背景：全膝关节置换是治疗膝关节骨关节炎的有效方法，基于生物-心理-社会医学模式的转变，生活质量的概念在医学领域中逐渐得到了关注。 目的：观察人工全膝关节置换对老年重度膝关节骨关节炎患者疼痛、功能及生活质量的影响。 方法：选择2010年1月至2013年1月在内蒙古医科大学第二附属医院就诊治疗重度膝关节骨关节炎的患者102例，进行临床观察及12个月随访。将行人工全膝关节置换患者59例作为全膝关节置换组，确诊但未行手术而采用药物等保守治疗患者43例作为对照组。在治疗前和治疗后12个月均对患者进行美国纽约特种外科医院评分(HSS 评分)和健康相关生活质量的 WHOQOL-100量表评价，并分析各相关因素与 HSS 评分及WHOQOL-100各项评分之间的相关性。 结果与结论：患者治疗后12个月，全膝关节置换组膝关节HSS评分等级为良，总分为(82.03±10.17)分，明显优于对照组(P<0.01)；全膝关节置换组WHOQOL-100评分显著优于对照组，组间差异有显著性意义(P<0.01)，心理子项评分接近于正常人群(P>0.05)。回归分析结果显示，婚姻状况(β=1.988)、并发症(β=2.035)及HSS评分(β=2.108)为影响患者置换后生活质量的主要因素。提示HSS评分能较好地评估人工全膝关节置换改善老年重度膝关节骨关节炎疼痛及功能障碍的疗效，将WHOQOL-100评分引入到人工全膝关节置换的疗效评估中能更全面的评价置换后患者的生活质量。婚姻状况、并发症及HSS评分是影响膝关节骨关节炎患者生活质量的主要因素。其中深静脉血栓影响患者离床时间，研究发现随访期间有配偶照顾对患者生活质量及心理状态都有正面的影响。%BACKGROUND:Total knee replacement is regarded an effective treatment of knee osteoarthritis, based on the transformation of biology-psychology-social medicine pattern, the concept of“quality of life”has attracted increasing concerns. OBJECTIVE:To observe the effects of total knee replacement surgery on the pain, function and quality of life among elder patients with severe knee osteoarthritis. METHODA total of 102 elder patients with severe knee osteoarthritis were recruited from the Second Affiliated Hospital of Inner Mongolia Medical University between January 2010 and January 2013. The clinical manifestations and 12-month fol ow-up outcomes were observed and recorded. The involved patients were randomly divided into two grouptreatment group (59 cases, receiving total knee replacement) and control group (43 cases, receiving expectant treatment such as drugs, but no surgery). Patients were evaluated using HSS scale and WHOQOL-100 scale before surgery and 12 months after surgery. Furthermore, the correlation between influencing factors and HSS and WHOQOL-100 scores was analyzed. RESULTS AND CONCLUSION:At 12 months postoperatively, the HSS scores of patients in treatment group was (82.03±10.17) points, which was obviously higher than that in control group (P<0.01). The WHOQOL-100 scores in treatment group were also significantly higher than that in control group (P<0.01). The psychology sub-item scores of patients after total knee replacement were close to that of normal controls (P>0.50). The regression analysis shows that marital status (β=1.988), complication (β=2.035) and HSS scores (β=2.108) are the main influencing factors for the quality of life among patients undergoing replacement. Experimental findings indicate that, HSS score is an effective indicator to assess the effect of total knee replacement on the pain and function of elder patients with severe knee osteoarthritis. WHOQOL-100 is introduced to further improve the assessment of quality of life after total knee replacement surgery in severe knee osteoarthritis. The marital status, complication and HSS scores are the key influencing factors for the quality of life among severe knee osteoarthritis patients. Deep vein thrombosis affects the out-of-bed time, and the mate-accompanying during the fol ow-ups plays a positive role on the quality of life and mental state of patients.
展开▼
