应用多学科诊疗对初次行单侧全膝关节置换术患者手术疗效及满意度的影响

Effect of multi-disciplinary treatment on surgical outcome and satisfaction of patients undergoing primary unilateral total knee arthroplasty

目的研究多学科诊疗(multi-disciplinary treatment,MDT)对初次行全膝关节置换术(total knee arthroplasty,TKA)患者手术疗效及满意度的影响。方法回顾性收集并分析2022年1月—9月在宁夏医科大学总医院因膝骨性关节炎初次行单侧TKA患者的临床资料。依据围手术期是否针对患者进行MDT分为MDT组和传统组。检测并记录两组围手术期营养相关指标和并发症发生情况、总住院时间、疼痛视觉模拟评分法(Visual Analogue Scale,VAS)评分、手术前后膝关节评分法(Hospital for Special Surgery Knee Score,HSS)评分及患者满意度。结果共纳入患者95例。其中,MDT组42例,传统组53例。MDT组患者术后并发症及总住院时间均少于传统组,满意度评分高于传统组(P<0.05)。两组患者围手术期的血清总蛋白(total protein,TP)、血红蛋白(hemoglobin,Hb)、血清白蛋白(albumin,ALB)水平和VAS评分、HSS评分均随时间而改变(P<0.05)。组内比较结果显示,与术前比较,两组的TP、Hb、ALB水平在术后第1天、术后第3天均降低(P<0.05);术后第3天,MDT组的TP、Hb、ALB水平和传统组的Hb、ALB水平均低于术后第1天(P<0.05);术后第3天,传统组的TP水平与术后第1天比较,差异无统计学意义(P>0.05)。两组患者的VAS评分、HSS评分在不同时间点组内两两比较,差异均有统计学意义(P<0.05)。结论对初次行单侧TKA术的高龄患者应用MDT,可缩短总住院时间,降低围手术期并发症的发生率,提高手术疗效及患者满意度。

Objective To study the effect of multi-disciplinary treatment(MDT)on the surgical efficacy and satisfaction of patients undergoing total knee arthroplasty(TKA)for the first time.MethodsThe clinical data of patients who underwent unilateral TKA for single-compartment osteoarthritis of the knee in the General Hospital of Ningxia Medical University between January and September 2022 were retrospectively collected and analyzed.According to whether MDT was performed on patients during the perioperative period,they were divided into MDT group and traditional group.Perioperative nutrition-related indicators,perioperative complications,total hospitalization time,Visual Analogue Scale(VAS),and Hospital for Special Surgery Knee Score(HSS)before and after surgery were detected and recorded.Results A total of 95 patients were included.Among them,there were 42 cases in the MDT group and 53 cases in the traditional group.The postoperative complications and total hospital stay of patients in the MDT group were lower than those in the traditional group,and their satisfaction scores were higher than those in the traditional group(P<0.05).The perioperative serum total protein(TP),hemoglobin(Hb),serum albumin(ALB)levels,VAS score,and HSS score of both groups of patients changed over time.The intra group comparison results showed that compared with preoperative,the levels of TP,Hb,and ALB in both groups decreased on the 1st and 3rd postoperative days(P<0.05).On the 3rd day after surgery,the levels of TP,Hb,ALB in the MDT group and Hb,ALB in the traditional group were lower than on the Ist day after surgery(P<0.05).There was no statistically significant difference in TP levels between the traditional group on the 3rd day after surgery and the 1st day after surgery(P>0.05).The results of intra group comparison at different time points showed that there were statistically significant dfferences in VAS score and HSS score between the two groups(P<0.05).Conclusion The application of MDT in elderly patients undergoing unilateral TKA for the first time can shorten the total hospitalization time,reduce the incidence of perioperative complications,and improve the surgical efficacyand patient satisfaction.