标题：糖尿病患者实施全膝关节置换术的风险及疗效评价

      作者：聂文波，龚 俊
    (应城市人民医院骨科，湖北 应城 432400)

      卷次： 2015年26卷18期

      【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。

      【关键词】 糖尿病；膝；置换；风险；疗效

      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2015）18—2691—04


Risk and efficacy of total knee arthroplasty for patients with diabetes mellitus.
NIE Wen-bo, GONG Jun.
Department of Orthopedics, Yingcheng People's Hospital, Yingcheng 432400, Hubei, CHINA

【Abstract】 Objective To evaluate the risk and efficacy of total knee arthroplasty (TKA) in patients with dia-
betes mellitus. Methods A retrospective analysis was performed in the clinical data of 145 patients with knee osteo-
arthritis in our hospital from March 2009 to July 2013. According to whether suffering from diabetes and pre-admis-
sion 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. Intra-
operative blood transfusion, length of hospital stay, hospitalization expenses, complication rate, hospital for special sur-
gery (HSS) knee score one year after the operation, and Western Ontario and McMaster Universities Osteoarthritis In-
dex (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 postop-
erative 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, flex-
ion contracture, stability and strength (P>0.05); There were no significant difference in the above indexes be-
tween 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 cer-
tain risk, and the rehabilitation effect is less than that of patients with diabetes, which should be paid attention to
by health care workers.