全膝关节置换术患者不满意危险因素分析

doi:10.3877/cma.j.issn.1674-134X.2021.03.005

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 289 -293. doi: 10.3877/cma.j.issn.1674-134X.2021.03.005

临床论著

全膝关节置换术患者不满意危险因素分析

王聪¹, 梁钰琪², 张国荣³, 马宁¹, 柳宁强¹, 解桐¹, 郭崇军², 牛东生²^,^†(

)

^1. 750002　银川，宁夏医科大学第三临床医学院，宁夏回族自治区人民医院骨科
^2. 750002　银川，宁夏回族自治区人民医院骨一科
^3. 750002　银川，宁夏回族自治区人民医院科教处

收稿日期:2020-03-24 出版日期:2021-06-01
通信作者: 牛东生
基金资助:
宁夏回族自治区重点研发计划重大（重点）项目(2019BFG02012)

Analysis of dissatisfaction factors in patients underwent total knee arthroplasty

Cong Wang¹, Yuqi Liang², Guorong Zhang³, Ning Ma¹, Ningqiang Liu¹, Tong Xie¹, Chongjun Guo², Dongsheng Niu²^,^†()

^1. The third Clinical College of Ningxia Medical University, Department of Orthopaedics, Ningxia Autonomous Region People′s Hospital, Yinchuan 750002, China
^2. Department of Orthopaedics, People′s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, China
^3. Department of Science and Education, People′s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, China

Received:2020-03-24 Published:2021-06-01
Corresponding author: Dongsheng Niu

全文 ( ) 下载PDF ( ) 导出引用

引用本文：

王聪, 梁钰琪, 张国荣, 马宁, 柳宁强, 解桐, 郭崇军, 牛东生. 全膝关节置换术患者不满意危险因素分析[J/OL]. 中华关节外科杂志(电子版), 2021, 15(03): 289-293.

Cong Wang, Yuqi Liang, Guorong Zhang, Ning Ma, Ningqiang Liu, Tong Xie, Chongjun Guo, Dongsheng Niu. Analysis of dissatisfaction factors in patients underwent total knee arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(03): 289-293.

目的

分析全膝关节置换术(TKA)后患者不满意度的相关因素。

方法

通过电话、门诊及视频电话等方式随访2012年1月至2015年12月行全膝关节置换手术患者，纳入因骨关节炎、类风湿性关节炎、创伤性关节炎及无严重术后并发症者，排除翻修患者。共纳入537例患者，按主观满意度评分分为满意组和不满意组，采用单因素和多因素logistic回归分析全膝关节置换术患者不满意的影响因素，包括年龄、常用膝关节评分及术后不适感等。

结果

多因素Logistic回归分析结果表明≥70岁，西安大略和麦克马斯特大学(WOMAC)骨关节炎评分高(OR＝13.128)以及术后不适感(OR＝19.275)可增加TKA术后患者不满意度，较高特种外科医院(HSS)评分可减少TKA术后患者不满意度(OR＝0.141)。

结论

年龄大于70岁的患者容易产生不满意情绪，降低术后不适感仍是控制不满意度的重要因素。

关键词: 关节成形术, 置换, 膝, 病人满意度, 危险因素

Objective

To analyze the related factors of patients′ dissatisfaction after total knee arthroplasty(TKA).

Methods

The patients who underwent TKA from January 2012 to December 2015 were followed up by telephone, outpatient clinic and video call, including the patients who suffered from osteoarthritis, rheumatoid arthritis, traumatic arthritis and no serious postoperative complications. The patients of revison surgery were exclued.A total of 537 patients were enrolled, they were divided into the satisfied group and the dissatisfied group according to the subjective satisfaction score. The single factor and multivariate logistic regressions were used to analyze the influencing factors(including age, regular knee scores and postoperative discomfort) of dissatisfaction in the patients with TKA.

Results

Multivariate logistic regression analysis showed that more than 70 years old, higher Western Ontario and McMaster Universities(WOMAC)osteoarthritis score (OR=13.128) and postoperative discomfort (OR=19.275) increased patient dissatisfaction after TKA, and higher Hospital for Special Surgery (HSS)score reduced dissatisfaction of the patients after TKA(OR=0.141).

Conclusions

The patients over 70 years old are prone to produce dissatisfaction. Reducing postoperative discomfort is still an important factor to control dissatisfaction.

