膝骨关节炎患者全膝关节置换术后膝关节功能恢复不理想的危险因素分析

Analysis of the Risk Factors of Knee Joint Dysfunction After Total Knee Arthroplasty in Patients with Knee Osteoarthritis

目的探讨膝骨关节炎患者全膝关节置换术(TKA)后膝关节功能恢复不理想的危险因素。方法选取封丘县人民医院2015年7月至2018年12月收治的137例膝骨关节炎患者。所有患者均接受TKA治疗,随访1 a,并根据美国特种外科医院膝关节评分(HSS)情况分为恢复不理想组(67例)和恢复理想组(70例)。分析两组临床一般资料,采用logistic回归分析影响膝关节功能恢复不理想的危险因素。结果恢复不理想组年龄≥65岁,体质量指数≥25 kg·m^-2,术前HSS评分<45分,未实施软组织平衡术,术后视觉模拟评分法(VAS)评分≥6分,术后胫骨平台后倾角≥5°及发生术后并发症占比均高于恢复理想组(P<0.05)。年龄≥65岁(OR=2.735,95%CI:1.004~7.445),术前HSS评分<45分(OR=2.092,95%CI:1.045~4.186),未实施软组织平衡术(OR=2.416,95%CI:1.082~5.396),术后VAS评分≥6分(OR=1.711,95%CI:1.131~2.587)及发生术后并发症(OR=2.125,95%CI:1.060~4.262)是膝骨关节炎患者TKA后膝关节功能恢复不理想的独立危险因素。结论年龄≥65岁,术前HSS评分<45分,未实施软组织平衡术,术后VAS评分≥6分及发生术后并发症均可能增加膝骨关节炎患者TKA后膝关节功能恢复不理想的发生风险。

Objective To explore the risk factors of poor functional recovery of knee joint after total knee arthroplasty(TKA)in patients with knee osteoarthritis.Methods One hundred and thirty-seven patients with osteoarthritis of knee from July 2015 to December 2018 were selected into the data.All patients were followed up for 1 year and were divided into the group with ideal recovery(70 cases)and the group with unsatisfactory recovery(67 cases)according to the hospital for special surgery knee score(HSS).The general clinical data of the two groups were analyzed,and the risk factors influencing the knee joint function recovery were analyzed by logistic regression.Results The age≥65 years old,body mass index≥25 kg·m^-2,preoperative HSS score<45,no soft tissue balancing operation,postoperative visual analogue score(VAS)≥6,postoperative tibial plateau caster angle≥5°and the proportion of postoperative complications in the group with unsatisfactory recovery were higher than those in the group with ideal recovery(P<0.05).Age≥65 years(OR=2.735,95%CI:1.004-7.445),preoperative HSS score<45(OR=2.092,95%CI=1.045-4.186),no soft tissue balancing operation(OR=2.416,95%CI:1.082-5.396),postoperative VAS score≥6(OR=1.711,95%CI=1.131-2.587)and postoperative complications(OR=2.125,95%CI=1.060-4.262)were the independent risk factors for the poor recovery of knee joint function after TKA.Conclusion Age≥65 years old,preoperative HSS score<45,no soft tissue balance operation,postoperative VAS score≥6,and postoperative complications may increase the risk of knee joint dysfunction after TKA.