肥胖患者人工全膝关节置换的特点

Features of total knee arthroplasty for obese patients

目的:调查肥胖患者人工全膝关节置换的特点及疗效,并与非肥胖患者进行对比。方法:选择2004-09/2007-03在北京协和医院骨科接受初次单侧全膝关节置换的膝骨关节炎患者共80例(80膝),均使用后稳定型固定平台假体。其中体质量指数<25.0kg/m2者入非肥胖组,体质量指数≥27.1kg/m2者入肥胖组,非肥胖组和肥胖组各40例。对患者进行定期随访,记录置换前和末次随访时的膝关节最大伸屈度数、HSS评分结果及并发症发生情况。结果:所有入组病例均获得随访,随访时间25～54个月,平均36.7个月。2组末次随访的膝关节最大屈曲度及HSS评分均高于置换前(P<0.05),最大伸直度低于置换前(P<0.05)。肥胖组置换前及末次随访时的膝关节最大伸屈度数和HSS评分与非肥胖组差异无显著性意义(P>0.05)。非肥胖组只有1例出现伤口并发症,发生率为2.5%;而肥胖组中有4例出现伤口并发症,其中1例合并症状性下肢深静脉血栓,2例合并关节僵硬,并发症发生率为10%,二者比较差异有显著性意义(P<0.05)。结论:人工全膝关节置换是终末期膝骨关节炎的有效治疗方法,肥胖患者可以获得同非肥胖患者相似的近期临床效果,但围手术期应重视伤口处理和下肢深静脉血栓等并发症的预防。

OBJECTIVE： To investigate the technical tips and outcomes of total knee arthroplasty in obese patients and compare them with non-obese patients. METHODS： A total of 80 patients （80 knees） with knee esteoarthritis, who underwent unilateral total knee arthroplasty for the first time using posterior stable-fixed plateau prosthesis in Department of Orthopaedics, Peking Union Medical College Hospital between September 2004 and March 2007, were selected. Of them, people with body mass index 〈 25.0 kg/m2 were regarded as non-obese group （n=40）, and body mass index ≥ 27.1 kg/m2 were regarded as obese group （n=40）. All patients were followed up regularly. The maximum extension/flexion degree of knee joint and HSS score at preoperative and latest follow-up as well as perioperative complications were recorded. RESULTS： All patients were followed up for 36.7 months （ranging 25-54 months）. The maximum flexion degrees and HSS scores of both groups were significantly greater than before surgery （P 〈 0.05）, while the maximum extension degrees was less than before surgery （P 〈 0.05）. The maximum extension/flexion degrees and HSS scores of obese groups before surgery and at the latest follow-up were similar to non-obese group （P 〉 0.05）. In the non-obese group, 1 case developed wound complication, with incidence of 2.5%; in obese group, 4 cases had wound problems, including 1 combined with deep venous thrombosis and 2 combined with joint stiffness, with incidence of 10%. There were significant differences between two groups in incidence of complications （P 〈 0.05）. CONCLUSION： Total knee arthreplasty is an effective therapy for advanced knee osteoarthritis. Obese patient could obtain similar outcome to non-obese after total knee arthroplasty, but its perioperative complication such as wound and deep venous thrombosis requires close attention.