Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake Miyazaki, Miyazaki 889-1692, Japan.
School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake Miyazaki, Miyazaki 889-1692, Japan.
Biomed Res Int. 2021 Jul 8;2021:3919989. doi: 10.1155/2021/3919989. eCollection 2021.
The purpose of this study is to investigate the treatment efficacy of total knee arthroplasty (TKA) on locomotive syndrome (LS) focusing on total clinical decision limit (CDL) stage 3 leading to revealing the motor function indicators that can predict LS improvement in knee osteoarthritis patients who had received TKA.
This prospective cohort study was conducted in 47 patients evaluated as total CDL stage 3 before TKA who received primary TKA on the operated side and were diagnosed with Kellgren-Lawrence grade 2, 3, or 4 knee osteoarthritis on the nonoperated side. LS was evaluated using stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale. In addition, the motor function indicators which could predict the LS improvement were examined. All assessments were conducted before TKA and three months after TKA.
Of the 47 subjects who were evaluated to be in total CDL stage 3 before TKA, 13 patients (27.7%) were determined to show improvements in total CDL. From the result of the decision tree analysis, when the CDL of the two-step test before TKA was 1 or less, the improvement rate was 83.3%. Even if the CDL of the two-step test before TKA was higher than 1 and if the 3 m-Timed Up and Go test (3m-TUG) before TKA was 9.6 or less, the improvement rate was 50%.
As of three months after surgery, TKA can improve LS in about 30% of knee osteoarthritis patients. A two-step test before TKA and 3m-TUG before TKA can be used as motor function indicators to predict LS improvement. This study provides useful information for setting the goal for rehabilitation prior to surgery.
本研究旨在探讨全膝关节置换术（TKA）治疗运动综合征（LS）的疗效，重点关注导致总临床决策限（CDL）第 3 期的治疗，以揭示能预测接受 TKA 的膝骨关节炎患者 LS 改善的运动功能指标。
本前瞻性队列研究纳入了 47 例在 TKA 前评估为总 CDL 第 3 期的患者，这些患者在接受单侧 TKA 的同时，对未手术侧的 Kellgren-Lawrence 分级 2、3 或 4 膝骨关节炎进行了原发性 TKA。LS 使用站立试验、两步试验和 25 项老年运动功能量表进行评估。此外，还检查了能够预测 LS 改善的运动功能指标。所有评估均在 TKA 前和 TKA 后 3 个月进行。
在 47 例在 TKA 前评估为总 CDL 第 3 期的患者中，有 13 例（27.7%）患者的总 CDL 得到改善。决策树分析结果显示，TKA 前两步试验的 CDL 为 1 或更低时，改善率为 83.3%。即使 TKA 前两步试验的 CDL 高于 1，且 TKA 前 3m-Timed Up and Go 测试（3m-TUG）为 9.6 或更低，改善率也为 50%。
在手术后 3 个月，TKA 可以改善约 30%的膝骨关节炎患者的 LS。TKA 前的两步试验和 3m-TUG 可作为运动功能指标，预测 LS 的改善。本研究为术前康复目标的设定提供了有用的信息。
