对体质指数与牛津活动平台单髁置换术后疗效关系的探讨

Study of correlation between body mass index and Oxford mobile- bearing unicompartmental knee arthroplasty

目的 分析体质指数(BMI)与第三代牛津活动平台单髁置换术(UKA)后早期疗效的关系。方法 2018年6月至2020年12月因退行性膝关节骨性关节炎(KOA)于河北医科大学第一医院骨科行单髁置换术的患者227例(292膝);男72例,女165例;年龄(66.3±7.1)岁。根据BMI将患者分为体重偏轻(<18.5 kg/m^(2))、体重正常(18.5~23.9 kg/m^(2),42例)、超重(24.0~27.9 kg/m^(2),79例)、肥胖(28.0~31.9 kg/m^(2),79例)和病态肥胖(≥32.0 kg/m^(2),27例)组。对比分析各组患者术前及术后膝关节Oxford评分(OKS)、 Lysholm膝关节评分(LKS)、 Forgotten关节评分(FJS)、数字等级评定量表评分(NRS)、关节活动度范围(ROM)和并发症发生率;评价各组患者膝关节功能状态的差异。结果 227例患者随访时间为(25.9±9.2)个月。各组患者人口学数据及术前OKS、LKS、NRS评分及ROM对比差异无统计学意义(P>0.05)。经过2年以上随访,所有患者OKS评分及LKS评分均较术前明显改善;NRS疼痛评分降至1.4~1.7分,ROM提高至127°~129°,FJS评分波动于89.3~91.5,组间对比差异无统计学意义(P>0.05)。术后并发症发生率为7.9%。近期并发症发生率随BMI增加而上升,但组间差异无统计学意义。结论 肥胖不应视为Oxford活动平台UKA的绝对或者相对禁忌症。但BMI较大术后早期并发症发生率稍高,需要引起临床医师的重视。

Objective To analyze the relationship between body mass index(BMI) and early clinical outcomes and Oxford phase Ⅲmobile-bearing unicompartmental knee arthroplasty(UKA).Methods The clinical data of 227 patients(292 knees),males 72 and females 165,with an average age of(66.3±7.1)years who suffered from degenerative knee osteoarthritis(KOA) and underwent UKA in Department of Orthopedics,the First Hospital of Hebei Medical University,from June 2018 to December 2020,were retrospectively analyzed.By BMI the patients were divided into the groups:underweight normal(18.5),normal(18.5-23.9,42 patients),overweight(24.0-27.9,79 patients),obesity(28.0-31.9,79 patients),morbid obesity(32.0 and more,27 patients).Pre-and postoperative OKS,LKS,FJS,NRS and ROM were compared and postoperative complication rate for each group were also analyzed.Results The follow-up time was(25.9±9.2)months.There were no significant differences in demographic data,preoperative OKS,LKS,NRS and ROM between each group(P>0.05).After more than 2 years follow-up,OKS and LKS scores of all patients were significantly improved.NRS and ROM were 1.4-1.7 and 127 °-129 °.FIS ranges changed from 89.3 to 91.5.There were no statistical differences between each group for all variables mentioned above(P>0.05).The incidence of postoperative complication was 7.9%.Short-term complication rate increased with the increase of BMI,but there were no significant differences between each group.Conclusion Obesity should not be considered as a contraindication for medial Oxford UKA.However,the higher the BMI,the higher incidence of short-term postoperative complications,which should be paid more attention to by clinicians.