肥胖对膝骨关节炎内侧单髁置换术疗效的影响△

Impact of obesity on clinical outcome of primary unicompartmental knee arthroplasty for unilateral medial knee osteoar⁃ thritis

摘要:

[目的] 探讨肥胖对膝骨关节炎内侧单髁置换术 (unicompartmental knee arthroplasty, UKA) 临床效果的影响。[方法] 回顾性分析 2016 年 7 月—2018 年 6 月因内侧室膝骨关节炎行初次单侧 UKA 196 例患者的临床资料。根据术前体重指数 (body mass index, BMI) 将患者分为 3 组：正常组 41 例 (BMI 18.50~24.99 kg/m² )，超重组 113 例 (BMI 25.00~29.99 kg/m² )，肥胖组 42 例(BMI≥30.00 kg/m2 )。比较三组患者的围手术期、随访与影像资料。[结果]三组患者均顺利完成手术，无严重并发症。围手术期不良事件，正常组为 2/41(4.88%)，超重组为 6/113(5.31%)，肥胖组为 2/42(4.76%)；经相应处理，均未引发严重不良后果，三组间围手术期不良事件的发生率差异无统计学意义 (P＞0.05)。三组患者切口均一期愈合，术后均无伤口感染。所有患者均获随访 2 年以上，平均(35.12±6.53)个月。随访期间三组患者均无假体失败翻修。与术前相比，末次随访时三组患者 WOMAC 评分均显著改善(P＜0.05)；相应时间点，三组间 WOMAC 评分的差异均无统计学意义(P＞0.05)。末次随访时三组患者均对手术满意，三组间患者主观满意评分的差异无统计学意义 (P＞0.05)。影像方面，末次随访时 HKAA，正常组为 (175.86±2.50)°，超重组为 (177.30±2.66)°，肥胖组为 (176.23±2.52)°，三组之间整体差异有统计学意义 (P=0.010)； 两两比较，肥胖组与正常组之间差异无统计学意义 (P=0.563)。[结论] 肥胖对内侧 UKA 的疗效影响不显著，肥胖患者 UKA 术后可以获得治疗内侧室膝骨关节炎的满意疗效。

Abstract:

[Objective] To explore the impact of obesity on the clinical outcome of primary unicompartmental knee arthroplasty (UKA) for medial knee osteoarthritis. [Methods] A retrospective study was done on 196 patients who underwent primary unilateral UKA for medial knee osteoarthritis from July 2016 to June 2018. According to preoperative body mass index (BMI), the patients were divided into three groups, including normal group (n=41) (BMI 18.50~24.99 kg/m² ) , overweight group (n=113) (BMI 25.00~29.99 kg/m² ) , and obese group (n= 42) (BMI ≥30.00 kg/m² ) . The documents regarding to perioperative period, follow- up and radiographs were compared among the three groups. [Results] All patients in three groups had UKA performed successfully, without serious complications. Perioperative adverse events were of 2/41 (4.88%) in the normal group, 6/113 (5.31%) in the overweight group, and 2/42 (4.76%) in the obesity group, which did not lead serious consequences after corresponding treatment, and were not statistically significantly different among the three groups (P＞0.05) . All the patients in the three groups got well incision healing, without postoperative wound infection in anyone of them. During the follow up last- ed for more than two years, with an average of (35.12±6.53) months, no prosthetic failure, nor revision surgery happened in anyone of the pa- tients in three groups. Compared with that preoperatively the WOMAC score in the three groups was significantly improved at the latest fol- low-up (P＜0.05) , whereas which proved not significantly different among the three groups at any corresponding time points (P＞0.05) . At the last follow-up, all patients in the three groups were satisfied with the operation without significant difference in subjective satisfaction score among the three groups (P＞0.05) . In terms of imaging, the hip- knee-ankle angle (HKAA) at the last follow- up was of (175.86± 2.50) ° in the normal group, (177.30±2.66)° in the overweight group, and (176.23±2.52)° in the obese group, with a significant overall differ- ence among the three groups (P=0.010) . However, there was no significant difference in HKAA between the obese group and the normal group (P=0.563) . [Conclusion] Obesity does not impact clinical outcome of UKA significantly for medial knee osteoarthritis, in other word,the obese patients can still get good clinical outcome after UKA.