Key words: Arthroplasty, replacement, knee, Patient satisfaction, Risk factors

表1 TKA术后患者满意度的单因素分析

		满意组	不满意组	统计值	P值
例数		475	62
随访时间[个月，(±s)]		63.6±13.1	65.7±12.0	t＝-1.198	0.232
手术时间[h，(±s)]		1.7±0.5	1.9±0.6	t＝-1.938	0.053
病史时间[年，(±s)]		10.6±7.6	10.8±8.3	t＝-0.175	0.861
住院时间[d，(±s)]		22.2±7.3	24.0±7.3	t＝-1.888	0.060
HSS(±s)		86.9±6.8	73.4±10.7	t＝13.861	<0.001
WOMAC(±s)		56.2±22.6	95.9±35.8	t＝-12.390	<0.001
	疼痛	9.6±6.0	19.7±10.0	t＝-11.410	<0.001
	僵硬	6.0±2.2	7.9±3.4	t＝-6.281	<0.001
	关节功能	40.8±19.0	68.3±25.8	t＝-10.210	<0.001
性别(例)				χ²＝0.077^a	0.782^a
	男	100	14
	女	375	48
年龄(例)				χ²＝7.470	0.004^a
	≥70岁	260	46
	<70岁	215	16
BMI(例)				χ²＝14.412	<0.001^a
	超重组	263	50
	正常组	212	12
屈曲畸形(例)				χ²＝2.303	0.129^a
	轻度	393	56
	中度	82	6
心脑血管疾病(例)				χ²＝4.275	0.039^a
	有	248	41
	无	227	21
糖尿病(例)				χ²＝0.832	0.362^a
	有	57	5
	无	418	57
单双侧(例)				χ²＝0.125	0.723^a
	单侧	311	42
	双侧	164	20
诊断(例)				χ²＝0.721	0.426^b
	OA	443	56
	其他	32	6
教育水平(例)				χ²＝3.801	0.149^a
	文盲	170	16
	小学、中学	229	38
	高中以上	76	8
假体厂家(例)				χ²＝1.728^a	0.189^a
	史赛克	249	27
	强生	226	35
定期复诊(例)				χ²＝39.725	<0.001^a
	是	100	36
	否	375	26
术后跪姿(例)				χ²＝0.315	0.575^b
	是	10	2
	否	465	60

表1 TKA术后患者满意度的单因素分析

		满意组	不满意组	统计值	P值
例数		475	62
随访时间[个月，(±s)]		63.6±13.1	65.7±12.0	t＝-1.198	0.232
手术时间[h，(±s)]		1.7±0.5	1.9±0.6	t＝-1.938	0.053
病史时间[年，(±s)]		10.6±7.6	10.8±8.3	t＝-0.175	0.861
住院时间[d，(±s)]		22.2±7.3	24.0±7.3	t＝-1.888	0.060
HSS(±s)		86.9±6.8	73.4±10.7	t＝13.861	<0.001
WOMAC(±s)		56.2±22.6	95.9±35.8	t＝-12.390	<0.001
	疼痛	9.6±6.0	19.7±10.0	t＝-11.410	<0.001
	僵硬	6.0±2.2	7.9±3.4	t＝-6.281	<0.001
	关节功能	40.8±19.0	68.3±25.8	t＝-10.210	<0.001
性别(例)				χ²＝0.077^a	0.782^a
	男	100	14
	女	375	48
年龄(例)				χ²＝7.470	0.004^a
	≥70岁	260	46
	<70岁	215	16
BMI(例)				χ²＝14.412	<0.001^a
	超重组	263	50
	正常组	212	12
屈曲畸形(例)				χ²＝2.303	0.129^a
	轻度	393	56
	中度	82	6
心脑血管疾病(例)				χ²＝4.275	0.039^a
	有	248	41
	无	227	21
糖尿病(例)				χ²＝0.832	0.362^a
	有	57	5
	无	418	57
单双侧(例)				χ²＝0.125	0.723^a
	单侧	311	42
	双侧	164	20
诊断(例)				χ²＝0.721	0.426^b
	OA	443	56
	其他	32	6
教育水平(例)				χ²＝3.801	0.149^a
	文盲	170	16
	小学、中学	229	38
	高中以上	76	8
假体厂家(例)				χ²＝1.728^a	0.189^a
	史赛克	249	27
	强生	226	35
定期复诊(例)				χ²＝39.725	<0.001^a
	是	100	36
	否	375	26
术后跪姿(例)				χ²＝0.315	0.575^b
	是	10	2
	否	465	60

