痛控制与慢性术后疼痛(CPSP)的发生情况及生活质量的关系，并构建CPSP早期风险预测模型。方法：采用单中心回顾性队列研究设计，纳入2022年9月至2025年6月于本院接受后路脊柱融合术的312例AIS患者。记录术后24、48、72 h视觉模拟评分(VAS)；于术前及术后3、6、12个月采用术前脊柱侧弯研究学会-22r修订版(SRS-22r)量表评估生活质量。根据术后3个月VAS>3分将患者分为CPSP组与非CPSP组。采用多因素Logistic回归分析CPSP的相关因素，构建受试者工作特征(ROC)曲线及联合预测模型，并通过线性混合效应模型分析两组生活质量变化轨迹。进一步根据术后48 h平均VAS(静息痛与活动痛VAS的均值)进行疼痛分层分析，比较不同疼痛水平患者的远期结局。结果：患者术后24 h中重度疼痛发生率为76.3%，术后72 h降至32.1%；术后3个月CPSP发生率为23.1%(72/312)。术后12个月SRS-22r总分由术前(3.47±0.41)分升至(4.22±0.35)分(P<0.001)。多因素Logistic分析显示，术后48 h平均VAS≥5分(OR=2.77，95%CI：1.63~4.70，P<0.001)及术前SRS-22r总分<3.5分(OR=2.10，95%CI：1.26~3.49，P=0.004)是CPSP发生的独立影响因素。ROC曲线分析显示，术后 48 h 平均 VAS、术前 SRS-22r 总分预测 CPSP 的曲线下面积(AUC) 分别为 0.761、0.728；二者联合模型 AUC 达 0.846，判别效能显著优于单一指标(P=0.006)。线性混合效应模型提示，时间、分组主效应及时间×分组交互效应均有统计学意义(均P<0.05)，校正基线后两组生活质量差异随时间增加逐渐增大。疼痛分层分析显示，术后48 h高疼痛组(VAS≥5分)CPSP发生率更高，术后12个月SRS-22r总分显著更低(均P<0.001)。结论：AIS后路脊柱融合术后CPSP发生率较高，并与远期生活质量下降相关。术后48 h内急性疼痛控制不佳、术前生活质量较差是CPSP发生的独立危险因素，联合两项指标构建的预测模型具备良好的早期风险识别能力。

Objective: To explore the relationship between acute pain control, the incidence of chronic post-surgical pain(CPSP) and quality of life in adolescents idiopathic scoliosis(AIS) after posterior spinal fusion, and to establish an early risk prediction model for postoperative CPSP. Methods: A single-center retrospective cohort study was conducted. A total of 312 AIS patients who underwent posterior spinal fusion in our hospital from September 2022 to June 2025 were enrolled. The Visual Analogue Scale(VAS) scores were recorded at 24, 48 and 72 h postoperatively. The Scoliosis Research Society-22r(SRS-22r) questionnaire was used to assess quality of life before surgery and at 3, 6 and 12 months after operation. Patients were divided into the CPSP group and the non-CPSP group according to a VAS score>3 points at 3 months postoperatively. Multivariate Logistic regression analysis was performed to identify factors associated with CPSP. Receiver operating characteristic(ROC) curves and a combined prediction model were constructed. A linear mixed-effects model was adopted to analyze the changing trajectory of quality of life between the two groups. In addition, patients were stratified by the mean VAS score(average of resting pain and activity pain VAS) at 48 h postoperatively, and the long-term outcomes were compared among patients with different pain levels. Results: The incidence of moderate-to-severe pain was 76.3% at 24 h postoperatively, which decreased to 32.1% at 72 h. The overall incidence of CPSP at 3 months after surgery was 23.1%(72/312). The total SRS-22r score increased from(3.47±0.41) points preoperatively to(4.22±0.35) points at 12 months postoperatively(P<0.001). Multivariate Logistic regression analysis revealed that a mean VAS score ≥5 points at 48 h postoperatively(OR=2.77, 95%CI:1.63-4.70, P<0.001) and a preoperative SRS-22r total score＜3.5 points(OR=2.10, 95%CI:1.26-3.49, P=0.004) were independent influencing factors for CPSP. ROC curves analysis showed that the area under the curve(AUC) of the mean VAS score at 48 h postoperatively and the preoperative SRS-22r total score for predicting CPSP was 0.761 and 0.728, respectively. The AUC of the combined model reached 0.846, which was significantly superior to that of single indicators(P=0.006). The linear mixed-effects model indicated that the main effects of time and grouping, as well as the time-by-group interaction effect, were all statistically significant(all P<0.05), and the between-group difference in quality of life gradually increased over time after adjusting for baseline data. Stratified analysis demonstrated that the high-pain group(mean VAS ≥5 points at 48 h postoperatively) had a higher incidence of CPSP and a significantly lower total SRS-22r score at 12 months postoperatively(all P<0.001). Conclusion: The incidence of CPSP is relatively high after posterior spinal fusion for AIS, which is correlated with the decline of long-term quality of life. Poor control of acute pain within 48 h after surgery and low preoperative quality of life are independent risk factors for CPSP. The prediction model combining the two indicators has a good capability for early risk identification.

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