作　　者： (陈俊泽）; (王维）; (徐凯）; (林淮）; (黄山东）;

机构地区： 饶平县中医医院骨科,广东饶平575700

出　　处： 《中国骨与关节外科》 2017年第3期207-211,共5页

摘　　要： 背景:骨密度(bone mineral density,BMD)与骨关节炎(osteoarthritis,OA)的发生发展密切相关,同时也发现骨质疏松症(osteoporosis,OP)是很多骨关节病的重要危险因素,但目前尚无以绝经后女性BMD预测全膝关节置换术(total knee arthroplasty,TKA)治疗OA后功能恢复的报道。目的:评价绝经后OA患者的术前BMD对行TKA后膝关节疼痛及活动度的影响。方法:选取2013年1月至2016年12月因中重度OA行TKA治疗的绝经后女性156例,术前运用双能X线测量BMD,分为骨质疏松症(OP)组和非骨质疏松症(NOP)组。分别于术前1 d,术后1年内不同时间点随访患者膝关节VAS及活动度。比较两组VAS和活动度的差异,分析术前BMD与术前VAS、术后VAS改善值的关系。结果:与NOP组比较,术前OP组膝关节疼痛明显(P<0.01),但活动度比较,差异无统计学意义(P=0.515)。与术前比较,两组术后1年VAS评分和膝关节活动度均改善(P<0.01)。从术后6个月开始,OP组膝关节VAS评分较NOP组高,术后1年时更明显(P<0.05),但活动度比较,差异无统计学意义(P>0.05)。Pearson相关性分析显示,术前BMD与VAS改善值呈正相关(r=0.478,P<0.01)。Logistic回归分析示,BMD是患者术后VAS改善值的重要影响因素(β=0.423,P<0.01)。结论:绝经后OA患者的术前BMD与TKA术后疼痛恢复呈正相关,改善患者BMD有助于术后康复。 Background： Bone mineral density（BMD） is closely related to the occurrence and development of osteoarthritis.Osteoporosis is found to be an important risk factor for many diseases of bone and joint. But whether BMD of postmenopausal women can predict functional recovery after total knee arthroplasty（TKA） is still not reported. Objective： To discuss the predictive value of BMD on postoperative pain and knee range of motion in postmenopausal women undergoing TKA.Methods： A total of 156 postmenopausal women with moderate or severe osteoarthritis undergoing TKA between January2013 and December 2016 were enrolled in this study. Their BMD were measured by dual-energy X ray absorptiometry before surgery, and the patients were divided into osteoporosis group and non-osteoporosis group. The visual analog scale（VAS） score and knee range of motion were recorded before surgery and at different time points within 1 year after surgery.The VAS score and knee range of motion were compared between the two groups. The relation of preoperative BMD with preoperative VAS and VAS change after surgery were evaluated. Results： Before surgery, knee pain was severer in osteoporosis group than in non-osteoporosis group（P〈0.01）, but knee range of motion had no statistic difference between the two groups（P=0.515）. Compared with the baseline, VAS and knee range of motion were significantly improved after surgery in both groups（P〈0.01）. VAS score was higher in osteoporosis group than in non-osteoporosis group at 6 months after surgery, and the difference was more statistically significant at 1 year（P〈0.05）, but knee range of motion had no difference at any time point between groups（P〉0.05）. Pearson correlation analysis showed that preoperative BMD was positively correlated with the change of VAS score（r=0.478, P〈0.01）. Logistic regression analysis showed that preoperative BMD was an independent influencing factor for postoperative VAS change（β =0.423, P〈0.01）. Conclusions： Preopera

关 键 词： 骨质疏松症 骨关节炎 全膝关节置换术 骨密度 预后价值