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体质量指数对全膝人工关节表面置换后功能的影响
引用本文:高辉.体质量指数对全膝人工关节表面置换后功能的影响[J].中国组织工程研究与临床康复,2010,14(26).
作者姓名:高辉
作者单位:赣南医学院第一附属医院骨科,江西省赣州市,341000
摘    要:背景:目前有一些研究考虑到了体质量指数对全膝人工关节表面置换后功能的影响,但是大部分病例数较少,随访时间较短.目的:观察体质量指数对全膝人工关节表面置换后功能的影响.方法:选择北京大学人民医院骨关节科收治的骨关节炎患者320例,均接受初次膝关节髌骨置换,其中双膝置换200例,共520个膝关节,左膝置换219个,右膝置换301个.由同一组医生采用同一种假体(均为Scorpio后稳定型膝关节假体)对320例患者行全膝人工关节表面置换治疗.按体质量指数分为4组(超重组:体质量指数25.1~27.0 kg/m2,肥胖组:体质量指数27.1~30.0 kg/m2,病理性肥胖组:体质量指数> 30 kg/m2,对照组:体质量指数< 25 kg/m2).按1989年美国纽约特种外科医院评分标准(HSS),记录置换前及随访时膝关节评分和功能评分,以及膝关节最大屈曲度、伸直度数和并发症.结果与结论:320例患者均通过门诊复查进行随访,随访时间12~46个月,平均28.3个月.置换前超重组、肥胖组、病理性肥胖组功能评分较对照组低(P < 0.05),但关节评分无显著性差异.在最后的随访中发现,无论膝评分和功能评分各组置换后均明显提高,各组提高的幅度无显著性差异(P > 0.05).肥胖组和病理性肥胖组围置换期并发症明显增高(P < 0.05),181膝中有14膝(9.2%)合并伤口并发症,1膝(0.5%)感染,2膝(1.3%)内侧副韧带损伤,感染发生于置换后10周内并与伤口并发症有关;而超重组258膝中有6膝(2.3%)合并伤口并发症;对照组81膝中有1膝(1%)合并伤口并发症.围置换期无死亡和肺栓塞病例.提示体质量指数对全膝人工关节表面置换后早期的功能恢复无明显影响.

关 键 词:体质量指数  全膝人工关节表面置换  功能随访  并发症

Influence of body mass index on function outcome after total knee replacement
Gao Hui.Influence of body mass index on function outcome after total knee replacement[J].Journal of Clinical Rehabilitative Tissue Engineering Research,2010,14(26).
Authors:Gao Hui
Abstract:BACKGROUND: Some studies have considered the influence of body mass index (BMI) on the function following total knee replacement (TKR), but the cases were few and follow-up time is short in most of them.OBJECTIVE: To analyze the function outcome influenced by BMI after TKR. METHODS: A total of 320 osteoarthritis patients who were admitted in Department of Bone and Joint at Peking University People's Hospital, were involved in this study. They all received primary knee joint patellar resurfacing, including both knees replacement in 200 case of 520 knees, left 219 and right 301. The involved 320 patients underwent primary TKR performed by a single surgeon with the same type of prosthesis (Scorpio posterior stable prosthesis). The patients were divided into four groups based on obesity (overweight group, BMI 25.1-27.0 kg/m2; obese group, BMI 27.1-30.0 kg/m2; morbidly obese group, BMI > 30 kg/m2; control group, BMI < 25 kg/m2). According to the Hospital for Special Surgery (HSS) rating scale, their knee score and functional scores were recorded before replacement and at follow-ups, as well as maximal range of flexion and extension, complications. Preoperative and postoperative assessment was based on the HSS score. RESULTS AND CONCLUSION: A total of 320 patients received clinical recheck at 28.3 months (range 12-46 months). Compared with control group, patients in overweight, obese and morbidly obese groups had lower preoperative functional score (P < 0.05), but knee scores were not significantly different for any patient group. The postoperative mean HSS score of all the groups rose significantly at the last follow-up. These differences were not statistically significant among groups (P > 0.05). The rate of perioperative complications was significantly higher in the obese and morbidly obese patients (P < 0.05). Of the 181 knees in obese and morbidly obese patients, 14 knees (9.2%) had a wound complication, 1 knee (0.5%) had an infection, and 2 knees (1.3%) had an avulsion of the medial collateral ligament. The infected case developed within ten weeks after the operation, and was associated with a wound complication. Among 266 knees in the overweight patients, 6 knees (2.3%) had a wound complication. There was 1 knee (1%) of the 81 knees in the control group had a wound complication. No death or pulmonary embolism cases were observed in perioperative period. It is suggested that BMI has no obvious influence on the functional outcome following TKR in the short-term.
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