体质指数过低对全膝关节置换术后疗效的影响  

Impact of low body mass index on the clinical outcomes of total knee arthroplasty

作　　者：吴乾 王宏志 陈张欢 张勇[1] 蒋定华[1] 李立松 黄立新[1] 徐五 WU Qian;WANG Hong-zhi;CHEN Zhang-huan;ZHANG Yong;JIANG Ding-hua;LI Li-song;HUANG Li-xin;XU Wu(Department of Orthopedics,The First Affiliated Hospital,Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《中国矫形外科杂志》2021年第8期679-683,共5页Orthopedic Journal of China

基　　金：苏州市临床重点病种诊疗技术专项项目:膝关节骨关节炎的临床大数据挖掘及规范化精准化诊疗体系(苏州体系)的构建;苏州大学大学生课外学术科研基金项目:基于互联网技术开发膝骨关节炎术后快速康复程序。

摘　　要：[目的]探究术前体质指数(body mass index, BMI)过低对全膝关节置换术后功能恢复的影响。[方法]回顾性分析2015年01月~2017年12月于本院行全膝关节置换术的176例患者,其中,低BMI (BMI<18.5 kg/㎡) 35例;正常BMI (18.5kg/㎡≤BMI<25 kg/㎡) 141例。对比两组患者的住院时间、术中出血量、术后血栓发生率、围手术期输血率、术后抢救率、术后早期VAS评分、术后ROM恢复情况、KSS评分以及随访期间并发症发生情况。[结果]低BMI组住院时间显著多于正常BMI组(P<0.05),但两组间术中失血量的差异无统计学意义(P>0.05)。在不良事件方面,低BMI组的血栓事件发生率高于正常BMI组,虽差异无统计学意义(8.57%vs 1.42%,P>0.05);低BMI组伤口并发症率显著高于正常BMI组(17.14%vs 2.84%,P<0.05);低BMI组输血率显著高于正常BMI组(22.86%vs 2.13%,P<0.05);低BMI组围手术期抢救事件发生率高于正常BMI组,但差异无统计学意义(5.71%, vs 0.71%,P>0.05)。疼痛方面,两组患者术前VAS评分的差异无统计学意义(P>0.05)。而术后24、48、72 h,低BMI组VAS评分均显著高于正常BMI组(P<0.05);随时间推移,两组患者VAS评分均显著下降(P<0.05)。随访过程中随时间推移,两组患者膝关节伸屈ROM和KSS评分显著增加(P<0.05)。相应时间点,两组间ROM和KSS评分的差异均无统计学意义(P>0.05)。两组患者随访过程中不良事件发生率差异无统计意义(11.42%vs 7.80%,P>0.05)。[结论] BMI低于正常值的患者行全膝关节置换可达到与正常体重患者相同的临床效果,但术后早期疼痛症状更明显,输血率更高。[Objective] To explore the impact of preoperative low body mass index on functional recovery after total knee arthroplasty.[Method] A retrospective study was done on 176 patients who underwent total knee arthroplasty in our hospital from January 2015 to December 2017. Of them, 35 patients had low BMI(BMI<18.5 kg/㎡), while the remaining 141 patients were of normal BMI(18.5 kg/㎡≤BMI<25 kg/㎡). The hospitalization time, intraoperative blood loss, incidence of postoperative thrombosis, perioperative blood transfusion rate,postoperative rescue rate, early postoperative VAS score, postoperative ROM recovery, KSS score, and adverse event during follow-up were compared between the two groups of patients. [Results] The hospital stay in the low BMI group was significantly longer than that in the normal BMI group(P<0.05), but the difference in intraoperative blood loss between the two groups was not statistically significant(P>0.05).In terms of early adverse events, the incidence of thrombotic events in the low BMI group was higher than that in the normal BMI group, although the difference was not statistically significant(8.57% vs 2.84%, P>0.05);the wound complication rate in the low BMI group was significantly higher than that in the normal BMI group(17.14% vs 2.84%, P<0.05);the blood transfusion rate of the low BMI group was significantly higher than that of the normal BMI group(22.86% vs 2.13%, P<0.05);the low BMI group had a higher chance of perioperative rescue events than the normal BMI group regardless of that the difference was not statistically significant(5.71%, vs 0.71%, P>0.05). In terms of pain early stage after operation, the VAS scores were not statistically significant between the two groups before operation(P>0.05), while which was significantly higher in the low BMI group than the normal BMI group at 24 h, 48 h and 72 h after operation(P<0.05). In addition, the VAS scores in both groups decreased significantly over time(P<0.05). During the follow-up process, the knee extension and flexion ROMs, as

关 键 词：全膝关节置换术 体质指数 功能恢复 

分 类 号：R687.4[医药卫生—骨科学]