表2 影响TKA术后患者不满意度的多因素回归分析

相关因素	b	SE	P值	wald	OR值	OR值的95% CI
年龄	1.084	0.404	0.009	6.733	2.851	(1.292，6.289)
HSS	-1.962	0.384	<0.001	26.122	0.141	(0.066，0.298)
不适感	2.959	0.646	<0.001	19.275	19.275	(5.429，68.434)
WOMAC评分≥120	2.575	0.776	0.001	13.128	13.128	(2.868，60.094)
WOMAC评分80～120	2.277	0.764	0.003	9.749	2.182	(2.182，43.562)

表2 影响TKA术后患者不满意度的多因素回归分析

相关因素	b	SE	P值	wald	OR值	OR值的95% CI
年龄	1.084	0.404	0.009	6.733	2.851	(1.292，6.289)
HSS	-1.962	0.384	<0.001	26.122	0.141	(0.066，0.298)
不适感	2.959	0.646	<0.001	19.275	19.275	(5.429，68.434)
WOMAC评分≥120	2.575	0.776	0.001	13.128	13.128	(2.868，60.094)
WOMAC评分80～120	2.277	0.764	0.003	9.749	2.182	(2.182，43.562)

[1]	Zhang Y, JM Jordan. Epidemiology of osteoarthritis.[J]. Clinics in geriatric medicine, 2010, 26(3): 355-369.
[2]	王波，余楠生. 膝骨关节炎阶梯治疗专家共识(2018年版)[J/CD]. 中华关节外科杂志(电子版), 2019, 13(1): 124-130.
[3]	Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U．S., 2014 to 2030 [J]. J Bone Joint Surg Am, 2018, 100(17): 1455-1460.
[4]	杨礼庆，马超，杜帅. 人工全膝关节置换术围手术期疼痛管理现状[J]. 中国矫形外科杂志，2017, 25(3): 247-250.
[5]	Jenkins PJ, Clement ND, Hamilton DF, et al. Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis.[J]. Bone Joint J, 2013, (1): 115-121.
[6]	Schulze A, Scharf HP. Satisfaction after total knee arthroplasty. Comparison of 1990-1999 with 2000-2012 [J]. Der Orthopade, 2013, 42(10): 858-865.
[7]	Scott CE, Howie CR, MacDonald D, et al. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients [J]. Bone Joint Surg Br, 2010, 92(9): 1253-1258.
[8]	Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not？[J]. Clin Orthop Relat Res, 2010, 468(1): 57-63.
[9]	Dunbar MJ, Richardson G, Robertsson O. I can′t get no satisfaction after my total knee replacement: rhymes and reasons [J]. Bone Joint J, 2013, 148-152.
[10]	Scott CE, Oliver WM, MacDonald D, et al. Predicting dissatisfaction following total knee arthroplasty in patients under 55 years of age [J]. Bone Joint J, 2016, (12): 1625-1634.
[11]	Keudell AV, Sodha S, Collins J, et al. Patient satisfaction after primary total and unicompartmental knee arthroplasty: an age-dependent analysis [J]. Knee, 2014, 21(1): 180-184.
[12]	Noble PC, Conditt MA, Cook KF, et al. The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty [J]. Clin Orthop Relat Res, 2006, 45235-45243.
[13]	Townsend LA, Roubion RC, Bourgeois DM, et al. Impact of age on patient-reported outcome measures in total knee arthroplasty [J]. J Knee Surg, 2018, 31(6): 580-584.
[14]	Woon CY, Piponov H, Schwartz BE, et al. Total knee arthroplasty in obesity: in-hospital outcomes and national trends[J]. J Arthroplasty. 2016, 31(11): 2408-2414.
[15]	Martinez-Carranza N, Pettas A, Razzaz D, et al. Younger age is associated with increased odds of manipulation under anesthesia for joint stiffness after total knee arthroplasty[J]. Orthop Traumatol Surg Res, 2019, 105(6): 1067-1071.
[16]	Barrack RL, Ruh EL, Chen J, et al. Impact of socioeconomic factors on outcome of total knee arthroplasty [J]. Clin Orthop Relat Res, 2014, 472(1): 86-97.
[17]	刘桂梅，陈向梅. 老年心血管病合并焦虑抑郁症患者心律失常的动态心电图分析[J]. 中国现代药物应用，2018, 12(8)：11-12.
[18]	Pérez-Prieto D, Gil-González S, Pelfort X, et al. Influence of depression on total knee arthroplasty outcomes [J]. J Arthroplasty, 2014, 29(1): 44-47.
[19]	周红，崔新会. 膝关节损伤术后早期康复训练对其恢复的促进作用[J]. 海南医学，2020, 31(1): 92-95.
[20]	李东文. 髋膝关节置换术后患者家庭康复现状及对策研究[D]. 第二军医大学，2008.
[21]	翟振武，陈佳鞠，李龙. 2015～2100年中国人口与老龄化变动趋势[J]. 人口研究，2017, 41(4): 60-71.
[22]	Messier SP, Gutekunst DJ, Davis C, et al. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis [J]. Arthritis Rheum, 2005, 52(7): 2026-2032.
[23]	Tang X, Wang S, Zhan S, et al. The prevalence of symptomatic knee osteoarthritis in China: results from the China Health and Retirement Longitudinal Study [J]. Arthritis Rheum, 2016, 68(3): 648-653.
[24]	Dhurve K, Scholes C, El-Tawil S, et al. Multifactorial analysis of dissatisfaction after primary total knee replacement[J]. Knee. 2017, 24(4): 856-862.
[25]	Husain A, Lee GC. Establishing realistic patient expectations following total knee arthroplasty[J]. J Am Acad Orthop Surg, 2015, 23(12): 707-713.
[26]	Ghomrawi HMK, Lee LY, Nwachukwu BU, et al. Preoperative expectations associated with postoperative dissatisfaction after total knee arthroplasty: a cohort study.[J]. J Am Acod Orthop Surg, 2020, 28(4): e145-e150.
[27]	Eymard F, Charles-Nelson A, Katsahian S, et al. "Forgotten knee" after total knee replacement: a pragmatic study from a single-centre cohort[J]. Joint Bone Spine, 2015, 82(3): 177-181.
[28]	宋志颖，高冲，陈宝安. 天气对骨关节炎疼痛的影响[J]. 现代医学，2019, 47(9): 1156-1160.
[29]	Shannak O, Palan J, Esler C. A regional registry study of 216 patients investigating if patient satisfaction after total knee arthroplasty changes over a time period of five to 20 years[J]. Knee, 2017, 24(4): 824-828.

