初次膝关节置换术后一年步态分析参数与患者满意度的研究

Gait analysis and satisfaction survey of patients after primary knee arthroplasty

目的探讨全膝关节置换术(total knee arthroplasty,TKA)患者术前与术后1年三维步态参数的差异及其与满意度之间的关系。方法选择2019年4月至2019年11月,于我院行TKA的61例患者,于术前及术后1年进行三维步态测试及WOMAC、李克特五点满意度评分,采用步速、支撑相时间百分比、步幅、膝关节屈伸范围、膝关节最大屈曲度对患者步态进行评定。根据术后1年满意度将患者分为五组,使用有序Logistic回归分析各步态参数与患者满意度之间的潜在联系。结果患者TKA术后1年步速由术前(1.09±0.09)m/s提高至(1.20±0.23)m/s,步幅由(1.08±0.24)m提高至(1.21±0.08)m,膝关节屈伸范围由(45.46±8.26)°提高至(48.35±7.59)°,膝关节最大屈曲角度由(48.06±6.31)°提升至(50.56±5.90)°,差异均有统计学意义(P<0.05);支撑相时间百分比差异无统计学意义(P=0.33)。患者满意度与上述步态有序Logistic回归分析提示膝关节最大屈曲角度与患者满意度存在显著性相关(P<0.05)。结论患者TKA术后1年步态较术前有显著改善。膝关节最大屈曲角度是影响患者TKA术后1年满意度的重要因素。

Objective To compare the differences of three-dimensional gait parameters preoperatively and1 year postoperatively of patients after total knee arthroplasty(TKA)and the association with satisfaction after surgery.Methods From April 2019 to November 2019,61 patients after TKA were recruited in this study.Gait analysis,WOMAC,Likert’s five-point satisfaction score were assessed before and 1 year after the operation.Gait was evaluated using the speed,ratio of support phase,stride length,range of knee flexion and extension,and maximum knee flexion.Patients were divided into 5 groups according to the postoperative satisfaction,and the potential association between each gait parameter and satisfaction was analyzed using ordinal logistic regression.Results Gait speed,stride length,range of knee flexion and extension,and the maximum knee flexion increased from(1.09±0.09)m/s,(1.08±0.24)m,(45.46±8.26)°,(48.06±6.31)°before TKA to(1.20±0.23)m/s,(1.21±0.08)m,(48.35±7.59)°,(50.56±5.90)°after TKA(P<0.05).There were no statistical differences in the ratio of the supporting phase(P=0.33).Ordinal logistic regression analysis suggested that the maximum knee flexion was significantly correlated with patient satisfaction(P<0.05).Conclusions The patient’s gait is significantly improved 1 year after TKA.The maximum knee flexion is an important factor that affects the satisfaction 1 year after TKA.