肥胖病人全膝关节表面置换术后疗效观察

Study of the outcome after total knee replacement (TKR) in obese patients

[目的]本研究回顾性研究肥胖(根据体重指数)是否是全膝关节表面置换术的危险因素。[方法]由同一组医生使用同一种假体对320例520个膝骨性关节炎患者行全膝关节表面置换手术治疗。[结果]术前肥胖组功能评分较超重组、非肥胖组为低(分别P<0.05),但关节评分无显著性差异。通过平均28.3个月的随访,无论膝评分和功能评分各组术后均明显提高,各组提高的幅度比较在统计学上无显著性差异(分别P>0.05)。肥胖组围手术期并发症明显增高。[结论]肥胖病人膝关节置换手术可以取得满意疗效,但围手术期并发症增多,包括伤口愈合、感染、内侧副韧带损伤,注意伤口缝合技术和保护内侧副韧带可减少此类并发症。

[ Objective] To determine if obesity（ according to body mass index, BMI） is a risk factor for total knee replacement（TKR）. [ Method] A total of 320 patients with 520 knees underwent TKR operation by a single surgeon with the same type of prosthesis for osteoarthritis （OA）. All the patients were divided into 3 groups according to the body mass index： group A with obese patients; group B with sub-obese patients; and group C with non-obese patients. Postoperative results were studied respectively. [ Result] Patients in group A had lower preoperative function score than those of group B ,C （ P 〈 0.05, respectively）, but knee scores were not significantly different from any other group. The postoperative mean HSS score of all the groups rose significantly according to a 28.3 months＇（ ranged, 12 -46 months ） follow - up, while differences between each group were not statistically significant （ P 〉 0.1, respectively）. The rate of perioperative complications was significantly higher in the obese patients. [ Conclusion] Total knee replacement in obese patients can be successful but is associated with an increased rate of perioperative complications, including problems with Wound -healing, infection, and avulsion of the medial ligament. Alteration in the operative technique for soft - tissue closure and protection of the medial collateral ligament have decreased the rates of complications related to woundhealing and the medial collateral ligament.