“生不如死”，等待关节置换。

'Worse than death' and waiting for a joint arthroplasty.

机构信息

Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.

Department of Orthopaedics, University of Edinburgh, Edinburgh, UK.

出版信息

Bone Joint J. 2019 Aug;101-B(8):941-950. doi: 10.1302/0301-620X.101B8.BJJ-2019-0116.R1.

DOI:10.1302/0301-620X.101B8.BJJ-2019-0116.R1

PMID:31362549

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6681678/

Abstract

AIMS

The EuroQol five-dimension (EQ-5D) questionnaire is a widely used multiattribute general health questionnaire where an EQ-5D < 0 defines a state 'worse than death' (WTD). The aim of this study was to determine the proportion of patients awaiting total hip arthroplasty (THA) or total knee arthroplasty (TKA) in a health state WTD and to identify associations with this state. Secondary aims were to examine the effect of WTD status on one-year outcomes.

PATIENTS AND METHODS

A cross-sectional analysis of 2073 patients undergoing 2073 THAs (mean age 67.4 years (sd 11.6; 14 to 95); mean body mass index (BMI) 28.5 kg/m (sd 5.7; 15 to 72); 1253 female (60%)) and 2168 patients undergoing 2168 TKAs (mean age 69.3 years (sd 9.6; 22 to 91); BMI 30.8 kg/m (sd 5.8; 13 to 57); 1244 female (57%)) were recorded. Univariate analysis was used to identify variables associated with an EQ-5D score < 0: age, BMI, sex, deprivation quintile, comorbidities, and joint-specific function measured using the Oxford Hip Score (OHS) or Oxford Knee Score (OKS). Multivariate logistic regression was performed. EQ-5D and OHS/OKS were repeated one year following surgery in 1555 THAs and 1700 TKAs.

RESULTS

Preoperatively, 391 THA patients (19%) and 263 TKA patients (12%) were WTD. Multivariate analysis identified preoperative OHS, deprivation, and chronic obstructive pulmonary disease in THA, and OKS, peripheral arterial disease, and inflammatory arthropathy in TKA as independently associated with WTD status (p < 0.05). One year following arthroplasty EQ-5D scores improved significantly (p < 0.001) and WTD rates reduced to 35 (2%) following THA and 53 (3%) following TKA. Patients who were WTD preoperatively achieved significantly (p < 0.001) worse joint-specific Oxford scores and satisfaction rates one year following joint arthroplasty, compared with those not WTD preoperatively.

CONCLUSION

In total, 19% of patients awaiting THA and 12% awaiting TKA for degenerative joint disease are in a health state WTD. Although specific comorbidities contribute to this, hip- or knee-specific function, mainly pain, appear key determinants and can be reliably reversed with an arthroplasty. Cite this article: 2019;101-B:941-950.

摘要

目的

EuroQol 五维健康量表（EQ-5D）是一种广泛使用的多维一般健康问卷，其中 EQ-5D<0 定义为“比死亡还差”（WTD）状态。本研究的目的是确定等待全髋关节置换术（THA）或全膝关节置换术（TKA）的患者中处于 WTD 状态的比例，并确定与该状态相关的因素。次要目的是检查 WTD 状态对一年结局的影响。

患者和方法

对 2073 例接受 2073 例 THA（平均年龄 67.4 岁（标准差 11.6；14 至 95）；平均体重指数（BMI）28.5kg/m2（标准差 5.7；15 至 72）；女性 1253 例（60%））和 2168 例接受 2168 例 TKA（平均年龄 69.3 岁（标准差 9.6；22 至 91）；BMI 30.8kg/m2（标准差 5.8；13 至 57）；女性 1244 例（57%））的患者进行了横断面分析。采用单变量分析确定与 EQ-5D 评分<0 相关的变量：年龄、BMI、性别、贫困五分位数、合并症和使用牛津髋关节评分（OHS）或牛津膝关节评分（OKS）测量的关节特异性功能。进行了多变量逻辑回归。在 1555 例 THA 和 1700 例 TKA 中，在手术后一年重复了 EQ-5D 和 OHS/OKS。

结果

术前，391 例 THA 患者（19%）和 263 例 TKA 患者（12%）为 WTD。多变量分析确定术前 OHS、贫困和慢性阻塞性肺疾病与 THA 的 WTD 状态独立相关，而 OKS、外周动脉疾病和炎症性关节炎与 TKA 的 WTD 状态独立相关（p<0.05）。术后一年，EQ-5D 评分显著改善（p<0.001），WTD 率分别降至 THA 后 35 例（2%）和 TKA 后 53 例（3%）。与术前未 WTD 的患者相比，术前 WTD 的患者在关节置换术后一年时的关节特异性牛津评分和满意度明显较差（p<0.001）。