关节镜部分半月板切除术后无放射学退行性关节病证据的患者中，体重指数对临床结局的影响。
The Effect of Body Mass Index on Clinical Outcomes in Patients Without Radiographic Evidence of Degenerative Joint Disease After Arthroscopic Partial Meniscectomy.
机构信息
Department of Orthopaedics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, U.S.A.
Department of Biostatistics, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, U.S.A.
出版信息
Arthroscopy. 2017 Nov;33(11):2054-2063.e10. doi: 10.1016/j.arthro.2017.06.021. Epub 2017 Sep 29.
PURPOSE
To examine the effect of obesity on clinical outcomes at 1 year after arthroscopic partial meniscectomy.
METHODS
We conducted a secondary analysis of the ChAMP (Chondral Lesions and Meniscus Procedures) randomized controlled trial (N = 256). The visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, and presence of effusion were assessed preoperatively and at 1 year after arthroscopic partial meniscectomy. Body mass index was categorized as normal weight, 24.99 or less; overweight, 25 to 29.99; or obese, 30 or greater. Analysis of variance or the Cochran-Mantel-Haenszel test was used to examine differences in clinical outcomes between body mass index categories, and mean ± standard deviation or number (percentage) is reported.
RESULTS
Preoperatively, obese patients had worse WOMAC pain (56.2 ± 17.2 vs 61.3 ± 17.2, P = .02), WOMAC physical function (55.8 ± 17.1 vs 62.8 ± 17.1, P = .004), pain visual analog scale (4.9 ± 2.1 vs 4.2 ± 1.9, P = .01), KOOS pain (49.5 ± 14.9 vs 54.0 ± 15.1, P = .02), and KOOS quality-of-life (27.9 ± 18.3 vs 36.9 ± 17.0, P = .001) scores, as well as decreased flexion (121.8° ± 22.6° vs 132.3° ± 16.5°, P = .003), compared with normal-weight patients. Overweight patients (n = 51 [51.5%], P = .03) and obese patients (n = 56 [52.8%], P = .002) were more likely to have knee effusion before surgery than normal-weight patients (n = 17 [34%]). At 1 year after surgery, overweight (130.2° ± 7.7°, P = .03) and obese (128.1° ± 7.1°, P = .003) patients had decreased flexion compared with normal-weight patients (134.5° ± 8.3°).
CONCLUSIONS
Obese patients had worse pain, physical functioning, and quality-of-life scores, as well as decreased flexion, compared with normal-weight patients before arthroscopic partial meniscectomy. At 1 year after arthroscopic partial meniscectomy, there were no statistically significant differences in clinical outcomes but obesity was associated with decreased knee flexion.
LEVEL OF EVIDENCE
Level II, prospective comparative trial.
目的
探讨关节镜下半月板部分切除术 1 年后肥胖对临床结果的影响。
方法
我们对 ChAMP（软骨病变和半月板手术）随机对照试验（N=256）进行了二次分析。在关节镜下半月板部分切除术前和术后 1 年，采用视觉模拟评分法评估疼痛、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、膝关节损伤和骨关节炎结果评分（KOOS）、关节活动度和关节积液。体重指数分为正常体重，24.99 或以下；超重，25 至 29.99；肥胖，30 或以上。采用方差分析或 Cochran-Mantel-Haenszel 检验比较体重指数类别之间的临床结果差异，报告均值±标准差或数量（百分比）。
结果
术前，肥胖患者 WOMAC 疼痛（56.2±17.2 比 61.3±17.2，P=.02）、WOMAC 躯体功能（55.8±17.1 比 62.8±17.1，P=.004）、疼痛视觉模拟评分（4.9±2.1 比 4.2±1.9，P=.01）、KOOS 疼痛（49.5±14.9 比 54.0±15.1，P=.02）和 KOOS 生活质量（27.9±18.3 比 36.9±17.0，P=.001）评分较差，且膝关节屈曲度（121.8°±22.6°比 132.3°±16.5°，P=.003）也较差，与正常体重患者相比。超重患者（n=51 [51.5%]，P=.03）和肥胖患者（n=56 [52.8%]，P=.002）术前更有可能出现膝关节积液，而非正常体重患者（n=17 [34%]）。术后 1 年，超重（130.2°±7.7°，P=.03）和肥胖（128.1°±7.1°，P=.003）患者膝关节屈曲度较正常体重患者（134.5°±8.3°）下降。
结论
与正常体重患者相比，关节镜下半月板部分切除术前肥胖患者疼痛、躯体功能和生活质量评分更差，膝关节屈曲度更低。关节镜下半月板部分切除术后 1 年，临床结果无统计学显著差异，但肥胖与膝关节屈曲度下降有关。
证据等级
II 级，前瞻性对照试验。
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