目的 观察运用两种不同缝线固定修补材料对疝修补术后的复发、切口感染、慢性疼痛等并发症发生情况。方法 对2008年4月至2010年4月期间笔者所在科室收治的250例腹股沟疝患者行无张力疝修补手术时，采用多股丝线或可吸收合成缝线固定修补材料进行前瞻性对比研究。结果 2组患者术后疝复发、切口感染和切口疼痛（包括慢性疼痛）发生率间的差异均无统计学意义（P＞0.05）。结论 腹股沟疝无张力修补术后的复发、切口感染、慢性疼痛等并发症的发生与缝线选择无关。术者的操作技巧、严格的无菌操作原则、彻底止血以及组织损伤小才是防止术后感染、慢性疼痛等并发症发生的重要因素。
Objective To explore the cause and treatment of chronic pain after tension-free repair of inguinal hernia. Methods 〗The clinical data of 426 cases with inguinal hernia underwent the tension-free hernioplasty during February 2002 to September 2007 were retrospectively analyzed. Results 〗Tension-free hernioplasty was performed to all patients. According to operative methods, they were divided into two groups: polypropylene filling group (n=210) and expanded polytetrafluoroethylene (e-PTFE) mycromesh group (n=216). The chronic pain rate after operation, polypropylene filling group (9.0%, 19/210) was significantly higher than e-PTFE mycromesh group (4.2%, 9/216)， P＜0.05. Conclusion 〗The tension-free repair by e-PTFE mycromesh has less pain in the inguinal hernia due to the material is more suitable to human physiology, more soft and light, with less complications.
ObjectiveTo follow-up pain after discharged in patients with liver resection and provide a reference to carry out the continued pain treatment outside the hospital. MethodsPost-discharged pain follow-up in patients with liver resection in our department from December 1, 2014 to April 30, 2015 were conducted, and the pain incidence, characteristics and level on 14 days, 1 month, 2 months, and 3 months after operation were understanded. Results①The pain score of patients on 14 days after operation was 0-3 points, which was mild pain. In 2 months after operation, 24 patients still had pain, the incidence was 20.69% (24/116). In 3 months after operation, the pain incidence was 18.97% (22/116).②There was no significant difference in the pain incidence between men and women in 2 months after operation (P > 0.05). In 3 months after operation, the pain incidence of male and female patients was 13.04% (9/69) and 27.66% (13/47), respectively, the pain incidence of female was significantly higher than men (P < 0.05).③The postoperative pain score and incidence in patients more than 60 years old were lower than that in patients less than 60 years old, but the score and the incidence of postoperative pain in patients with different ages were not statistically significant (P > 0.05).④In chronic pain patients, 81.82% (18/22) were visceral pain, 18.182% (4/22) were skin tingling or numbness. ConclusionWe should focus on the continued pain treatment outside the hospital in patients with hepatic resection, make efforts to alleviate pain, and improve the postoperative quality of life.
ObjectiveTo investigate the clinical characteristics and risk factors of chronic pain after laparoscopic inguinal hernia repair.MethodsThe clinical data of 142 cases underwent laparoscopic inguinal hernia repair from January 2013 to December 2017 in The Second Affiliated Hospital of Xiamen Medical College were retrospectively analyzed.ResultsThe incidence of chronic pain after laparoscopic inguinal hernia repair was 12.7% (18/142), and 83.3% (15/18) of the patients were located in the inguinal region. Univariate analysis showed that postoperative chronic pain rates were higher in patients receiving standard patch, large patch, mechanical fixation patch, and with postoperative complications (P<0.05). Multivariate analysis showed that large patch [OR=1.82, 95% CI was (1.18, 5.36), P=0.023], mechanical fixation patch [OR=1.44, 95% CI was (1.07, 3.62), P=0.039], and postoperative complications [OR=2.53, 95% CI was (1.27, 7.31), P=0.011] were independent risk factors for postoperative chronic pain after laparoscopic inguinal hernia repair.ConclusionThe occurrence of chronic pain after laparoscopic inguinal hernia repair is the result of many factors, especially the complications and patch factors.
ObjectiveTo summarize the research status of risk factors of chronic postoperative inguinal pain (CPIP).MethodWe searched and summarized the domestic and foreign literatures about the risk factors of CPIP in recent years.ResultsThere was no doubt that the risk factors of CPIP included preoperative pain, acute pain at postoperative, recurrent inguinal hernia, smaller hernia sac, higher body mass index (BMI), and surgical methods. These effects were controversial such as age, gender, and the mesh. In recent years, hypertension and a past history of chronic pain may also be risk factors for the development of CPIP.ConclusionsThe risk factors of CPIP still need the further study.
