老年骨关节炎患者全膝关节置换术后膝关节功能的影响因素分析

Clinical analysis on the influencing factors for knee joint function after total knee arthroplasty in elderly patients with osteoarthritis

目的研究老年骨关节炎患者经全膝关节置换术后膝关节功能的影响因素。方法回顾性分析2016年5月至2017年5月在唐山市第二医院受治疗并符合入组标准的老年骨关节炎患者共42例。在患者进行全膝关节置换(TKA)术前与术后分别进行HSS评分,采用Logistic分析与Pearson相关分析分别对患者的年龄、BMI、疼痛评分、膝关节内翻畸形程度、术前术后股骨前髁偏距(ACO)改善、术后胫骨平台后倾角(PSA)与手术后膝关节活动度(ROM)关系进行分析。结果通过Pearson相关分析显示,在术后HSS评分上,患者术前疼痛评分、术前膝关节活动度、术后胫骨平台后倾角、术前术后股骨前髁偏距变化和全膝关节置换与其存在正相关性;身体质量指数、手术部位变化情况与其存在负相关性。分析确定BMI(P<0.05)、疼痛评分(P<0.01)与术后PSA(P<0.01)为变量。研究显示,术前ACO大于术后的患者在术后的ROM评分明显比术前ACO小于术后的患者高,差异有统计学意义(P<0.05)。术后ROM在术后PSA为7°~9°时最好。结论患者术前疼痛情况、术前膝关节活动度、术后胫骨平台后倾角、术前和术后股骨前髁偏距的变化)、BMI、膝关节内翻畸形程度均为TKA术后膝关节功能的影响因素。

Objective To explore the influencing factors for knee function in patients with senile osteoarthritis after total knee arthroplasty. Methods A total of 42 elderly patients with osteoarthritis in this hospital during May 2016 to May 2017 were enrolled in this study. HSS scores were evaluated before and after total knee arthroplasty（ TKA） in these patients. Logistic analysis and Pearson correlation analysis were performed on relatiionship with age,BMI,pain scores,knee varus deformity,and preoperative and postoperative femora. The improvement of anteroposterior offset（ ACO）,postoperative tibial plateau（ PSA） and postoperative knee mobility（ ROM） were analyzed. Results Pearson correlation analysis showed that there was positive correelation existed among postoperative HSS scores,patient＇s preoperative pain scores,preoperative knee joint motion,postoperative tibial plateau inclination angle,preoperative and postoperative femoral ankle offset changes,and total knee joint replacement There was negative correlation among body mass index,surgical site changes and its negative correlation. BMI（ P〈0. 05）,pain scores（ P〈0. 01） and postoperative PSA（ P〈0. 01） were analyzed as variables. This study showed that patients with preoperative ACO greater than postoperative ROM scores was significantly higher than preoperative ACO and less than that of postoperative patients,and the difference was statistically significant（ P〈0. 05）. Postoperative ROM was best in postoperative PSA at 7° ~ 9°. Conclusion Preoperative pain,preoperative knee joint motion,postoperative tibial plateau inclination,preoperative and postoperative femoral anterior spastic deviation,BMI,and knee varus deformity are factors of knee joints after TKA. affecting their function.