全膝关节置换术后较术前患者躯体重心转移程度与关节功能恢复程度的相关性研究

摘要

目的 探讨患者全膝关节置换术(TKA)后躯体重心位置(GCP)转移程度与膝关节功能恢复程度之间的关系.方法 对2012年6月至2013年12月在新疆维吾尔自治区人民医院骨科中心关节外科接受单侧TKA并符合纳入排除标准的176例患者进行研究.其中男性46例,女性130例;年龄55～ 81岁,平均(64±4)岁.根据术侧将患者分为右膝组和左膝组,其中右膝组92例,左膝组84例.两组患者年龄、身高、体重指数等差异均无统计学意义,具有可比性(P＞0.05).患者术前、术后6个月、1年时采用重心测量仪进行GCP测定,同时进行美国特种外科医院(HSS)膝关节功能评分.量化GCP较术前位置的转移程度,并与同一时间点的HSS功能评分较术前时水平的变化程度进行Pearson相关性分析.结果 两组患者术后6个月、1年时HSS评分均显著高于术前水平,且差异有统计学意义(右膝组:t=-42.82和-62.46,均P=0.00;左膝组:t=-43.10和-62.82,均P=0.00).术后6个月、1年时右膝组HSS评分从术前(51.6±4.2)分提升至(76.6±3.6)、(86.5±3.1)分,左膝组从术前(52.2±4.5)分提升至(76.0±3.8)、(86.6±2.7)分.术后6个月、1年时两组患者HSS功能评分与GCP较术前的变化程度之间呈相关性(r=0.424和0.139).结论 术后随着关节功能恢复,术侧患肢负重量逐渐增大,患者GCP的位置会逐渐向术侧方向转移,且其转移程度一定程度上能够表明关节功能的恢复情况.%Objective To study the correlation between the shifting degree of the gravity center position(GCP) and recovering degree of the knee's function of the patients after total knee arthroplasty (TKA) at the same time point.Methods One hundred and seventy-six patients who underwent single TKA between June 2012 and December 2013 were measured GCP by corresponding instrument prospectively.Ninety-two patients underwent right knee arthroplasty (25 male and 67 female),eighty-four patients underwent left knee arthroplasty (21 male and 63 female).They were evaluated by Hospital For Special Surgery (HSS) scores pre-operatively,6-month and 1-year post-operatively,and were measured GCP simultaneously.Pearson's correlation analysis were conducted between shifting degree of GCP and changing degree of HSS score when be compared with pre-operatively.Results All the patient's HSS score had significantly improved at 6-month and 1-year after surgery than pre-operatively (right knee group:t =-42.82 and-62.46,all P =0.00;left knee group:t =-43.10 and-62.82,all P =0.00).HSS scores had been improved from 51.6 ±4.2 to 76.6 ±3.6 and 86.5 ±3.1 in right knee patients,and improved from 52.2 ±4.5 to 76.0 ±3.8,86.6 ±2.7 in left knee patients at 6-month and 1-year after surgery.There was a correlation between shifting degree of GCP and changing degree of HSS score 6-month and 1-year after surgery (r =0.424 and 0.139).Conclusion As recovering of the joint function,the weight on operated limb could be increased,thus the GCP moves from its initial position to the operative side after TKA.While,the shifting degree of GCP can be a reflection of recovering of the joint function in some extent.