肥胖患者膝关节置换的挑战与近期疗效分析  

The Analysis of Challenge and Short-term Outcome of Total Knee Replacement in Obese Patients

作　　者：朱元莉[1] 蔡聪 肖骏 李锋[2] 赵利波 

机构地区：[1]华中科技大学同济医学院附属同济医院病理科,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院骨科,湖北武汉430030

出　　处：《实用骨科杂志》2017年第10期888-890,911,共4页Journal of Practical Orthopaedics

基　　金：国家自然科学基金面上项目(81572200)

摘　　要：目的探讨对于肥胖患者进行人工膝关节置换术可能面临的问题及评估其术后近期疗效。方法以我科自2011年11月至2014年9月同一手术组医生进行人工膝关节置换术的23例(28膝)终末期膝关节病变合并肥胖患者为研究对象,并与同期随机抽取的23例(24膝)非肥胖患者对比分析。研究组和对照组疗效评估采用美国膝关节协会评分(knee society score,KSS)系统。结果患者术后均获随访,随访时间2~18个月,平均15.2个月。术前两组间KSS临床评分差异无统计学意义(P>0.05),功能评分差异有统计学意义(P<0.05)。末次随访时,两组间KSS临床评分和功能评分差异无统计学意义(P>0.05),与术前比较差异均有统计学意义(P<0.05)。术后研究组患者中1例切口因脂肪液化而延迟愈合,1例患者未按要求服用抗凝药物发生下肢深静脉血栓,经治疗均获得治愈。结论对于终末期膝关节病变合并肥胖的患者进行人工全膝关节置换,合理治疗术前合并症,熟练术中操作技术以及进行系统的术后管理,可达到满意的近期临床疗效。Objective To explore the possible problems and evaluate the short-term outcome post-operation of total knee replacement in obese patients.Methods We researched 23 cases（28 knees）of the total knee replacement in treating end-stage gonarthrosis combined with obesity,and compared with the randomly selected23 cases（24 knees）of the total knee replacement in the nonobese patients.All were treated by the same surgeons from november 2011 to september 2014.Pre-and post-operative evaluations were performed with Knee Society Scoring System in the both experimental and control group.All the patients were averagely followed up for averaged 15.2 months,ranged from 2 to 18 months.Results There were significant difference of KSS clinical score（P〈0.05）and no significant difference of kss function score（P〉0.05）between the two groups at preoperative time.At the last follow-up,there was no significant difference of KSS score（P〉0.05）,but the score was improved obviously compared with the preoperative conditions（P〈0.05）.After surgery,one case had incision fat liquefaction resulting to delayed healing,and one had lower limbs deep venous thrombosis because of not using anticoagulant drugs according to requirements.All the patients with complications recovered after the treatment.Conclusion End-stage gonarthrosis patients combined with obesity,they can have achieve satisfactory short-term clinical curative effect through reasonable treatment of preoperative complications.Skilled operating technology and systematic Postoperative management are key to get good clinical results.

关 键 词：肥胖 膝关节置换 近期疗效 

分 类 号：R687.42[医药卫生—骨科学]