全膝关节置换术后下肢术前肌肉组成与步态功能的关联。

Association of preoperative muscle composition of the lower extremity with gait function after total knee arthroplasty.

作者信息

Yasuda Tadashi, Honda Shintaro, Matsunaga Kazuhiro, Hashimura Takumi, Tsukamoto Yoshihiro, Ota Satoshi, Fujita Satoshi, Onishi Eijiro

机构信息

Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan.

出版信息

J Orthop Sci. 2023 Jan;28(1):188-194. doi: 10.1016/j.jos.2021.10.001. Epub 2021 Oct 30.

DOI:10.1016/j.jos.2021.10.001

PMID:34728112

Abstract

BACKGROUND

Limitations of gait function persist in some patients with knee osteoarthritis after total knee arthroplasty. This study aimed to identify preoperative muscle composition variables of the operated limb associated with postoperative gait function.

METHODS

Longitudinal data from 45 patients who underwent unilateral primary total knee arthroplasty were retrospectively analyzed. Timed Up-and-Go test and gait speed were measured preoperatively and at 3 and 6 months postoperatively. Preoperative muscle composition in the glutei medius and minimus, the quadriceps, the hamstrings, and combination of the hamstrings and quadriceps were evaluated by computed tomography. The area ratio of the individual muscle composition to the total muscle was calculated. The factors associated with Timed Up-and-Go test and gait speed were identified using stepwise regression analysis.

RESULTS

Shorter Timed Up-and-Go test and faster gait speed at each time point correlated with higher lean muscle mass area of the total hamstrings, higher area ratio of lean muscle mass to the total hamstrings or to combination of the hamstrings and quadriceps, and lower area ratio of low density lean tissue or intramuscular adipose tissue to the total hamstrings. Shorter Timed Up-and-Go test at each time point also correlated with higher combined area of lean muscle mass of the hamstrings and quadriceps. Faster gait speed at each time point additionally correlated with lower area ratio of intramuscular fat to the total hamstrings and lower area ratio of lean tissue mass or intramuscular adipose tissue to combination of the hamstrings and quadriceps. Regression analysis using the significant muscle composition variables revealed that the area ratio of lean muscle mass to the total hamstrings was the only predictor of Timed Up-and-Go test and gait speed after operation.

CONCLUSIONS

Preoperative area ratio of ipsilateral lean muscle mass to the total hamstrings could predict gait function after total knee arthroplasty.

摘要

背景

部分膝关节骨关节炎患者在全膝关节置换术后步态功能仍存在局限性。本研究旨在确定与术后步态功能相关的患侧术前肌肉成分变量。

方法

回顾性分析45例行单侧初次全膝关节置换术患者的纵向数据。术前及术后3个月和6个月测量定时起立行走测试和步速。通过计算机断层扫描评估臀中肌和臀小肌、股四头肌、腘绳肌以及腘绳肌与股四头肌组合的术前肌肉成分。计算各肌肉成分面积与总肌肉面积的比值。采用逐步回归分析确定与定时起立行走测试和步速相关的因素。

结果

各时间点定时起立行走测试时间越短、步速越快，与总腘绳肌的瘦肌肉质量面积越大、瘦肌肉质量与总腘绳肌或腘绳肌与股四头肌组合的面积比值越高、低密度瘦组织或肌内脂肪组织与总腘绳肌的面积比值越低相关。各时间点定时起立行走测试时间越短，还与腘绳肌和股四头肌的瘦肌肉质量联合面积越大相关。各时间点步速越快，还与肌内脂肪与总腘绳肌的面积比值越低、瘦组织质量或肌内脂肪组织与腘绳肌和股四头肌组合的面积比值越低相关。使用显著的肌肉成分变量进行回归分析显示，瘦肌肉质量与总腘绳肌的面积比值是术后定时起立行走测试和步速的唯一预测指标。