Risk factors for chronic pain after hip replacement and the predictive value of preoperative serum MMP-9 and Galectin-3
Objective To explore the risk factors of developing chronic postsurgical pain(CPSP)after hip replacement in hip fracture patients and to investigate the predictive value of preoperative serum levels of matrix met-alloproteinase-9(MMP-9)and Galectin-3(Galectin-3).Methods A total of 116 patients with hip fractures,in-cluding 65 males and 51 females who underwent hip replacement in the 903 Hospital of PLA Joint Logistic Support Force from Mar.2021 to Mar.2023,were prospectively selected.Patients aged 18-80 years,mean 59.1 years.The causes of injuries were road traffic accidents in 68 cases,falls from height in 19,and ground-level falls in 29.Pa-tients were followed up for 4 months after surgery and according to whether CPSP occurred they were divided into CPSP group(n=27)and non-CPSP group(n=89).Multivariate Logistic stepwise regression analysis was adopted to investigate the risk factors of CPSP in hip fracture patients after hip replacement.Serum MMP-9 and Galectin-3 levels were detected by enzyme-linked immunosorbent assay before and 4 months after surgery.The predictive value of preoperative serum MMP-9 and Galectin-3 for CPSP after hip replacement was analyzed by receiver operating characteristic(ROC)curves.Results Among the 116 included patients,CPSP occurred in 27 cases,with the inci-dence being 23.3％(95％CI:19.56％-27.49％).Comparison between the CPSP and non-CPSP groups revealed significant differences in terms of proportions of patients(1)with an age ≥ 60 years,(2)with diabetes,(3)with displaced fractures by Garden classification,and(4)with preoperative VAS score≥3,and intraoperatie blood loss,operation time,postoperative CRP or WBC level,and postoperative 4-month VAS(all P＜0.05).Further multivari-ate Logistic stepwise regression analysis showed that history of diabetes(OR=2.321,95％CI:1.559-3.455),opera-tion time ≥2.8 h(OR=2.026,95％CI:1.418-2.894),preoperative VAS score ≥3(OR=2.787,95％CI:1.790-4.340)and postoperative CRP level ≥33.9 mg/L(OR=2.467,95％CI:1.628-3.738)were independent risk fac-tors for CPSP in hip fracture patients after hip replacement(all P＜0.05).The serum levels of MMP-9 and Galec-tin-3 in CPSP group were much higher than those in non-CPSP group before surgery(P＜0.05),which were further increased in CPSP group but decreased in non-CPSP group at 4 months after surgery(P＜0.05 compared with that before surgery and between two groups after surgery).The area under the curve of preoperative serum MMP-9 and Galectin-3 in predicting CPSP after hip replacement in patients with hip fractures were 0.851(95％CI:0.800-0.902)and 0.748(95％CI:0.697-0.799),respectively,and 0.903(95％CI:0.852-0.954)with a combined use.Conclusion The incidence of CPSP after hip replacement in patients with hip fractures is associated with diabetes history,operation time,preoperative VAS score and postoperative CRP levels;serum MMP-9 and Galectin-3 have certain predictive values in predicting CPSP,especially when used combinedly.
Hip fracturesHip replacementChronic painMatrix metalloproteinase-9Galactin-3
NETL
NSTL
万方数据
维普
