【摘要】 目的评价糖尿病患者实施全膝关节置换术(TKA)的风险与疗效。方法回顾性分析我院2009年3月至2013年7月145例膝骨性关节炎患者的临床资料,根据入院前是否患有糖尿病以及糖尿病是否得到有效控制分为非糖尿病组(A组)52例、血糖未受控制组(B组)58例和血糖受控制组(C组)35例,对入组患者实施全膝关节置换,比较三组患者的术中输血量、住院时间、住院费用、并发症发生率,以及术后一年三组患者的美国纽约特殊外科医院的膝关节评分(HSS评分)与西安大略和麦克马斯特大学骨关节炎评分(WOMAC评分);对B、C两组与术后一年随访的HSS评分与WOMAC评分进行Pearson相关性分析。结果 (1)A组患者的平均术中输血量、住院时间、住院费用、并发症(心脏并发症、深静脉血栓和术后休克)发生率均低于B组和C组,其差异均具有统计学意义(P<0.05);C组患者的并发症发生率为22.85%,低于B组的34.48%,其差异具有统计学意义(P<0.05);(2)A组与B组和C组在疼痛和活动度方面比较差异均有统计学意义(P<0.05),但在功能、屈曲挛缩、稳定性和肌力方面比较则差异均无统计学意义(P>0.05);而B组和C组以上的各项指标比较差异均无统计学意义(P>0.05);(3)糖尿病得到控制和糖尿病未得到控制与日常活动度呈负相关(r值分别为-0.972、-1.114,P<0.05),与膝关节疼痛呈正相关(r值分别为0.781、0.682,P<0.05)。结论糖尿病患者实施全膝关节置换术存在一定风险,且康复疗效不如非糖尿病患者,需要引起医护人员的足够重视。更多还原

【Abstract】 Objective To evaluate the risk and efficacy of total knee arthroplasty(TKA) in patients with diabetes mellitus. Methods A retrospective analysis was performed in the clinical data of 145 patients with knee osteoarthritis in our hospital from March 2009 to July 2013. According to whether suffering from diabetes and pre-admission control, the patients were divided into group A(52 cases, without diabetes mellitus), group B(58 cases, with blood glucose not controlled), group C(35 cases, with blood glucose controlled). All the patients received TKA. Intraoperative blood transfusion, length of hospital stay, hospitalization expenses, complication rate, hospital for special surgery(HSS) knee score one year after the operation, and Western Ontario and Mc Master Universities Osteoarthritis Index(WOMAC) were compared between the three groups. HSS score and WOMAC score one year after the operation in group B, C were analyzed by Pearson correlation analysis. Results(1) The average blood transfusion, length of hospital stay, hospitalization expenses, complications rate(cardiac complications, deep venous thrombosis and postoperative shock) in group A were significantly lower than those in group B and group C(P<0.05). The complication rate of group C was 22.85%, significantly less than 34.48% in group B(P<0.05).(2) Group A, group B and group C showed statistically significant differences in terms of pain and activity(P<0.05), but not in the function, flexion contracture, stability and strength(P>0.05); There were no significant difference in the above indexes between group B and group C(P>0.05);(3) Diabetes under control and diabetes not under control were negatively correlated with daily activity(r=-0.972,-1.114, P<0.05), but positively associated with knee pain(r=0.781,0.682, P<0.05). Conclusion The implementation of total knee arthroplasty in patients with diabetes has a certain risk, and the rehabilitation effect is less than that of patients with diabetes, which should be paid attention to by health care workers.更多还原