影响高屈曲度人工全膝关节假体术后活动度的相关变量分析

Analysis of variables affecting range of motion of high flexion prosthesis in patients after total knee arthroplasty

目的探讨影响高屈曲度假体活动度的影响因素。方法 2013年8月-2014年8月于解放军总医院接受高屈曲度人工膝关节假体置换的182例患者纳入研究,通过填写问卷的方式采集数据资料:性别、年龄、体质量指数(body mass index,BMI)、术前诊断、髌骨是否置换、术前关节活动度、止血带应用时间、术前屈曲畸形程度、术前美国纽约特殊外科医院(Hospital for Special Surgery,HSS)膝关节评分和术后12个月的膝关节活动度。进行多因素分析。结果入组患者平均年龄63.2岁,男性62例,女性120例。相比膝关节活动度<125°的患者,膝关节活动度≥125°的患者BMI低,术前膝关节活动度范围大,止血带时间短,术前屈曲畸形程度轻及术前HSS评分高(P<0.05)。多因素分析结果显示,类风湿关节病、未行髌骨置换及术前关节活动度<120°为术后高屈曲活动度的不利因素(P<0.05)。结论与高屈曲度膝关节假体术后活动度有关的因素有BMI、术前HSS评分、病因、是否行髌骨置换、术前屈曲畸形程度和术前膝关节活动度。

Objective To explore factors affecting range of motion in patients accepting total knee replacement with high flexion prosthesis. Methods From August 2013 to August 2014, 182 patients accepting total knee replacement with high flexion prosthesis who accorded with our selection criteria were included. The following data were selected by the means of questionnaire： gender, age, body mass index（BMI）, diagnosis, patella resurfacing, preoperative ROM, application time of tourniquet, flexion deformity, HSS score and ROM of 12 months after surgery. The data were recorded and analyzed. Results There were 62 males and 120 females in this study with mean age of 63.2 years. The results showed that knee ROM of patients in osteoarthritis（OA） and patella resurfacing group was better than that of patients in rheumatoid arthritis（RA） and patella non-resurfacing group. Secondly, in comparison with patients whose postoperative ROM was less than 125°, lower BMI, greater ROM before surgery, less tourniquet time, less level of deformity and better HSS score were found in patients whose postoperative ROM was greater than 125°（P〈0.05）. Finally, multivariate analysis showed that RA, non-resurfacing and preoperative ROM100° were risk factors for postoperative ROM less than 120°（P〈0.05）. Conclusion The factors related to the final ROM for patients who accepted high flexion prosthesis include BMI, preoperative HSS scores, patella resurfacing, preoperative ROM and deformity.