全膝关节置换术后康复影响因素的前瞻性队列研究

Preoperative prediction of functional recovery after total knee arthroplasty: a prospective cohort study

目的探讨影响全膝关节置换术(TKA)患者术后康复的相关因素,为预测患者术后康复情况及制定预防控制措施提供科学依据。方法采用前瞻性队列研究方法,选取2010年1月-2014年6月在该院住院治疗并行TKA的患者310例,组成队列资料。应用Spearman相关性分析及多元Logistic回归的方法,分析人口学因素、临床及手术因素对患者术后功能恢复的影响。结果 310例患者中,12例因故取消或推迟手术,19例于随访期内脱失,最终纳入综合分析患者共279例。Spearman相关性分析结果显示,性别、年龄、体重指数(BMI)、吸烟史、糖尿病史、低白蛋白血症、应用静脉血栓形成危险度(RAPT)评分、基于性能的功能测试(PBT)评分、手术时间、术中出血量、术后疼痛与患者术后康复相关(P<0.05)。多元Logistic回归结果表明,较大的年龄及BMI、糖尿病史、RAPT及PBT评分较差为延长患者住院时间的危险因素;较大的年龄、糖尿病史、低白蛋白血症为罹患术后并发症的危险因素;较大的年龄、糖尿病史为影响术后肢体功能恢复的危险因素,RAPT及PBT评分为术后肢体功能恢复的预测因子。结论 TKA患者术后康复与多种因素相关。临床应重点关注具有上述危险因素的患者,于术前及术中采取有效预防措施,促进患者康复。

Objectives To evaluate the value of conventional factors, the Risk Assessment and Predictor Tool（RAPT） and performance-based functional tests as predictors of recovery after total knee arthroplasty（TKA）. Methods A prospective cohort study was performed in our hospital for 310 patients who underwent TKA between January 2010 and June 2014. Demographic and clinical variables were assessed and the data were analyzed by Spearman correlation analysis and multiple logistic regression analysis. Results Twelve cases of the total patients canceled or postponed the surgery, while 19 cases were lost in the follow-up period. A total of 279 cases were included in the final analysis. The results of Spearman correlation analysis showed that gender, age, body mass index（BMI）, history of smoking, diabetes, hypoalbuminemia, RAPT score, score based on the performance of functional testing（PBT）, operation time, intraoperative blood loss, as well as postoperative pain were significantly associated with postoperative rehabilitation（P〈0.05）. The results of multivariate logistic regression analysis indicated that elder age and higher BMI, history of diabetes, poorly RAPT and PBT scores were the risk factors for prolonged hospital stay; elder age, history of diabetes and hypoalbuminemia were the risk factors for complications; and elder age and history of diabetes were the risk factors for limb function recovery. Mostly, RAPT and PBT scores were the predictors of limb function recovery.Conclusions TKA postoperative rehabilitation is related with a variety of factors. To reduce the associated risk factors above is necessary, especially in at-risk patients.