血清n-3多不饱和脂肪酸水平与全膝关节置换早期股四头肌肌力变化的相关性

Correlation between the level of serum n-3 polyunsaturated fatty acids and quadriceps weakness in the early stage after total knee arthroplasty

背景:既往研究表明,全膝关节置换后早期股四头肌无力加重可能由手术创伤和/或止血带使用诱导的缺血再灌注所致,而摄入n-3多不饱和脂肪酸可减少与缺血再灌注相关的组织损伤。目的:探讨血清n-3多不饱和脂肪酸水平与全膝关节置换患者早期股四头肌无力的相关性。方法:选择2018年3月至2020年3月海南医学院第二附属医院收治的膝关节骨性关节炎患者66例,均接受全膝关节置换治疗。术后第1天检测血清n-3多不饱和脂肪酸水平,术前1 d和术后第4天检测股四头肌肌力、股四头肌测试时的膝关节疼痛和膝关节周长。根据股四头肌肌力检测结果分为高肌无力组(<-63.7%,n=33)与低肌无力组(≥-63.7%,n=33),对比两组血清n-3多不饱和脂肪酸水平、股四头肌测试时的膝关节疼痛和膝关节周长。采用Pearson相关分析探讨血清n-3多不饱和脂肪酸水平与股四头肌无力的相关性。采用多因素Logistic回归分析探讨股四头肌无力的影响因素。研究获得海南医学院第二附属医院伦理委员会批准。结果与结论:①与术前比较,66例患者全膝关节置换后的股四头肌肌力明显下降,膝关节疼痛加重,膝关节周长增加(P<0.01);②高肌无力组n-3多不饱和脂肪酸水平、股四头肌肌力低于低肌无力组(P<0.05),膝关节疼痛重于低肌无力组(P<0.05),膝关节周长大于低肌无力组(P<0.05);③Pearson相关分析显示,n-3多不饱和脂肪酸水平与股四头肌无力呈显著的正相关(r=0.356,P=0.004);④多因素Logistic回归分析结果显示,n-3多不饱和脂肪酸水平、膝关节疼痛、膝关节肿胀及体质量指数为全膝关节置换后股四头肌无力的独立影响因素(P<0.05);⑤结果表明,血清n-3多不饱和脂肪酸水平为全膝关节置换后股四头肌无力的独立保护因素。

BACKGROUND:Previous studies have shown that early quadriceps weakness aggravation is associated with ischemia and reperfusion resulting from surgical trauma and/or tourniquet use after total knee arthroplasty,while intake of sufficient amounts of dietary n-3 polyunsaturated fatty acids can limit tissue damage associated with ischemia and reperfusion.OBJECTIVE:To explore the correlation between the level of serum n-3 polyunsaturated fatty acids and quadriceps weakness in the early stage after total knee arthroplasty.METHODS:A total of 66 patients with knee joint osteoarthritis admitted to the Second Affiliated Hospital of Hainan Medical University from March 2018 to March 2020 were selected.All of them received total knee arthroplasty.On postoperative day 1,serum n-3 polyunsaturated fatty acids levels were measured.Quadriceps strength,knee pain during quadriceps testing,and knee circumference were measured on preoperative day 1 and postoperative day 4.According to the testing result of quadriceps strength,the patients were divided into high quadriceps weakness group(<-63.7%,n=33)and low quadriceps weakness group(≥-63.7%,n=33).Serum n-3 polyunsaturated fatty acids levels,knee pain during quadriceps testing,and knee circumference were compared between two groups.The correlation between the level of serum n-3 polyunsaturated fatty acids and quadriceps weakness was explored by Pearson correlation analysis.The influencing factors of quadriceps weakness were explored by multivariate Logistic regression analysis.The study was approved by the Ethics Committee of the Second Affiliated Hospital of Hainan Medical University.RESULTS AND CONCLUSION:(1)Compared with preoperatively,the quadriceps muscle strength decreased significantly,knee pain increased,and knee circumference increased after total knee arthroplasty in 66 patients(P<0.01).(2)The level of n-3 polyunsaturated fatty acids and quadriceps strength in high quadriceps weakness group were lower than those in low quadriceps weakness group(P<0.05).Knee pain was more serious in high quadriceps weakness group than that in low quadriceps weakness group(P<0.05).The knee circumference was longer in high quadriceps weakness group than that in low quadriceps weakness group(P<0.05).(3)Pearson correlation analysis showed that serum n-3 polyunsaturated fatty acids level was significantly positively correlated with quadriceps weakness(r=0.356,P=0.004).(4)Multivariate logistic regression analysis showed that serum n-3 polyunsaturated fatty acids levels,knee pain,knee swelling and body mass index were independent influencing factors for quadriceps weakness after total knee arthroplasty(P<0.05).(5)These results indicate that the level of serum n-3 polyunsaturated fatty acids was independent protective factors for quadriceps weakness after total knee arthroplasty.