影响全膝关节置换术疗效的术前因素分析

Effect of preoperative factors on the clinical outcome of total knee arthroplasty

分析人工全膝关节置换术患者术前相关因素对术后疗效的影响。方法2011年1月至2013年9月北京协和医院骨科全膝关节置换术的患者145例（206膝）纳入研究，年龄51～83（66．5±7．6）岁，男22例（31膝），女123例（175膝）。收集患者术前相关数据资料（性别、年龄、体质指数、术前关节活动度、内翻畸形程度、术前屈曲畸形程度、术前HSS评分）并与术后膝关节HSS评分及术后关节活动度行相关性统计学分析。结果术后平均随访35（24～56）个月。HSS评分由术前（55．1±7．6）分提高到术后（89．3±5．1）分，活动度由术前（95．6±10．0）°改善至术后（115．1±7．8）°。多因素分析显示，术后关节活动度与术前关节活动度呈正相关（r=0．209，P〈0．01），与体质指数、内翻畸形程度呈负相关（r=-0．864、-0．353，均P〈0．01）；术后HSS评分与术前关节活动度、术前HSS评分呈正相关（r=0．101、0．244，P=0．033），与患者的体质指数呈负相关（r=-0．277，P=0．039）。结论全膝关节置换能有效改善膝关节的功能。患者体质指数、术前关节活动度、内翻畸形程度及术前HSS评分对术后膝关节功能存在影响。

Objective To analyze the effect of preoperative factors on the clinical outcome in patients receiving total knee replacement. Methods From January 2011 to September 2013, 145 patients （206 knees ; 22 males, 31 knees ; 123 females, 175 knees） receiving total knee arthroplastywere successfully included in this study and followed up. The average ages was （66. 5 ±7. 6） years old（range, 51 -83 years old）. The data of preoperative factorsincludedgender, age, body mass index （BMI）,preoperative range of motion （ROM）, the knee varus angle, flexion deformity and preoperative the hospital for special surgery （HSS） scorewere collected. The correlation between preoperative factors and the clinical outcome （postoperative HSS score, postoperative ROM ）after total knee replacement was evaluated statistically. Results The average follow-up time was 35 months （ range, 24 - 56 months）. The HSS score was increased from （55.1 ±7. 6） preoperativelyto （89. 3± 5.1 ） postoperatively. ROM elevated from （95.6 ± 10.0）° preoperatively to （115. 1 ± 7.8 ）° postoperatively. The correlation analysis showed that the postoperative ROM was positively correlated with the preoperative ROM, and was negatively correlated with the BMI, the knee varus angle （ r = - 0. 864, - 0. 353, all P 〈 0. 01 ）. The postoperative HSS score was positively correlated with preoperative ROM, preoperative HSS score（ r = 0. 101, 0. 244 ,P = 0. 033, P 〈 0. 01 ）, and was negatively correlated with the BMI （ r = - 0. 277, P = 0. 039）. Conclusions Total knee arthroplasty can definitely improve the function of knee joint. The BMI, the preoperative ROM, the knee varus angle and preoperative HSS score have influence on postoperative function of patients receiving total knee arthroplasty.