摘要目的 利用关节遗忘度评分(forgotten joint scores,FJS)研究肥胖对膝关节置换术后关节遗忘度的影响。方法 对2020年1月至2021年5月安徽医科大学第一附属医院关节外科110例膝关节骨关节炎的患者进行回顾性研究,均为初次单侧膝关节置换。其中男性24例,女性86例;年龄47~84岁,平均(64.80±8.43)岁。按照身体质量指数(body mass index,BMI)分级标准分为三组,BMI<24 kg/m2的患者为正常组,24 kg/m2≤BMI<28 kg/m2的患者为超重组,BMI≥28 kg/m2的患者为肥胖组。术后3个月、6个月、1年进行膝关节FJS评分,术前、术后3个月、术后1年进行美国特种外科医院(hospital for special surgery,HSS)膝关节评分。所得数据进行统计学分析。结果 110例患者均获随访,随访时间12~18个月,平均(13.40±1.46)个月。术后3个月时,正常组FJS评分(28.55±6.62)分,超重组FJS评分(25.34±5.03)分,肥胖组FJS评分(24.41±5.75)分;术后6个月时,正常组FJS评分(46.70±6.12)分,超重组FJS评分(43.59±4.60)分,肥胖组FJS评分(42.00±4.40)分;术后1年时,正常组FJS评分(60.20±7.09)分,超重组FJS评分(56.19±6.92)分,肥胖组FJS评分(54.44±5.87)分。在术后同一随访时间点,随着BMI的升高,FJS评分均有下降的趋势,差异有统计学意义(P<0.05),但差异均未超过最小临床意义变化值(minimal clinically important diference,MCID)。三组在术前HSS评分上差异有统计学意义(P<0.05),术后同一随访时间点随着BMI的升高HSS评分有下降的趋势,但差异无统计学意义(P>0.05)。结论 肥胖不会对患者在日常活动中遗忘人工关节的能力产生负面影响。
[1]Wang L,Zhou B,Zhao Z,et al.Body-mass index and obesity in urban and rural China:Findings from consecutive nationally representative surveys during 2004-18[J].Lancet,2021,398(10294):53-63.
[2]Richmond SA,Fukuchi RK,Ezzat A,et al.Are joint injury,sport activity,physical activity,obesity,or occupational activities predictors for osteoarthritis?A systematic review[J].J Orthop Sports Phys Ther,2013,43(8):515-B19.
[3]Weber KL,Jevsevar DS,Mcgrory BJ.AAOS clinical practice guideline:Surgical management of osteoarthritis of the knee:Evidence-based guideline[J].J Am Acad Orthop Surg,2016,24(8):e94-96.
[4]Behrend H,Giesinger K,Giesinger JM,et al.The “forgotten joint” as the ultimate goal in joint arthroplasty:Validation of a new patient-reported outcome measure[J].J Arthroplasty,2012,27(3):430-436.
[5]Behrend H,Zdravkovic V,Giesinger J,et al.Factors predicting the forgotten joint score after total knee arthroplasty[J].J Arthroplasty,2016,31(9):1927-1932.
[6]Peersman G,Verhaegen J,Favier B.The forgotten joint score in total and unicompartmental knee arthroplasty:A prospective cohort study[J].Int Orthop,2019,43(12):2739-2745.
[7]Collins JE,Donnell-Fink LA,Yang HY,et al.Effect of obesity on pain and functional recovery following total knee arthroplasty[J].J Bone Joint Surg(Am),2017,99(21):1812.
[8]中国营养学会肥胖防控分会,中国营养学会临床营养分会,中华预防医学会行为健康分会,等.中国居民肥胖防治专家共识[J].中华流行病学杂志,2022,43(5):18.
[9]Holtz N,Hamilton DF,Giesinger JM,et al.Minimal important differences for the WOMAC osteoarthritis index and the forgotten joint score-12 in total knee arthroplasty patients[J].BMC Musculoskelet Disord,2020,21(1):401.
[10]Wang Y,Chen X.How much of racial/ethnic disparities in dietary intakes,exercise,and weight status can be explained by nutrition-and health-related psychosocial factors and socioeconomic status among US adults?[J].J Am Diet Assoc,2011,111(12):1904-1911.
[11]Boyce L,Prasad A,Barrett M,et al.The outcomes of total knee arthroplasty in morbidly obese patients:A systematic review of the literature[J].Arch Orthop Trauma Surg,2019,139(4):553-560.
[12]Schoffman DE,Wilcox S,Baruth M.Association of body mass index with physical function and health-related quality of life in adults with arthritis[J].Arthritis,2013(2013):190868.
[13]MerleVincent F,Couris CM,Schott AM,et al.Osteoarthritis section of the french society for rheumatology.Factors predicting patient satisfaction 2 years after total knee arthroplasty for osteoarthritis[J].Joint Bone Spine,2011,78(4):383-386.
[14]J-rvenp J,Kettunen J,Soininvaara T,et al.Obesity has a negative impact on clinical outcome after total knee arthroplasty[J].Scand J Surg,2012,101(3):198-203.
[15]Adriani M,Malahias MA,Gu A,et al.Determining the validity,reliability,and utility of the forgotten joint score:A systematic review[J].J Arthroplasty,2020,35(4):1137-1144.
[16]Thompson SM,Salmon LJ,Webb JM,et al.Construct validity and test re-test reliability of the forgotten joint score[J].J Arthroplasty,2015,30(11):1902-1905.
[17]任燕,刘爽,杨琳,等.北京市全膝关节置换术手术部位感染监测的多中心研究[J].实用骨科杂志,2022,28(3):215-219.
[18]Lozano LM,Tió M,Rios J,et al.Severe and morbid obesity (BMI≥35 kg/m2) does not increase surgical time and length of hospital stay in total knee arthroplasty surgery[J].Knee Surg Sports Traumatol Arthrosc,2015,23(6):1713-1719.
[19]Giesinger JM,Kuster MS,Holzner B,et al.Development of a computer-adaptive version of the forgotten joint score[J].J Arthroplasty,2013,28(3):418-422.
[20]Thienpont E,Vanden Berghe A,Schwab PE,et al.Joint awareness in osteoarthritis of the hip and knee evaluated with the“Forgotten Joint”score before and after joint replacement[J].Knee Surg Sports Traumatol Arthrosc,2016,24(10):3346-3351.
[21]Kiran A,Bottomley N,Biant LC,et al.Variations in good patient reported outcomes after total knee arthroplasty[J].J Arthroplasty,2015,30(8):1364-1371.
[22]Baker PN,Rushton S,Jameson SS,et al.Patient satisfaction with total knee replacement cannot be predicted from preoperative variables alone:A cohort study from the national joint registry for England and Wales[J].Bone Joint J,2013,95 (10):1359-1365.
[23]Issa K,McElroy MJ,Pourtaheri S,et al.Outcomes of primary total knee arthroplasty in the morbidly obese patients[J].J Long Term Eff Med Implants,2013,23(4):301-307.