Biomechanics-related degenerative lumbar spondylosis refers to the diseases of lumbar spine joints, muscles, fascia, and ligaments that related to maintaining lumbar spine mechanical balance and stability, which are mainly manifesting as lumbar pain and lumbocrural pain. The occurrence of biomechanics-related degenerative lumbar spondylosis is related to continuous static load and dynamic load, extra load, and aging. This article describes the etiology of biomechanics-related degenerative lumbar spondylosis, summarizes the functional compensation and structural compensation of losing balance by analyzing the characteristics of human biomechanical balance and the biomechanics of lumbar spondylolisthesis, and interprets the clinical classification of lumbar spondylosis, so as to provide a better reference for the diagnosis and treatment of lumbar spine diseases.
ObjectiveTo systematically review the prevalence and risk factors of the chronic post-cesarean section pain (CPCSP). MethodsPubMed, EMbase, The Cochrane Library, CINAHL, PsycInfo, CBM, WanFang Data, VIP, and CNKI databases were electronically searched to collect studies on the prevalence and risk factors of CPCSP from inception to August 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 15.1 software. ResultsA total of 43 studies involving 12 435 participants were included. The results of meta-analysis showed that the prevalence of CPCSP for 2 to 5 months, 6 to 11 months, and at least 12 months were 19% (95%CI 15% to 23%), 13% (95%CI 9% to 17%), and 8% (95%CI 6% to 10%), respectively. The risk factors included preoperative pain present elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety, postpartum depression, etc. ConclusionsThe current evidence shows that the overall prevalence of CPCSP is high. Preoperative pain presents elsewhere, postoperative severe acute pain, low abdominal transverse incision, non-intrathecal administration of morphine, preoperative anxiety and postpartum depression may increase the risk of CPCSP.
Objective To explore the risk factors of chronic postoperative inguinal pain (CPIP) after transabdominal preperitoneal hernia repair (TAPP), establish and verify the risk prediction model, and then evaluate the prediction effectiveness of the model. Methods The clinical data of 362 patients who received TAPP surgery was retrospectively analyzed and divided into model group (n=300) and validation group (n=62). The risk factors of CPIP in the model group were screened by univariate analysis and multivariate logistic regression analysis, and the risk prediction model was established and tested. Results The incidence of CPIP at 6 months after operation was 27.9% (101/362). Univariate analysis showed that gender (χ2= 12.055, P=0.001), age (t=–4.566, P<0.01), preoperative pain (χ2=44.686, P<0.01) and early pain at 1 week after operation (χ2=150.795, P<0.01) were related to CPIP. Multivariate logistic regression analysis showed that gender, age, preoperative pain, early pain at 1 week after operation, and history of lower abdominal surgery were independent risk predictors of CPIP. The area under curve (AUC) of the receiver operating characteristic (ROC) of the risk prediction model was calculated to be 0.933 [95%CI (0.898, 0.967)], and the optimal cut-off value was 0.129, while corresponding specificity and sensitivity were 87.6% and 91.5% respectively. The prediction accuracy, specificity and sensitivity of the model were 91.9% (57/62), 90.7% and 94.7%, respectively when the validation group data were substituted into the prediction model. Conclusion Female, age≤64 years old, preoperative pain, early pain at 1 week after operation and without history of lower abdominal surgery are independent risk factors for the incidence of CPIP after TAPP, and the risk prediction model established on this basis has good predictive efficacy, which can further guide the clinical practice.
By reviewing the current status of chronic pain and combining with the new definition of pain revised by the International Association for the Study of Pain in 2020, firstly a prevention-based approach, self-management of pain, and multidisciplinary collaboration based on the integration of bio-psycho-social-environmental factors is proposed. The medical mode will greatly improve the treatment effect of chronic pain and the quality of life of patients. Secondly, the importance of strengthening humanistic care and paying attention to health education, as well as improving medical staff’s awareness of chronic pain and the level of diagnosis and treatment are pointed out. Finally, it is clarified that innovative non-drug treatments and the establishment of digital pain management platforms are the future of chronic pain.
Objective To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies. Methods A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI. Results All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences (P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up (P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up. Conclusion For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment.