脂肪质量指数对全膝关节置换术后早期功能康复的影响  

Impact of the fat mass index on early functional recovery after total knee arthroplasty

作　　者：支力强 昝强 张增瑞 徐超 卿忠 马建兵 陈永程 Zhi Liqiang;Zan Qiang;Zhang Zengrui;Xu Chao;Qing Zhong;Ma Jianbing;Chen Yongcheng(Department of Joint Surgery,Xi'an Honghui Hospital,Xi'an 710054,China;Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China;Department of Orthopaedics,Binzhou Hospital of Chinese Medicine,Binzhou 256600,China;Shaanxi University of Chinese Medicine,Xianyang 712000,China)

机构地区：[1]西安市红会医院关节外科,西安710054 [2]陕西中医药大学附属医院骨科,咸阳712000 [3]滨州市中医医院骨科,滨州256600 [4]陕西中医药大学,咸阳712000

出　　处：《中华骨科杂志》2023年第11期737-743,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨脂肪质量指数(fat mass index,FMI)对全膝关节置换(total knee arthroplasty,TKA)术后早期康复的影响。方法回顾性分析2020年7月至2021年7月于西安市红会医院关节外科接受初次单侧TKA的患者,采用双能X线吸收测定法测量患者术前的体成分并计算FMI。根据FMI大小将患者分为正常组(男:3.0~6.0 kg/m^(2);女:5.0~9.0 kg/m^(2))、超重组(男:6.1~9.0 kg/m^(2);女:9.1~13.0 kg/m^(2))、肥胖组(男:>9 kg/m^(2);女:>13 kg/m^(2)),并收集患者的手术时间、出血量、术后并发症的发生率等指标。使用广义线性模型进行FMI对TKA术后早期康复影响的多因素分析。绘制FMI和体质指数(body mass index,BMI)对术后西大略和麦克马斯特大学(Western Ontario and McMaster Universities,WOMAC)骨关节炎指数评分和美国膝关节协会评分(Knee Society Score,KSS)预测效果的受试者工作特征(receiver operating characteristics,ROC)曲线,比较FMI与BMI对TKA术后早期功能的影响。结果100患者纳入研究,男24例、女76例,年龄(65.0±8.2)岁(范围42~81岁)。正常组15例、超重组55例、肥胖组30例。所有患者均顺利完成手术并获得随访,随访时间(3.15±0.72)个月(范围2.8~3.2个月)。肥胖组术后2周、1个月、2个月的WOMAC评分为(34.57±3.68)分、(22.03±2.79)分、(15.77±2.96)分,大于正常组的(28.73±2.58)分、(19.07±2.71)分、(12.27±3.10)分和超重组的(30.05±4.09)分、(19.33±2.42)分、(14.84±2.42)分,差异有统计学意义(P<0.05)。肥胖组术后1个月、2个月的KSS评分分别为(68.83±5.52)分、(81.17±4.49)分,小于正常组的(77.33±5.63)分、(87.33±4.17)分和超重组的(72.64±5.43)分、(83.73±5.02)分,差异有统计学意义(P<0.05)。选取术后2个月时的WOMAC评分、KSS评分、术后并发症作为结局指标绘制ROC曲线,术后2个月WOMAC评分的ROC曲线示FMI对应的曲线下面积为0.744(95%CI:0.54,0.82),大于BMI的0.624(95%CI:0.51,0.74),差异有统计学意义(Z=2.19,P=0.021)。�Objective To investigate the effect of fat mass index(FMI)on early recovery after total knee arthroplasty(TKA).Methods Patients who underwent primary unilateral TKA in Xi'an Honghui Hospital from July 2020 to July 2021 were retrospectively analyzed.The preoperative body composition was measured by dual energy X-ray absorptiometry and the FMI was calculated.Patients were divided into normal group(male:3.0-6.0 kg/m^(2);female:5.0-9.0 kg/m^(2)),overweight group(male:6.1-9.0 kg/m^(2);female:9.1-13.0 kg/m^(2)),and obese group(male:>9 kg/m^(2);female:>13 kg/m^(2))according to level of FMI,and the operation time,blood loss,and incidence of postoperative complications were collected.Multifactorial analysis of the effect of FMI on early recovery after TKA was performed using a generalized linear model.Draw the receiver operating characteristics(ROC)curve of BMI and FMI on the predicted effect of postoperative Western Ontario and McMaster Universities(WOMAC)osteoarthritis index scores and Knee Society Score(KSS)to compare the effect of FMI with BMI on early recovery after TKA.Results A total of 100 patients were included in the study,24 males and 76 females,aged 65.0±8.2 years(range,42-81 years).There were 15 cases in normal group,55 cases in overweight group and 30 cases in obese group.All patients successfully completed the operation and were followed up for 3.15±0.72 months(range,2.8-3.2 months).The WOMAC scores of the obese group at 2 weeks,1 and 2 months postoperative were 34.57±3.68,22.03±2.79,and 15.77±2.96,which were greater than those of the normal group(28.73±2.58,19.07±2.71,12.27±3.10),as well as the overweight group(30.05±4.09,19.33±2.42,14.84±2.42),with statistically significant differences(P<0.05).The KSS scores of the obese group at postoperative 1 and 2 months were 68.83±5.52 and 81.17±4.49,which were lower than those of the normal group(77.33±5.63,87.33±4.17),as well as the overweight group(72.64±5.43,83.73±5.02),with statistically significant differences(P<0.05).The WOMAC score,KSS score,

关 键 词：关节成形术 置换 膝 脂肪组织 康复 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]