[1]	陈晓玲, 钟永洌, 刘巧梨, 李娜, 张志奇, 廖威明, 黄桂武. 超高龄髋膝关节术后谵妄及心血管并发症风险预测[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 575-584.
[2]	马桥桥, 张传开, 郭开今, 蒋涛, 王子豪, 刘勇, 郝亮. 可降解止血粉减少初次全膝关节置换术失血量的研究[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 585-589.
[3]	刘鹏, 罗天, 许珂媛, 邓红美, 李瑄, 唐翠萍. 八段锦对膝关节炎疗效的初步步态分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 590-595.
[4]	李焕玺, 何淳诺, 田志敏, 周胜虎, 吴昊越, 张浩强. 全膝关节置换术后股骨远端假体周围骨折治疗现状[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 630-637.
[5]	谢江燕, 王亚菲, 贺芳. 妊娠合并血栓性血小板减少性紫癜2例并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 556-563.
[6]	王振宇, 张洪美, 荆琳, 何名江, 闫奇. 膝骨关节炎相关炎症因子与血浆代谢物间的因果关系及中介效应[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 467-473.
[7]	贺斌, 马晋峰. 胃癌脾门淋巴结转移危险因素[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 694-699.
[8]	林凯, 潘勇, 赵高平, 杨春. 造口还纳术后切口疝的危险因素分析与预防策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 634-638.
[9]	杨闯, 马雪. 腹壁疝术后感染的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 693-696.
[10]	宋庆成, 郑占乐, 王天瑞, 王宇钏, 张凯旋, 纳静, 蔚佳昊, 杨思繁, 宋九宏, 张英泽. “人老膝不老”：膝关节健康管理的全方位探索与实践[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 321-324.
[11]	郑占乐, 王宇钏, 蔚佳昊, 宋庆成, 张凯旋, 纳静, 王天瑞, 宋九宏, 张英泽, 王娟. 保膝须“开膝”——“开膝”在膝骨关节炎中的临床应用价值[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 325-330.
[12]	茹江英, 廖启宇, 温国洪, 潘思华, 刘栋, 张皓琛, 牛云飞. 直接前方入路和后外侧入路半髋关节置换治疗老年痴呆股骨颈骨折的疗效比较[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 287-293.
[13]	高广涵, 张耀南, 石磊, 王林, 王飞, 郑子天, 王鸿禹, 郭民政, 薛庆云. 膝骨关节炎患者前交叉韧带功能影像学影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 301-307.
[14]	王松雷, 张贻良, 孟浩, 宋威, 白林晨, 袁心, 张辉. 股骨前髁预截骨髓外定位技术在全膝关节置换术中的应用[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 811-819.
[15]	颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Analysis of dissatisfaction factors in patients underwent total knee arthroplasty

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Analysis of dissatisfaction factors in patients underwent total knee arthroplasty