体质量指数对内侧膝骨关节炎单髁置换近期疗效的影响

Association of body mass index and short-term clinical outcome after unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis

目的:探讨移动平台单髁置换术(mobile platform unicompartmental knee arthroplasty,MB UKA)治疗不同级别体质量指数(body mass index,BMI)膝关节内侧间室骨关节炎(osteoarthritis,OA)患者的近期疗效。方法:回顾性分析2017年6月—2019年12月UKA治疗的膝内侧间室膝OA患者43例(43膝),按照BMI分为正常组(<24 kg/m^2)、超重组(24~<30 kg/m^2)、肥胖Ⅰ级组(30~<35 kg/m^2)、肥胖Ⅱ级组(35~<40 kg/m^2)。比较同组间术前与术后膝关节活动度(range of motion,ROM)、疼痛视觉模拟评分(visual analogue scale,VAS)变化。对4组手术时间、术后24 h引流量、术后72 h血红蛋白下降量、住院时间、并发症及术前与术后1、8周VAS评分及ROM进行比较分析。结果:4组患者年龄、手术时间、术后24 h引流量及术后72 h血红蛋白下降量差异均无统计学意义(均P>0.05);4组术后1、8周VAS评分及ROM均高于术前(均P<0.05)。肥胖Ⅱ级组住院时间和术后ROM与正常组比较差异均有统计学意义(均P<0.05)。与正常组比较,另3组并发症发生情况差异均无统计学意义(均P>0.05),肥胖Ⅱ级组出现下肢静脉血栓、切口愈合不良患者有所增加。结论:MB UKA治疗不同级别BMI内侧OA患者,术后均可取得良好的功能康复疗效,但BMI≥35 kg/m^2者选择UKA应谨慎。

Objective:To explore the association of body mass index(BMI)and short-term clinical outcome after mobile platform unicompartmental knee arthroplasty(MB UKA)for medial compartmental knee osteoarthritis(OA).Methods:A retrospective analysis of 43 medial compartmental knee OA patients(43 knees)treated with UKA from June 2017 to December 2019 was performed.All patients were divided into group A(normal<24 kg/m^2),group B(overweight 24-<30 kg/m^2),group C(obeseⅠ30-<35 kg/m^2)and group D(obeseⅡ35-<40 kg/m^2)according to BMI.The pain visual analogue scale(VAS),and range of motion(ROM)in each group were evaluated before operation.The time of operation,postoperative drainage volume,hemoglobin decrease 72 hours after operation,the average hospital stay,complications,VAS scores and ROM 1 week and 8 weeks after operation were compared to group A which was selected as the control group.Results:All patients were followed up after surgery in a minimum period of 8 weeks.There were no significant differences in age between the four groups(P>0.05),as well as the time of operation,postoperative drainage volume and hemoglobin decrease 72 hours after operation were no significant differences(P>0.05).There were statistically significant differences in VAS scores and ROM in each group before surgery and 8 weeks follow-up(P<0.05).Compare to group A,the average hospital stay,complications,VAS scores and ROM were signif-icant differences in group D(P<0.05).There were no significant differences in complications between the four groups(P>0.05).Conclusion:MB UKA can achieve satisfactory postoperative short-term efficacy on patients of varying BMI levels with medial compartmental knee OA.Furthermore,UKA should be approached with caution in patients who have high BMIs(≥35 kg/m^2).