绝经后女性体质量指数与内侧单髁置换后疗效的关系

Correlation between body mass index and efficacy after medial unicompartmental knee arthroplasty in postmenopausal women

背景:单髁置换后随访中,部分患者出现膝关节疼痛活动受限,其中绝经后肥胖女性最为多见;体质量指数作为衡量身体肥胖程度的重要指标,是否与单髁置换后疗效有关,肥胖是否会影响术后膝关节功能,值得进一步研究。目的:评价绝经后肥胖女性患者行内侧单髁置换后的临床疗效,明确体质量指数对单髁置换后患者生活质量的影响。方法:纳入新疆医科大学第四临床医学院2017年1月至2019年1月因内侧膝关节疼痛并初次行内侧单髁置换的女性绝经患者;根据标准共纳入270例,按照术前体质量指数分为4组:正常组42例(体质量指数18.5-22.9 kg/m^(2)),超重组58例(体质量指数23.0-24.9 kg/m2),肥胖组122例(体质量指数25.0-29.9 kg/m^(2)),重度肥胖组48例(体质量指数≥30 kg/m^(2))。分别比较各组术前、术后及末次随访美国特种外科医院膝关节评分、安大略省西部和麦克马斯特大学骨关节炎指数评分、膝关节活动度、目测类比评分及髋膝踝角;随访并记录患者术后假体使用时间、失效或翻修原因,计算并比较各组假体的有效使用率,采用生存曲线对假体有效使用率进行统计学分析。结果与结论:(1)各组患者间术后随访时间、膝关节活动度、目测类比评分、髋膝踝角比较差异无显著性意义(P>0.05);(2)术后末次随访各组间美国特种外科医院膝关节评分、安大略省西部和麦克马斯特大学骨关节炎指数评分均较术前显著改善(P<0.05),且各组间比较差异有显著性意义(P<0.05),对于美国特种外科医院膝关节评分重度肥胖组改善效果最差;(3)各组术后即刻与末次随访髋膝踝角对比发现,除正常组外(P>0.05),其余各组2个时间点之间差异均有显著性意义(P<0.05);(4)正常、超重、肥胖及重度肥胖组假体有效使用率依次为100%,95%,94%和94%,组间比较差异无显著性意义(χ^(2)=2.532,P=0.469);(5)提示绝经后肥胖女性患者体质量指数值对内侧单髁假体有效使用率无显著影响;肥胖是影响患者术后膝关节功能评分及假体有效使用率的重要因素,单髁置换前后应适当控制体质量,同时女性体质量指数≥30 kg/m^(2)不是单髁置换的最佳适应证,建议行单髁置换的女性患者应将体质量指数控制在30 kg/m^(2)以下。

BACKGROUND:In the follow-up after unicompartmental knee arthroplasty,some patients have knee pain,among which postmenopausal obese women are the most common.As an important index to measure the degree of body obesity,whether body mass index is related to the curative effect after unicompartmental knee arthroplasty and whether obesity will affect the function of knee joint after operation are worthy of further study.OBJECTIVE:To evaluate the clinical efficacy of postmenopausal obese women undergoing medial unicompartmental knee arthroplasty,and to determine the influence of body mass index on the quality of life after unicompartmental knee arthroplasty.METHODS:Female postmenopausal patients who underwent medial unicompartmental knee arthroplasty for the first time due to medial knee pain from January 2017 to January 2019 in the Fourth Clinical Medical College of Xinjiang Medical University were enrolled.A total of 270 cases were included according to inclusion and exclusion criteria,and were divided into 4 groups according to preoperative body mass index:There were 42 cases in normal group(body mass index 18.5-22.9 kg/m^(2)),58 cases in overweight group(body mass index 23.0-24.9 kg/m^(2)),122 cases in obese group(body mass index 25.0-29.9 kg/m^(2)),and 48 cases in severely obese group(body mass index≥30 kg/m^(2)).Hospital for Special Surgery score,Western Ontario and McMaster Universities Osteoarthritis Index score,knee range of motion,visual analog scale score,and hip-knee-ankle angle were compared before,after and at the last time in each group.Patients were followed up to record the time of use of prostheses after surgery and reasons for failure or revision.The effective utilization rate of prostheses was calculated and compared in each group.Survival curve was used for statistical analysis of the effective utilization rate of prostheses.RESULTS AND CONCLUSION:(1)There was no significant difference in postoperative follow-up time,knee joint range of motion,visual analog scale score,and hip-knee-ankle angle between the groups(P>0.05).(2)The Hospital for Special Surgery score and Western Ontario and McMaster Universities Osteoarthritis Index score of each group in final follow-up were significantly improved compared with those before surgery(P<0.05),and the postoperative effect was obvious in each group(P<0.05).Regarding Hospital for Special Surgery score,the improvement effect was worse in the severely obese group.(3)The comparison of hip-knee-ankle angle between all groups immediately after surgery and the last follow-up showed that there were significant differences between the other groups at two time points(P<0.05)except the normal group(P>0.05).(4)The effective utilization rate of prosthesis in normal,overweight,obesity,and severely obese groups was 100%,95%,94%,and 94%,respectively,and there was no significant difference between the groups(χ^(2)=2.532,P=0.469).(5)It is indicated that body mass index of postmenopausal obese women had no significant effect on the effective utilization rate of medial unicompartmental prosthesis.Obesity is an important factor affecting the postoperative knee function score and the effective utilization rate of prosthesis.Weight should be properly controlled before and after unicompartmental knee arthroplasty.At the same time,female body mass inde x≥30 kg/m^(2) is not the best indication for unicompartmental knee arthroplasty.It is suggested that female patients undergoing unicompartmental knee arthroplasty should control body mass index below 30 kg/m^(2).