影响全膝人工关节置换术后疗效的相关因素分析

目的分析后稳定型全膝人工关节置换（total knee replacement，TKR）术后疗效和并发症发生情况，探讨影响TKR术后疗效的相关因素。方法1998年1月～2004年8月，应用后稳定型膝关节假体对60例（74膝）骨性关节炎患者行TKR手术。以术后膝关节HSS（hospitl for special surgery）评分和各单项评分的改善率评定TKR术后疗效；比较有并发症和无并发症患者之间疗效优良率的差异；采用Pearson相关分析对TKR术后HSS评分与术前患者自身的有关因素进行相关性分析。结果60例患者获随访24～94个月，平均42．5个月。术后膝关节HSS评分、疼痛、功能、关节活动度、肌力、屈曲畸形及稳定性评分分别为84．2±14．2、25．7±6．9、17．9±4．3、13．1±2．0、9．2±0．8、8．1±0．4和9．3±0．1，较术前均有不同程度改善，尤以疼痛缓解最为明显，且差异均有统计学意义（P〈0．05）。疗效评定优良率为90．5％。10膝发生局部并发症，其中腓总神经损伤1膝，伤口愈合不良2膝，伤口感染、关节内感染及关节僵硬各1膝，症状性下肢深静脉血栓形成2膝，髌-股关节并发症2膝。有并发症患者膝关节优良率（60．0％）明显低于无并发症患者（95．3％），且差异有统计学意义（P〈0．05）。相关分析显示TKR术后HSS评分与膝关节术前HSS评分、疼痛和功能评分呈正相关，相关系数分别为0．523、0．431和0．418（P〈0．01）；而与患者术前关节活动度、肌力、屈曲畸形、稳定性、年龄、体重和体重指数等无相关（P〉0．05）。结论采用后稳定型TKR是治疗重症膝关节骨性关节炎的有效方法。术后疗效与术前膝关节HSS评分、疼痛和功能评分呈正相关；并发症的发生对术后疗效有明显负面影响。

ANALYSIS OF FACTORS RELATING TO CLINICAL OUTCOMES AFTER TOTAL KNEE REPLACEMENT

OBJECTIVE: To analyze the outcomes and complications after total knee replacement (TKR) with posterior stabilized prosthesis (PS) and to investigate the influencing factors relating to outcomes. METHODS: From January 1998 to August 2004, 60 cases (74 knees) of osteoarthritis underwent TKR with PS. The outcomes were evaluated according to the HSS (hospital for special surgery) scoring. The difference in outcomes between patients with post-operative complications and without complications were compared. Pearson correlation was used to analyze postoperative outcomes and the pre-operative factors relating to patients. RESULTS: All 74 knees were followed up 42.5 months (24 to 94 months). The scores for HSS, pain, function, ROM muscle strength, flexion deformity and stability of knees after operation were 84.2 +/- 14.2, 25.7 +/- 6.9, 17.9 +/- 4.3, 13.1 +/- 2.0, 9.2 +/- 0.8, 8.1 +/- 0.4 and 9.3 +/- 0.1 respectively. They were improved to some extents, especially pain alleviation was remarkable. The excellent and good rate for outcome assessment was 90.5%. Among 74 knees, 10 cases suffered from post-operative complications, including 1 case of common peroneal nerve paralysis, two cases of wound faulty union, one case of wound infection, one case of joint infection, one case of stiff knee, two cases of deep vein thrombosis and 2 cases of patellofemoral joint complications. The excellent and good rate of outcome in patients with complications (60%) was much lower than that in patients without complication (95.3%),and there was significant difference between them (P < 0.05). Analysis for correlation showed that postoperative HSS score was positively correlative with the postoperative HSS score, pain and function score of knees. The correlation value was 0.523, 0.431 and 0.418 respectively (P < 0.01). Whereas, postoperative HSS score was not correlative with ROM, muscle strength, flexion deformity, stability of knee, age, weight and body mass index (P > 0.05). CONCLUSION: TKR with PS is an effective method for severe osteoarthritis. The outcomes after TKR have a positive correlation with the HSS score, pain and function score of knees before surgery. Complications associating with surgery have a negative influence on outcomes.