身体锻炼对轻中度膝骨性关节炎生活质量的影响

Effect of physical exercise on quality of life and clinical presentations of mild to moderate knee osteoarthritis

摘要:

[目的]评估身体锻炼对轻中度膝骨性关节炎（knee osteoarthritis, KOA）生活质量与临床表现的影响。[方法]2022 年 9 月—2022 年 12 月在本院关节外科门诊就诊的 76 例 Kellgren-Lawrence 分级为 I~II 级的 KOA 患者纳入本研究。采集患者一般资料，采用世界卫生组织生活质量简表 （World Health Organization Quality-of-Life Scale, WHOQOL-Brief）、HSS、KOOS、 WOMAC 评分以及患者膝关节伸屈活动度 （range of motion, ROM） 评价患者生活质量和临床表现。采用单项因素比较，Pearson 相关分析和逻辑回归分析资料。[结果] 本研究 76 例患者中，29 例列入锻炼组，占 38.2%；其余 47 例列入不锻炼组，占 61.8%。锻炼组的 BMI [(23.8±1.3) vs (25.0±1.7), P=0.002]，以及糖尿病 （62.0% vs 91.8%, P＜0.001）、高血压 （75.9% vs 91.8%, P= 0.010）、冠心病（65.5% vs 87.2%, P＜0.001）的发病率均显著低于不锻炼组，而锻炼组文化程度和个人收入均显著高于不锻炼组 （P＜0.05）。两组在年龄、性别、病程、症状膝侧数和影像 K-L 分级的差异均无统计学意义 （P＞0.05）。锻炼组的 WHOQOLBrief 的生理健康 [(63.8±4.8) vs (54.6±3.4), P＜0.001]、心理健康 [(62.6±5.3) vs (53.7±3.4), P＜0.001]、社会关系 [(60.9±5.0) vs (53.6± 3.1), P＜0.001] 和周围环境 [(61.6±4.5) vs (54.0±4.8), P＜0.001]，以及 HSS 评分 [(74.1±4.2) vs (68.3±2.5), P＜0.001]、KOOS 评分 [(73.7±4.1) vs (68.4±3.3), P＜0.001] 和膝屈-伸 ROM [(139.3±9.2)° vs (129.4±13.3)°, P=0.001] 均显著大于不锻炼组，而前者的 WOMAC 评分显著低于后者 [(31.2±5.8) vs (43.3±3.0), P＜0.001]。WHOQOL-Brief 评分均与 HSS、KOOS 和膝 ROM 呈显著正相关 （P＜0.05），均与 WOMAC 评分呈显著负相关（P＜0.05）。逻辑回归表明：社会关系评分高是参与锻炼的积极因素（OR=0.664, P= 0.026），而 WOMAC 高是不参与锻炼的危险因素 （OR=1.681, P=0.001）。[结论] 身体锻炼可以控制轻中度 KOA 患者的 BMI， 减少慢性疾病的发病率，改善生活质量和临床表现。WHOQOL-Brief 评分与临床评分存在相关性，WOMAC 评分可较好体现患者情况。

Abstract:

[Objective] To evaluate the effects of physical exercise on quality of life and clinical manifestations of mild to moderate knee osteoarthritis (KOA). [Methods] A total of 76 patients who visited Outpatients Department of Joint Surgery of our hospital for Kell- gren-Lawrence grade I to II KOA from September 2022 to December 2022 were included in this study. The general data of patients were collected, and the World Health Organization Quality-of-Life Scale (WHOQOL-Brief), as well as HSS, KOOS, WOMAC scores and knee flexion-extension range of motion (ROM) were measured for evaluating the quality of life and clinical manifestations. Univariate compari- son, Pearson correlation analysis and logistic regression analysis were conducted on the data. [Results] Of the 76 patients included into this study, 29 patients fall into the exercise group, accounting for 38.2%, while the remaining 47 patients were classified as the non-exercise group, accounting for 61.8%. The exercise group proved significantly lower than the non-exercise group in terms of BMI [(23.8±1.3) vs (25.0±1.7), P=0.002], as well as incidence of diabetes (62.0% vs 91.8%, P＜0.001), hypertension (75.9% vs 91.8%, P=0.010) and coronary heart disease (65.5% vs 87.2%, P＜0.001), while the former had significantly higher levels of education and personal income than the latter (P＜0.05). However, there were no significant differences between the two groups in age, sex, course of disease, number of knee side in- volved, and imaging K-L grade (P＞0.05). The exercise groups was significantly greater than the non-exercise group in terms of WHOQOLBrief scores, including physical health [(63.8±4.8) vs (54.6±3.4), P＜0.001], mental health [(62.6±5.3) vs (53.7±3.4), P＜0.001], social rela-tions (60.9±5.0) vs (53.6± 3.1), P＜0.001] and the surrounding environment [(61.6±4.5) vs (54.0±4.8), P＜0.001], as well as the HSS score [(74.1±4.2) vs (68.3 ±2.5), P＜0.001], KOOS score [(73.7±4.1) vs (68.4±3.3), P＜0.001] and knee ROM [(139.3±9.2)° vs (129.4±13.3)°, P= 0.001], while the former got significantly lower WOMAC score than the latter [(31.2±5.8) vs (43.3±3.0), P＜0.001]. The WHOQOL-Brief scores were significantly positively correlated with HSS, KOOS and knee ROM (P＜0.05), whereas significantly negatively correlated with WOMAC score (P＜0.05). As results of logistic regression the high social relationship score was a positive factor for exercise participation (OR=0.664, P=0.026), while high WOMAC was a risk factor for non-exercise participation (OR=1.681, P=0.001). [Conclusion] Physical exercise does control BMI, reduce the incidences of chronic diseases, and improve quality of life and clinical manifestations in patients with mild to moderate KOA. There is a correlation between WHOQOL-Brief score and clinical score, and WOMAC score could better reflect the situation of the patients.