膝关节置换手术患者康复效果的相关影响因素分析

摘要

目的 分析膝关节置换手术患者的术后康复影响因素,为康复预测及患者预后恢复提供科学的防控措施.方法 选取2013年12月至2015年12月期间在菏泽市中医医院骨科治疗的膝关节置换手术患者共327例为研究对象,以Logistics回归分析、Spearson相关性分析等统计学方法对患者治疗及随访期间住院时间、术后并发症、静脉血栓形成危险评分(RAPT)、特殊外科医院膝关节评分(HSS评分)、骨关节炎评分(WOMAC评分)等进行差异度比较.探究个人因素与临床治疗因素对其康复效果的影响.结果 本组患者中有5例推迟手术治疗,21例拒绝随访或退出研究,最终共301例达到研究终点.经Spearson相关性分析检验结果显示,患者年龄、糖尿病史、低蛋白血症、BMI与患者住院时间(r=0.457、0.366、0.281、0.356)、并发症(r=0.156、0.245、0.462、0.154)呈正相关性(P<0.05).性别、年龄、糖尿病史、低蛋白血症、BMI与HSS评分呈负相关(r=-0.147、-0.362、-0.475、-0.276、-0.176,P<0.05),与WOMAC评分呈正相关(r=0.138、0.562、0.278、0.245、0.374,P<0.05);RAPT评分与患者住院时间、并发症及WOMAC评分呈负相关(r=-0.267、-0.218、-0.527,P<0.05),与HSS评分呈正相关(r=0.472,P<0.05);术中出血量、VAS评分与住院时间呈正相关(r=0.286;0.156,P<0.05),手术时间与并发症呈正相关(r=0.145,P<0.05).Logistics回归分析显示,年龄≥65岁、糖尿病史、RAPT评分高危是影响膝关节置换患者术后康复效果的危险因素.结论 膝关节置换术患者术后康复效果的影响因素较多,年龄≥65岁、糖尿病史、RAPT评分高危是影响患者膝关节置换术后康复效果的重要因素,对于此类患者,应于术前及术中采取防护措施,减少其影响,促进患者恢复.%Objective To analyze the factors influencing postoperative rehabilitation of patients undergoing knee arthroplasty, to provide scientific prevention and control measures for rehabilitation and prognosis. Methods A to-tal of 327 patients undergoing knee arthroplasty who were treated in Heze Traditional Chinese medicine hospital from December 2013 to December 2015 were selected as the Cohort study data of this study. Hospitalization time, postopera-tive complications, the risk assessment profile for thromboembolism (RAPT), Hospital for Special Surgery knee score (HSS score), McMaster university of orthopedic index (WOMAC score) of patients during treatment and follow-up were compared between the two groups through Logistics regression analysis and Pearson correlation analysis. The influence of individual factors and clinical treatment factors on rehabilitation was explored. Results A total of 301 patients had finished all the analysis works, 5 patients were delayed surgery, and the other 21 patients refused to follow up or quit. Pearson correlation analysis results showed that age, history of diabetes, hypoproteinemia, body mass index (BMI) were positively correlated with hospitalization time (r=0.457;0.366;0.281;0.356) and complications (r=0.156;0.245;0.462;0.154) (P<0.05), while gender, age, history of diabetes, hypoproteinemia, BMI were negatively correlated with HSS score (r=-0.147;-0.362;-0.475;-0.276;-0.176, P<0.05) and positively correlated with WOMAC score (r=0.138;0.562;0.278; 0.245; 0.374, P<0.05). RAPT score was negatively correlated with hospitalization time, complications and WOMAC score (r=-0.267;-0.218;-0.527, P<0.05) and positively correlated with HSS score (r=0.472, P<0.05). Preop-erative bleeding and VAS score were positively correlated with hospitalization time (r=0.286;0.156, P<0.05), and opera-tion time was positively correlated with complications (r=0.145, P<0.05). Logistics regression analysis showed that age≥65 years old, history of diabetes, RAPT score high risk were the risk factors for postoperative rehabilitation in pa-tients undergoing knee arthroplasty. Conclusion There are many factors affecting the rehabilitation effect of patients af-ter total knee arthroplasty, age≥65 years old, history of diabetes, RAPT score of high risk were the important factors in-fluencing the rehabilitation effect of patients after knee replacement. Protective measures should be taken before and dur-ing the operation to reduce the impact and promote the recovery of patients.