肥胖对初次全膝关节置换早期临床效果的影响

Effect of obesity on early clinical outcomes of total knee arthroplasty

[目的]探讨肥胖对初次全膝关节置换术后早期临床效果的影响。[方法] 2016年9月～2017年3月在本科行初次单侧全膝关节置换患者106例,男性36例、女性70例。根据BMI,30例患者列入肥胖组(BMI≥30 kg/m^2),36例列入超重组(BMI 25.00～29.90 kg/m^2),40例列入正常体重组(BMI≤24.90 kg/m^2)。对比三组的手术时间、术中出血量、住院时间、VAS评分、KSS评分、伤口并发症、血栓事件、30 d再入院率以及膝关节屈伸活动范围等情况。[结果]在手术时间、术中出血量,住院时间方面,肥胖组>超重组>正常体重组,三组间差异均有统计学意义(P<0.05)。术后24、48、72 h时VAS评分,肥胖组>超重组>正常体重组,差异均有统计学意义(P<0.05)。肥胖组有3例、超重组有1例发生伤口脂肪液化;肥胖组有2例、正常组有1例发生肌间静脉血栓,经相应处理均末造成不良后果。术后随访6个月,术后3个月肥胖组的KSS评分和膝关节屈伸活动度低于超重组和正常体重组,差异有统计学意义(P<0.05),而术后6个月时,三组之间KSS评分和膝关节屈伸活动度差异无统计学意义(P>0.05)。[结论]肥胖患者行全膝关节置换可达到与正常体重、超重患者相同的临床效果,但术后疼痛症状较重,早期康复速度较慢,手术时间较长、术中出血量较多,住院时间延长,伤口并发症的发生率较高。

[Objective] To explore the effect of obesity on early clinical outcomes following total knee arthroplasty(TKA).[Methods] From September 2016 to March 2017, 106 patients underwent primary TKA in our department, including 36 males and 70 females. Based on the body mass index(BMI), 30 patients were enrolled into the obesity group(BMI≥30 kg/m^2), 36 patients into the overweight group(BMI 25.00~29.90 kg/m^2) and the remaining 40 patients into normal body weight group(BMI≤24.90 kg/m^2). The incision length, operative time, intraoperative blood loss and hospital stay were compared. In addition, the visual analogue scale(VAS) for pain, Knee Society Sore(KSS), wound complication, thromboembolic events, 30-day readmission,and knee range of motion(ROM) were also assessed among the 3 groups. [Results] Regarding to operation time, intraoperative blood loss and hospital stay, the obesity group proved statistically significantly larger than the overweight group, while the latter was greater than the normal weight group(P<0.05). Similarly, the VAS ranked in sequence of the obesity group > the overweight group > the normal weight group, where was statistically significant at 24 h, 48 h and 72 h postoperatively(P<0.05). In term of early complication, incision fat necrosis happened in 3 cases of the obesity group and 1 case of the overweight group,whereas intermuscular venous thrombosis occurred in 2 cases of the obesity group and 1 case of the normal weight group, which all were properly treated without serious consequences. All the patients were followed up for 6 months. At 3 months postoperatively, the KSS and ROM graded in order of the obesity group < the overweight group < the normal weight group with significantly statistical differences among the 3 groups(P<0.05), despite the fact that no statistical differences were noted at 6 months after operation(P>0.05). [Conclusion] Although the obese can get similar TKA outcomes with the overweight and normal weight,the obese take disadvantages of longer operation time, more intraoperative blood loss, longer hospital stay, severer postoperative pain and higher incidence of complication.