体重指数与膝关节骨关节炎患者膝关节置换术临床疗效的关系
The relationship between body mass index and clinical efficacy of knee arthroplasty in patients with knee osteoarthritis.
作者信息
Guo Tongya, Liu Qingpeng, Chen Xintong, Chen Wei
机构信息
Department of Bone and Joint Surgery, Xuzhou Central Hospital, Xuzhou, China.
Department of Sports Medicine, The Second Affiliated Hospital of Shandong First Medical University, Taian, China.
出版信息
Ann Transl Med. 2022 Mar;10(6):289. doi: 10.21037/atm-22-819.
BACKGROUND
Increase body mass index (BMI) is often accompanied by metabolic diseases such as diabetes, which will increase the uncertainty of total knee arthroplasty (TKA) efficacy and the risk of postoperative complications. The present study was to study the relationship between increase BMI and clinical efficacy of knee arthroplasty in patients with knee osteoarthritis.
METHODS
A total of 97 patients (36 males and 61 females) with knee osteoarthritis (KOA) who underwent TKA surgery were selected. According to the preoperative body mass index (BMI), the patients were divided into a normal group (n=42), overweight group (n=35), and obese group (n=20). All patients received TKA after admission. Seven days after surgery, the American Knee Society (AKS) and the Hospital for Special Surgery (HSS) scales were used to evaluate the recovery of knee function. The recovery was poor if the scores of AKS and HSS were less than 70.
RESULTS
Seven days after TKA, the scores of AKS and HSS in different BMI groups were significantly different, and decreased with the increase of BMI (P<0.05). Age, increased BMI, diabetes, preoperative range of motion (ROM), intraoperative blood loss, postoperative C-reactive protein (CRP), postoperative posterior slope angle (PSA), postoperative infection, and postoperative deep vein thrombosis (DVT) of lower extremities were related to AKS score <70 (P<0.05). Diabetes, preoperative ROM, intraoperative blood loss, postoperative CRP, postoperative PSA, and postoperative infection were related to HSS score <70 (P<0.05). Increased BMI, diabetes, postoperative CRP, postoperative infection, and postoperative DVT were independent risk factors for AKS score <70 (HR =3.458, 1.152, 2.960, 1.023, 3.589, P<0.05). Increased BMI, diabetes, postoperative CRP, and postoperative infection were independent risk factors for HSS score <70 (HR =6.891, 1.263, 1.967, 1.235, P<1.235). The area under the curve (AUC) (95% CI) of BMI in diagnosing AKS <70 was 0.740 (0.641-0.839). The AUC (95% CI) of BMI in diagnosing HSS <70 was 0.809 (0.723-0.894).
CONCLUSIONS
The increase of BMI is an independent risk factor for the poor recovery of knee function after TKA in patients with KOA.
背景
体重指数（BMI）增加常伴有糖尿病等代谢性疾病，这会增加全膝关节置换术（TKA）疗效的不确定性及术后并发症风险。本研究旨在探讨BMI增加与膝关节骨关节炎患者膝关节置换术临床疗效之间的关系。
方法
选取97例行TKA手术的膝关节骨关节炎（KOA）患者（男性36例，女性61例）。根据术前体重指数（BMI）将患者分为正常组（n = 42）、超重组（n = 35）和肥胖组（n = 20）。所有患者入院后均接受TKA手术。术后7天，采用美国膝关节协会（AKS）和特种外科医院（HSS）评分量表评估膝关节功能恢复情况。若AKS和HSS评分低于70分，则恢复较差。
结果
TKA术后7天，不同BMI组的AKS和HSS评分存在显著差异，且随BMI增加而降低（P < 0.05）。年龄、BMI增加、糖尿病、术前活动范围（ROM）、术中出血量、术后C反应蛋白（CRP）、术后后倾角（PSA）、术后感染及术后下肢深静脉血栓形成（DVT）与AKS评分<70分相关（P < 0.05）。糖尿病、术前ROM、术中出血量、术后CRP、术后PSA及术后感染与HSS评分<70分相关（P < 0.05）。BMI增加、糖尿病、术后CRP、术后感染及术后DVT是AKS评分<70分的独立危险因素（HR = 3.458、1.152、2.960、1.023、3.589，P < 0.05）。BMI增加、糖尿病、术后CRP及术后感染是HSS评分<70分的独立危险因素（HR = 6.891、1.263、1.967、1.235，P < 1.235）。BMI诊断AKS<70分的曲线下面积（AUC）（95%CI）为0.740（0.641 - 0.839）。BMI诊断HSS<70分的AUC（95%CI）为0.809（0.723 - 0.894）。
结论
BMI增加是KOA患者TKA术后膝关节功能恢复不良的独立危险因素。
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