肥胖患者全膝关节置换术的临床疗效观察-外科学专业论文.docxVIP

山西医科大学硕士学位论文 山西医科大学硕士学位论文 I I 肥胖患者全膝关节置换术的临床疗效观察 摘 要 目的： 比较体重正常、超重和肥胖患者全膝关节置换术后的短期功能结果及术后并发症的差 异，评价不同程度肥胖对全膝关节置换术后临床疗效的影响。 方法： 按照体重指数将 152 例接受全膝关节置换术的患者分为 3 组。其中体重正常组（体重 指数 18.5-23.9kg/m2）52 例，超重组（体重指数 24.0-27.9kg/m2）50 例，肥胖组（体重指数 ≥28kg/m2）50 例。记录患者术前的年龄、性别、合并症及术后并发症等情况，进行 2 年的 随访。疗效评估包括美国膝关节协会评分（KSS）、健康调查简表（SF-36）、疼痛视觉模 拟评分(VAS)以及住院时间等。 结果： 无论是体重正常组、超重组还是肥胖组，患者全膝关节置换术后的美国膝关节协会评 分（KSS）、健康调查简表（SF-36）和疼痛视觉模拟评分(VAS)较术前均有显著改善（P0.05）， 且 3 组之间的住院时间没有显著性差异。但是，与体重正常组和超重组的患者相比，肥胖 患者的并发症发生率显著升高（P0.001）。体重正常组有 1 例患者出现下肢深静脉血栓； 超重组有 1 例患者因切口浅表感染需要行负压切口治疗；肥胖组有 1 例患者因切口浅表感 染需要行负压切口治疗，有 1 例患者出现了腓总神经麻痹症状，有 1 例患者出现了深部感 染需要行清创灌洗术。 I II 结论： 全膝关节置换术在超重和肥胖患者中也可以取得令人满意的短期功能改善；但应重视 肥胖患者全膝关节置换术后潜在的围手术期并发症风险。 关键词：肥胖；体重指数；全膝关节置换；临床疗效；并发症 PAGE PAGE III Functional outcomes after Total Knee Arthroplasty in obese patients Abstract Objective： To assess the clinical outcomes and complications of primary total knee arthroplasty (TKA) in normal weight patients,overweight patients and obese patients. Methods： A total of 152 obese patients who had undergone a primary TKA were stratified by BMI (≤23.9kg/m2, normal group, n=52; 24.0-27.9kg/m2, overweight group, n=50 and ≥28kg/m2, obese group, n=50).Preoperative demographics,perioperative and postoperative complications were recorded. They were followed up for two years and the outcomes were assessed using the american knee society knee score (KSS), short form-36 (SF-36), visual analog scale pain scores (VAS) and the length of hospital stay. Results： The american knee society knee score(KSS), short form-36(SF-36) and visual analog scale pain score(VAS)were significantly ameliorated in all groups(P0.05). Moreover, there was no difference in the length of hospital stay among the three groups.The obese patients had a higher rate of complications than normal weight patients and overweight patients(P0.001).In the normal group,there were one deep-vein thrombosis .There were one superficial wound infection in the overweight group that required negative press