糖尿病对全膝关节置换术的早期影响△

Early impact of diabetes mellitus on total knee arthroplasty

摘要:

［目的］ 探讨糖尿病 （diabetes mellitus, DM） 对全膝关节置换术 （total knee arthroplasty, TKA） 后早期影响。［方法］ 回顾性分析在本院初次行 TKA 的膝骨关节炎 252 例患者的临床资料。按有无糖尿病分为两组，非糖尿病组 138 例，糖尿病组 114 例。比较两组膝关节肿胀、疼痛程度，评价膝关节的功能康复情况。［结果］ 两组患者手术时间、切口长度、术后引流量差异无统计学意义 （P>0.05）。非糖尿病组在失血量、切口愈合和住院时间显著优于糖尿病组 （P<0.05）。所有患者随访 6～8 个月，平均 （6.56±1.35） 个月，非糖尿病组恢复术后行走活动时间、完全负重活动显著早于糖尿病组 （P<0.05）。随时间推移，两组术后 VAS 评分和膝周径差值均显著减小 （P<0.05），而膝 ROM 和 HSS 评分均显著增加 （P<0.05），术后 1~3 个月时， 除术后 3 个月两组膝周径差值无统计学意义外 （P>0.05），上述指标非糖尿病组均显著优于糖尿病组 （P<0.05）。术后 6 个月， 两组间上述指标的差异均无统计学意义 （P>0.05）。影像方面，两组患者末次随访时较术前 FTA 和 MPTA 均显著改善 （P< 0.05），而 PTS 无显著改变 （P>0.05）。相应时间点，两组间 FTA、MPTA 和 PTS 的差异均无统计学意义 （P>0.05）。［结论］ DM 确实影响 TKA 术后早期功能恢复，使患膝肿胀加重，减少了患膝活动范围和功能评分，增加了术后并发症风险。

Abstract:

[Objective] To explore the early impact of diabetes mellitus (DM) on total knee arthroplasty (TKA) . [Methods] A retrospec- tive study was conducted on 252 patients who underwent primary TKA for knee osteoarthritis in our hospital. The patients were divided into two groups according to whether they had diabetes or not, including 138 cases in the non-DM group and 114 cases in the DM group. The ex- tents of knee swelling, pain and function were evaluated and compared between the two groups. [Results] Although there were no signifi- cant differences in operative time, incision length and postoperative drainage between the two groups (P＜0.05) , the non-DM group proved significantly superior to the DM group in terms of intraoperative blood loss, wound healing and hospital stay (P＜0.05) . All patients were fol- lowed up for 6~8 months with an average of (6.56±1.35) months. The VAS score and bilateral difference of knee circumference significantly decreased (P＜0.05) , whereas the knee ROM and HSS significantly increased in both groups over time (P＜0.05) . The non-DM group was significantly superior to the DM group in abovementioned items from 1 to 3 months postoperatively (P＜0.05) , despite of the fact that the dif- ferences between the two group in VAS, ROM and HSS score became not statistically significant at 6 months postoperatively (P＞0.05) . Ra- diographically, the femorotibial angle (FTA) and medial proximal tibial angle (MPTA) significantly improved (P＜0.05) , whereas the posteri- or tibial slope (PTS) remained unchanged postoperatively in both groups compared with those preoperatively (P＜0.05) . However, there were no statistically significant differences in FTA, MPTA and PTS between the two groups at any corresponding time points (P＞0.05) . [Conclusion] The DM does impair early postoperative functional recovery of TKA, with increasing affected knee swelling, reducing the range of mo- tion and functional score of affected knee, and increasing the risk of postoperative complications.