血清 n-3 多不饱和脂肪酸与全膝关节置换术后即刻股四头肌无力的关系。
Association between serum n-3 polyunsaturated fatty acids and quadriceps weakness immediately after total knee arthroplasty.
机构信息
Department of Rehabilitation, Kobori Orthopaedic Clinic, Nearaichou, Kita-ku, Hamamatsu City, Shizuoka, Japan.
Department of Rehabilitation Sciences, Seirei Christopher University, Mikataharachou, Kita-ku, Hamamatsu City, Shizuoka, Japan.
出版信息
PLoS One. 2020 Jan 29;15(1):e0228460. doi: 10.1371/journal.pone.0228460. eCollection 2020.
OBJECTIVES
Quadriceps weakness (QW) following total knee arthroplasty (TKA) can be elicited by tourniquet-induced ischaemia reperfusion (IR), which causes a vigorous acute inflammatory response. Dietary n-3 polyunsaturated fatty acids (PUFA) are important determinants of organ and tissue protection from IR. This study aimed to examine the association between serum n-3 PUFA levels and QW, knee pain, and knee swelling immediately after TKA.
METHODS
A total of 32 patients who underwent unilateral TKA participated in this prospective study. On Postoperative Day 1, serum n-3 PUFA (eicosapentaenoic acid and docosahexaenoic acid) levels were measured. Preoperatively and on Postoperative Day 4, quadriceps strength, knee pain during quadriceps testing, and knee circumference were measured. QW, knee pain, and knee swelling were defined as changes in quadriceps strength, knee pain during quadriceps testing, and knee circumference, respectively, between the preoperative to the postoperative measurement.
RESULTS
Mean serum n-3 PUFA levels were 192 μg/mL (standard deviation, 58 μg/mL) on Postoperative Day 1. All measured variables changed significantly between the preoperative and the postoperative measurement time-points (P <0.01). Quadriceps strength decreased from 1.2 to 0.4 Nm/kg (QW = -65%). Knee pain during quadriceps testing increased from 1.1 to 6.0 (knee pain = 4.0). Knee circumference increased from 40 to 44 cm (knee swelling = 10%). Multivariate analysis showed that lower serum n-3 PUFA levels were independently associated with an increased QW after adjusting for the Kellgren-Lawrence grade and the tourniquet time (P = 0.04). No significant relationship was observed between serum n-3 PUFA levels and knee pain or knee swelling.
CONCLUSION
Higher serum n-3 PUFA are independently associated with a lower increase in the QW immediately after TKA.
目的
全膝关节置换术（TKA）后，止血带引起的缺血再灌注（IR）可引发股四头肌无力（QW），引起强烈的急性炎症反应。饮食中的 n-3 多不饱和脂肪酸（PUFA）是保护器官和组织免受 IR 影响的重要决定因素。本研究旨在探讨 TKA 后血清 n-3 PUFA 水平与 QW、膝关节疼痛和膝关节肿胀之间的关系。
方法
本前瞻性研究共纳入 32 例行单侧 TKA 的患者。术后第 1 天测量血清 n-3 PUFA（二十碳五烯酸和二十二碳六烯酸）水平。术前和术后第 4 天测量股四头肌力量、股四头肌测试时的膝关节疼痛和膝关节周长。QW、膝关节疼痛和膝关节肿胀分别定义为术前至术后测量时股四头肌力量、股四头肌测试时膝关节疼痛和膝关节周长的变化。
结果
术后第 1 天平均血清 n-3 PUFA 水平为 192μg/mL（标准差为 58μg/mL）。所有测量变量在术前和术后测量时间点之间均有显著变化（P<0.01）。股四头肌力量从 1.2 降至 0.4 Nm/kg（QW=-65%）。股四头肌测试时的膝关节疼痛从 1.1 增加到 6.0（膝关节疼痛=4.0）。膝关节周长从 40 增加到 44cm（膝关节肿胀=10%）。多元分析显示，在校正 Kellgren-Lawrence 分级和止血带时间后，较低的血清 n-3 PUFA 水平与 TKA 后 QW 的增加独立相关（P=0.04）。血清 n-3 PUFA 水平与膝关节疼痛或膝关节肿胀之间无显著关系。
结论
较高的血清 n-3 PUFA 与 TKA 后 QW 的增加呈独立负相关。
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