影响血友病全膝置换临床效果的相关因素分析（开放获取）

Factors impacting clinical consequence of total knee arthroplasty in hemophilia

摘要:

[目的]探究影响血友病患者膝关节置换（total knee arthroplasty, TKA）术后疗效的相关因素。[方法]回顾性分析本院 2012 年 1 月—2020 年 12 月行 TKA 的血友病患者 83 例（111 膝）的临床资料。采用单因素比较和多元逻辑回归分析探索影响血友病患者 TKA 术后疗效的相关因素。[结果]所有患者术后膝关节功能明显改善，活动度以及膝关节评分明显提高。单因素分析：优秀组在术前 HAMD 评分 [(5.1±2.3) vs (7.2±3.9), P=0.003]、屈曲挛缩度数 [(6.6±6.2)°vs (15.3±15.7)°, P=0.003]、术前 VAS 评分 [(2.6±1.0)vs (3.7±1.5), P＜0.001]、重度血友病严重程度分级占比 [轻/中/重, (29/17/25)vs (1/8/31), P＜0.001]、术中失血量 [(522.5±172.5) mL vs (665.0±270.4) mL, P＜0.001] 和单次麻醉下双膝置换比率 [是/否, (20/51) vs (20/20), P=0.021]、术中经过股四头肌成形术的比例 [是/ 否, (0/71) vs (7/33), P＜0.001] 均显著小于欠佳组。而优秀组在术前膝关节 ROM [(88.2±13.6)° vs (46.2±23.2)°, P＜0.001] 显著大于欠佳组。此外，末次随访时，优秀组膝关节 HSS 评分、KSS 评分以及 KSF 评分、术后膝关节 ROM 显著高于欠佳组（P＜0.05），而优秀组屈曲挛缩度数、膝关节血肿占比以及翻修占比显著小于欠佳组 （P＜0.05）。逻辑回归分析显示，术前屈曲挛缩度数 （OR= 1.139, P= 0.041）是疗效欠佳发生的独立危险因素，术前 ROM（OR=0.872, P=0.027）是保护因素。[结论] TKA 可以明显改善血友病患者的膝关节功能。在血友病患者中，TKA 术后疗效与术前 ROM 以及屈曲挛缩度数相关，术前膝关节活动度越好，膝关节疗效越好，术前屈曲挛缩度数越大，膝关节疗效越差。

Abstract:

[Objective] To explore the factors impacting the postoperative outcomes of total knee arthroplasty (TKA) in hemophilia. [Methods] A retrospective study was conducted on 83 hemophilia patients (111 knees) who underwent TKA in our hospital from January 2012 to December 2020. Univariate comparison and multiple logistic regression analysis were used to explore the factors affecting the postoperative efficacy of TKA in hemophilia. [Results] All patients had significant improvement in knee function, mobility and knee score after operation. As result of univariate comparison, the excellent group proved significantly lesser than the poor group in terms of preoperative Hamilton depression scale(HAMD) [(5.1±2.3) vs (7.2±3.9), P=0.003], preoperative flexion contracture degree [(6.6±6.2)° vs (15.3±15.7)°, P= 0.003], preoperative VAS score [(2.6±1.02) vs (3.7±1.5), P＜0.001], hemophilia severity classification [mild/medium/severe, (29/17/25) vs (1/ 8/31), P＜0.001], and intraoperative blood loss [(522.5±172.5) mL vs (665.0±270.4) mL, P＜0.001], intraoperative quadriceps plasty [yes/no, (0/71) vs (7/33), P＜0.001], bilateral knee replacement under single anesthesia [yes/no, (20/51) vs (20/20), P=0.021]，while the former was significantly greater than the latter in preoperative knee ROM [(88.2 ±13.6)° vs (46.2±23.2)°, P＜0.001]. At the last follow-up, the excellent group was significantly greater than the poor group in HSS, KSS, KSF scores and postoperative knee ROM (P＜0.05), while the former proved significantly lesser than the latter in remained extent of flexion contracture, the proportion of hematoma and the proportion of revision surgery (P＜0.05). Based on the logistic regression analysis, the preoperative flexion contracture (OR=1.139, P=0.041) was an independent risk factor for poor outcome, while preoperative ROM (OR=0.872, P=0.027) was a protective factor. [Conclusion] TKA can significantly improve knee function in hemophilia, while the TKA consequence in hemophiliac is related to the preoperative ROM and the extent of flexion contracture. The better the preoperative knee motion, the better the outcome, and the greater the extent of preoperative flexion contracture, the worse the clinical consequence.