身体锻炼对轻中度膝骨性关节炎生活质量的影响
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王淼,副主任医师,研究方向:医院管理,(电话)13604514534,(电子信箱)382240188@qq.com

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R684.3


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

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王淼,唐胜斌,刘欣欣,等. 身体锻炼对轻中度膝骨性关节炎生活质量的影响[J]. 中国矫形外科杂志, 2023, 31 (18): 1651-1656. DOI:10.3977/j. issn.1005-8478.2023.18.04.
WANG Miao, TANG Sheng-bin, LIU Xin-xin, et al. Effect of physical exercise on quality of life and clinical presentations of mild to moderate knee osteoarthritis[J]. Orthopedic Journal of China , 2023, 31 (18): 1651-1656. DOI:10.3977/j. issn.1005-8478.2023.18.04.

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  • 收稿日期:2023-07-16
  • 最后修改日期:2023-08-16
  • 在线发布日期: 2023-09-22