摘要
背景:目前缺乏体重指数(BMI)对活动平台单髁置换术后临床疗效和假体存留率影响的中长期报道。目的:明确患者BMI对活动平台单髁假体中长期临床结果的影响。方法:选取2008年6月至2014年6月期间采用Oxfordphase3单髁假体系统治疗膝关节内侧间室骨关节炎患者193例(229膝),随访60~132个月,平均(93.3±24.2)个月。根据手术时的BMI将患者分为:体重正常组(BMI 18.5~22.9 kg/m2),超重组(23.0~24.9 kg/m2),肥胖组(25.0~29.9 kg/m2),重度肥胖组(≥30 kg/m2)。分别记录各组术前和末次随访时膝关节协会评分(KSS)、膝关节协会功能评分(KSFS)、特种外科医院评分(HSS)、关节活动度(ROM)、股骨胫骨角(FTA)进行统计分析。记录翻修或失败的原因、翻修的类型及从手术日期到翻修的持续时间。使用Kaplan-Meier生存曲线对假体存留率进行分析,计算并比较各BMI组假体存留率。结果:各组术前和末次随访时ROM无显著差异。与术后即刻FTA比较,BMI≥30 kg/m2患者末次随访时FTA内翻程度更大(P<0.05)。各组KSS评分、HSS评分、力线与术前相比均有明显改善。BMI≥30 kg/m2患者在随访时的KSS评分(F=8.141,P<0.05)、HSS评分(F=4.248,P<0.05)改善程度最小,与其余三组差异显著。从BMI最低到最高组假体存留率为100%、95.3%、95.5%和94.7%,各组假体存留率差异没有统计学意义(χ2=1.861,P=0.602)。结论:BMI对活动平台单髁假体中长期存留率无显著影响,重度肥胖(BMI≥30 kg/m2)是影响单髁置换术后中长期临床结果改善程度的一个显著性的指标。肥胖患者在选择单髁置换术时应当慎重。
Background:There is still lack of medium and long term data on the outcomes of mobile-bearing unicompartmental knee arthroplasty(UKA)and survival rate of prosthesis in different body mass index(BMI)groups.Objective:To determine the effect of BMI on the medium and long term clinical outcomes of mobile-bearing UKA.Methods:From June 2008 to June 2014,193 patients(229 knees)receiving the replacement of medial compartment of knee joint with Oxford phase 3 unicondylar prosthesis system due to osteoarthritis in our hospital were analyzed.The patients were followed up for 60-132 months with the average of(93.3±24.2)months.According to BMI,the patients were divided into four groups:normal weight group(BMI,18.5-22.9 kg/m2),overweight group(BMI,23.0-24.9 kg/m2),obesity group(BMI,25.0-29.9 kg/m2),severe obesity group(BMI≥30 kg/m2).The knee society score(KSS),knee society function score(KSFS),hospital for special surgery score(HSS),range of motion(ROM),femorotibial angle(FTA)were recorded before operation and at the last follow-up.The reason for the revision or failure,the type of revision,and the interval time between the first operation and the revision were also analyzed.Kaplan-Meier survival analysis was used to analyze the survival rate of prosthesis in each BMI group.Results:There was no significant difference in ROM among groups before operation and at the last follow-up.Compared with immediate postoperative FTA,patients with BMI≥30 kg/m2 had a greater degree of knee varus at the last follow-up(P<0.05).KSS score,HSS score and leg alignment were significantly improved compared with those before surgery.The degree of improvement of KSS(F=8.141,P<0.05)and HSS(F=4.248,P<0.05)in patients with BMI≥30 kg/m2was the least,which was significantly different from the other three groups.From the lowest to the highest BMI group,the survival rate of prosthesis was 100%,95.3%,95.5%and 94.7%,respectively,without statistically significance among these groups(χ2=1.861,P=0.602).Conclusions:BMI has no significant effect on the medium and long term survival rate of the implant.Severe obesity(BMI≥30 kg/m2)is a significant predictor of smaller improvement in clinical outcomes after UKA.Surgeons should be cautious in choosing UKA for obese patients.
作者
高焕绅
徐熙鹏
孙一
张海宁
GAO Huanshen;XU Xipeng;SUN Yi;ZHANG Haining(Department of Joint Surgery,Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong,China)
出处
《中华骨与关节外科杂志》
2021年第4期251-257,共7页
Chinese Journal of Bone and Joint Surgery
基金
国家自然科学基金(81672197)
关键词
肥胖
单髁置换术
体重指数
假体
翻修
Obesity
Unicompartmental Knee Arthroplasty
Body Mass Index
Implant
Revision
