rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2024-425-430rsp-3610Research ArticleРЕВМООРТОПЕДИЯ И РЕАБИЛИТАЦИЯORTHOPEDIC RHEUMATOLOGY AND REHABILITATIONФакторы, связанные с развитием посттравматической боли у пациентов с риском посттравматического остеоартритаFactors associated with the development of post-traumatic pain in patients at risk of post-traumatic osteoarthritishttps://orcid.org/0000-0002-5256-7346БяликА. А.BialikAnastasia A.

Бялик Анастасия Андреевна

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

nas36839729@yandex.ruhttps://orcid.org/0000-0002-1391-0711КаратеевА. Е.KarateevAndrey E.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-5626-7404МакаровМ. А.MakarovMaxim A.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-7179-8174НестеренкоВ. А.NesterenkoVadim A.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-3745-0924БяликВ. Е.BialikValerii E.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202403092024624425–430Copyright © Бялик А.А., Каратеев А.Е., Макаров М.А., Нестеренко В.А., Бялик В.Е., 20242024Бялик А.А., Каратеев А.Е., Макаров М.А., Нестеренко В.А., Бялик В.Е.Bialik A.A., Karateev A.E., Makarov M.A., Nesterenko V.A., Bialik V.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3610

Цель исследования – выявить факторы, связанные с развитием хронической посттравматической боли (ХПТБ) у пациентов с травмой коленного сустава (КС).

Материалы и методы

Материалы и методы. Исследуемую группу составили 136 пациентов (51,5% женщин, возраст 38,7±12,4 года), перенесших травму КС с повреждением передней крестообразной связки (ПКС) и/или менисков. Критерием включения являлось наличие боли в КС ≥4 по числовой рейтинговой шкале (ЧРШ 0–10) в течение не менее 1 месяца после травмы. Оперативное вмешательство (пластика ПКС, шов мениска, резекция мениска, комбинированные операции) непосредственно после травмы проводилось 48,5% пациентов. Оценивалась частота развития ХПТБ (сохранение боли при движении ≥4 по ЧРШ через 3 и 6 мес. наблюдения) и факторы, взаимосвязанные с развитием ХПТБ. Всем пациентам было рекомендовано использовать ортезы КС, занятия лечебной физкультурой и прием нестероидных противовоспалительных препаратов в режиме «по требованию».

Результаты

Результаты. ХПТБ была зафиксирована через 3 мес. у 33,1%, через 6 мес. – у 32,4% пациентов. Оперативное лечение не влияло на развитие ХПТБ: отношение шансов (ОШ) – 1,241, 95%-й доверительный интервал (95% ДИ): 0,775–1,986 (р=0,474). Риск ХПТБ через 6 мес. был статистически значимо выше у женщин, лиц с высоким индексом массы тела (≥30 кг/м2), исходно сильной болью (≥7 по ЧРШ), при наличии исходно признаков депрессии и тревоги (оценка по Госпитальной шкале тревоги и депрессии (HADS, Hospital Anxiety and Depression Scale) ≥8) и высоковероятной центральной сенситизации (оценка по Опроснику центральной сенситизации (CSI, Central Sensitisation Inventory) ≥40): ОШ=2,152, 95% ДИ: 1,383–3,348 (р=0,002); ОШ=1,243, 95% ДИ: 1,054–1,465 (p=0,05); ОШ=3,567, 95% ДИ: 1,717–5,708 (p=0,001); ОШ=2,330, 95% ДИ: 1,070–5,726 (p=0,0044); ОШ=2,446, 95% ДИ: 1,220–4,905 (p=0,016); ОШ=2,584, 95% ДИ: 1,101–8,133 (p=0,043) соответственно.

The aim of the study – to identify the factors associated with the development of chronic post-traumatic pain (CPTP) in patients with knee joint (KJ) injury.

Materials and methods. The study group consisted of 136 patients (51.5% women, age 38.7±12.4 years) who suffered a KJ injury with damage to the anterior cruciate ligament and/or menisci. The inclusion criterion was the presence of pain in KJ ≥4 on a numerical rating scale (NRS 0–10) for at least 1 month after injury. Surgical intervention (plastic surgery of the anterior cruciate ligament, meniscus suture, meniscus resection, combined operations) was performed immediately after injury in 48.5% of patients. The incidence of CPTP was assessed (persistence of pain during movement ≥4 on NRS after 3 and 6 months of follow-up) and factors related to the development of CPTP. All patients were recommended to use orthoses of KJ, physical therapy and taking nonsteroidal anti-inflammatory drugs in the “on-demand” mode. Results. CPTP was detected after 3 months in 33.1%, and after 6 months in 32.4% of patients. Surgical treatment did not affect the development of CPTP: odds ratio (OR) – 1.241, 95% confidence interval (95% CI): 0.775–1.986 (p=0.474). The risk of CPTP after 6 months was statistically significantly higher in women, persons with a high body mass index (≥30 kg/m2), initially severe pain (≥7 on NRS), in the presence of initial signs of depression and anxiety (HADS (Hospital Anxiety and Depression Scale) ≥8) and highly probable central sensitization (CSI (Central Sensitization Inventory) ≥40): OR=2,152, 95% CI: 1,383–3,348 (p=0,002); OR=1,243, 95% CI: 1,054–1,465 (p=0,05); OR=3,567, 95% CI: 1,717–5,708 (p=0,001); OR=2,330, 95% CI: 1,070–5,726 (p=0.0044); OR=2,446, 95% CI: 1,220–4,905 (p=0,016); OR=2,584, 95% CI: 1,101–8,133 (p=0.043), respectively.

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The authors declare that there are no conflicts of interest present.