全膝关节置换术后上下楼梯时持续存在功能障碍的术前预测因素。
Preoperative predictors of persistent impairments during stair ascent and descent after total knee arthroplasty.
机构信息
Department of Physical Therapy, University of Delaware, Newark, DE 19716, USA.
出版信息
J Bone Joint Surg Am. 2010 May;92(5):1130-6. doi: 10.2106/JBJS.I.00299.
BACKGROUND
Although total knee arthroplasty improves functional mobility in persons with end-stage knee osteoarthritis, many subjects have reported continued difficulty with stair ascent and descent after surgery. The purpose of the present study was to determine preoperative predictors of handrail use during stair ascent and descent following primary unilateral total knee arthroplasty.
METHODS
One hundred and five adults who were scheduled for unilateral total knee arthroplasty participated in the study. Postoperative handrail use during stair ascent or descent was predicted on the basis of preoperative functional measures. Preoperative age, body mass index, knee strength, knee flexion active range of motion, Knee Outcome Survey scores, time to complete a stair-climbing task, and previous handrail use were entered as covariates into a binary logistic regression. Forward logistic regression was performed to determine which preoperative factors best predicted handrail use at three months and two years after surgery. Handrail use in a control group was also evaluated at baseline and at the time of the two-year follow-up.
RESULTS
Prior to surgery, sixty-three of the 105 subjects required a handrail. Two years after surgery, sixty of the 105 subjects required a handrail. In the control group, nineteen of the sixty-four subjects required a handrail at baseline and ten of thirty-one required a handrail at the time of the two-year follow-up. At two years, the preoperative ability to ascend and descend stairs without a handrail was the best predictor of individuals who would not require a handrail after surgery, followed by younger age and greater quadriceps strength. Collectively, these variables correctly predicted the ability of ninety of 105 persons to negotiate stairs without a handrail at two years after surgery (p < 0.001).
CONCLUSIONS
Younger, stronger patients who do not use a handrail prior to unilateral total knee arthroplasty can expect the best outcomes in terms of ascending and descending stairs following surgery. This information may provide patients with more realistic expectations after surgery and allow them to make more appropriate discharge plans.
背景
虽然全膝关节置换术可改善终末期膝关节骨关节炎患者的功能移动能力，但许多患者报告术后仍难以上下楼梯。本研究的目的是确定初次单侧全膝关节置换术后上下楼梯时使用扶手的术前预测因素。
方法
105 名计划接受单侧全膝关节置换术的成年人参与了这项研究。根据术前功能测量结果预测术后上下楼梯时使用扶手的情况。将术前年龄、体重指数、膝关节力量、膝关节主动屈伸活动范围、膝关节结果调查评分、完成爬楼梯任务的时间以及以前是否使用过扶手作为协变量纳入二项逻辑回归。进行向前逻辑回归以确定哪些术前因素可最佳预测术后 3 个月和 2 年时使用扶手的情况。还在基线和 2 年随访时评估了对照组的扶手使用情况。
结果
术前，63 名 105 名受试者需要使用扶手。2 年后，105 名受试者中有 60 名需要使用扶手。在对照组中，64 名受试者中有 19 名在基线时需要使用扶手，31 名中有 10 名在 2 年随访时需要使用扶手。2 年后，无需扶手即可上下楼梯的术前能力是预测术后无需扶手的最佳指标，其次是年龄较小和股四头肌力量较大。这些变量共同正确预测了 105 名受试者中有 90 名在 2 年后无需扶手即可上下楼梯的能力（p < 0.001）。
结论
在接受单侧全膝关节置换术前不使用扶手的年轻、强壮的患者，术后上下楼梯的结果可能最好。这些信息可以为患者提供更切合实际的术后预期，并允许他们制定更合适的出院计划。
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