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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (1): 170-176. doi: 10.19723/j.issn.1671-167X.2022.01.027

• 论著 • 上一篇    下一篇

影响全膝关节置换术患者术前预期的患者因素

李志昌,侯云飞,周之伟,姜龙,张舒,林剑浩()   

  1. 北京大学人民医院骨关节科,北京 100044
  • 收稿日期:2021-01-13 出版日期:2022-02-18 发布日期:2022-02-21
  • 通讯作者: 林剑浩 E-mail:linjianhao@pkuph.edu.cn

Patient factors influencing preoperative expectations of patients undergoing total knee arthroplasty

LI Zhi-chang,HOU Yun-fei,ZHOU Zhi-wei,JIANG Long,ZHANG Shu,LIN Jian-hao()   

  1. Institute of Arthritis, Peking University People’s Hospital, Beijing 100044, China
  • Received:2021-01-13 Online:2022-02-18 Published:2022-02-21
  • Contact: Jian-hao LIN E-mail:linjianhao@pkuph.edu.cn

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摘要：

目的: 术前预期会影响关节置换术后患者的主观满意度及客观功能,调查患者对全膝关节置换术的预期情况,并分析其影响因素。方法: 收集108例单侧全膝关节置换术患者的人口学资料,以及术前的美国特种外科医院(Hospital for Special Surgery,HSS) 膝关节置换手术预期量表评分、30秒座椅站立测试、40米快速步行测试、12级爬楼梯测试、3米起立行走测试、6分钟步行测试、美国西部Ontario和McMaster大学(the Western Ontario and McMaster Universities,WOMAC)骨关节炎指数评分、膝关节学会评分 (Knee Society score,KSS)、健康调查简表(the MOS 36-item short-from health survey, SF-36)评分、视觉模拟评分(visual analogue scale, VAS)以及连续7天的每日步数。对各数据的观察值进行描述性报告,应用Pearson相关分析评估各参数间的相关性并进行多因素线性回归分析。结果: 患者的平均术前预期评分为58.98±5.44,其与患者的12级爬楼梯测试、3米起立行走测试、6分钟步行测试、KSS功能评分、SF-36的精神健康评分有弱相关性(相关系数0.1~0.3),与患者的每日平均步数,30秒座椅站立测试, 40米快速步行测试,KSS膝关节评分,WOMAC及其疼痛、僵直、功能三个评分,SF-36的生理功能、生理职能、躯体疼痛、活力及躯体健康评分有中度相关性(相关系数0.3~0.6)。多因素线性回归分析显示,仅有30秒座椅站立测试和SF-36量表中的生理职能、躯体疼痛及活力与患者对手术效果的预期评分有相关性(P<0.05)。结论: 术前疼痛更重、躯体功能更差、整体健康状况更低下的患者更迫切希望得到改善,医生要在术前与预期不现实的患者充分沟通。

关键词: 关节成形术, 置换, 膝, 病人满意度, 功能恢复, 日常生活活动

Abstract:

Objective: To investigate the expectations of patients for total knee arthroplasty (TKA), and to analyze its influencing factors. Methods: Experimental design: Single center, retrospective, multiple regression analysis. The data including the age, height, and weight of 108 patients undergoing unilateral TKA due to end-stage osteoarthritis were obtained. The patients’ preoperative Hospital for Special Surgery (HSS) knee arthroplasty expectation score, the Western Ontario and McMaster Universities (WOMAC) score, Knee Society score (KSS), the MOS 36-item short-from health survey (SF-36) score, and visual analogue scale (VAS) were evaluated, and the 30-second chair-stand test (30-CST), 40-meter fast-paced walk test (40-FPWT), 12-level stair-climb test (12-SCT), 3-meter timed up-and-go test (TUG), 6-minute walk test (6-MWT), and recorded daily steps for 7 consecutive days were performed. The SPSS 22.0 software was used for statistical analysis. The observed values of various data were described. Pearson correlation analysis was used to evaluate the correlation between various parameters, and the multi-factor linear regression analysis was used to investigate the influencing factors of the patients preoperative expectation scores. Results: The average expectation score of this group of patients was 58.98±5.44. In the Pearson correlation analysis, the patient’s preoperative expectation had a weak correlation to the result of the patient’s 12-SCT, TUG, 6-MWT, KSS function score, and SF-36 mental component score (correlation coefficient 0.1-0.3). The patient’s preoperative expectation had a moderate correlation to the patient’s daily average steps, 30-CST, 40-FPWT, KSS, WOMAC and its pain, stiffness, function scores, SF-36 physical functioning, role-physical, bodily pain, vitality, and physical component score (correlation coefficient 0.3-0.6). In the multivariate linear regression analysis, only the results of 30-CST and the role-physical, bodily pain and vitality in the SF-36 scale were related to the patient’s expectation score (P<0.05). Conclusion: The estimated expectation score of patients before TKA is not high. Patients with more severe preoperative pain, worse physical function, and lower overall health are more eager to improve after surgery. Thus surgeons must communicate fully with patients with unrealistic expectations before surgery in order to obtain more satisfactory results postoperatively.

Key words: Arthroplasty, replacement, knee, Patient satisfaction, Recovery of function, Activities of daily living

中图分类号: 

  • R687.4

表1

患者术前各项参数及其与手术结果预估的相关性"

Items Mean Standard deviation Minimum Maximum Correlation coefficient P value
Expectations 58.98 5.44 48.00 74.00
Age 64.88 4.42 48.00 77.00 -0.110 0.256
BMI 27.50 1.94 23.59 31.96 0.182 0.059
Steps 1 959.28 752.00 316.71 4 742.29 -0.444 <0.001
PBTs
30-CST 2.66 1.15 0 6.00 -0.312 0.001
40-FPWT 47.76 15.77 22.00 99.12 0.424 <0.001
12-SCT 25.28 4.69 15.67 40.63 0.249 0.009
TUG 10.10 1.67 7.34 14.33 0.299 0.002
6-MWT 215.74 50.97 98.00 331.00 -0.298 0.002
WOMAC 42.03 7.15 27.00 63.00 0.503 <0.001
Pain_WOMAC 10.82 2.54 6.00 19.00 0.495 <0.001
Stiff_WOMAC 2.61 1.70 0 7.00 0.508 <0.001
Function_WOMAC 28.59 4.26 18.00 38.00 0.346 <0.001
KSS 34.76 9.91 1.00 51.00 -0.465 <0.001
KSS-F 36.39 15.75 0 70.00 -0.295 0.002
SF-36
PF 43.01 7.36 30.00 60.00 -0.431 <0.001
RP 42.82 32.43 0 100.00 -0.322 0.001
BP 35.66 11.87 12.00 52.00 -0.585 <0.001
GH 57.62 7.14 37.00 77.00 -0.075 0.438
VT 57.59 6.71 35.00 70.00 -0.599 <0.001
SF 45.14 11.82 25.00 75.00 -0.054 0.578
RE 55.25 29.24 0 100.00 -0.095 0.327
MH 61.41 3.99 52.00 68.00 -0.076 0.433
PCS 44.78 10.51 21.75 63.25 -0.502 <0.001
MCS 54.85 8.01 36.25 72.50 -0.242 0.012
VAS 5.41 1.45 2.00 8.00 0.353 <0.001

图1

全膝关节置换术手术预期评分分布情况"

图2

HSS全膝关节置换手术预期各项功能重要性评分"

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