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中华关节外科杂志(电子版)

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. 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. 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
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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]. 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]. 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＝0.077a 0.782a
  男 100 14    
  女 375 48    
年龄(例)     χ2＝7.470 0.004a
  ≥70岁 260 46    
  <70岁 215 16    
BMI(例)     χ2＝14.412 <0.001a
  超重组 263 50    
  正常组 212 12    
屈曲畸形(例)     χ2＝2.303 0.129a
  轻度 393 56    
  中度 82 6    
心脑血管疾病(例)     χ2＝4.275 0.039a
  有 248 41    
  无 227 21    
糖尿病(例)     χ2＝0.832 0.362a
  有 57 5    
  无 418 57    
单双侧(例)     χ2＝0.125 0.723a
  单侧 311 42    
  双侧 164 20    
诊断(例)     χ2＝0.721 0.426b
  OA 443 56    
  其他 32 6    
教育水平(例)     χ2＝3.801 0.149a
  文盲 170 16    
  小学、中学 229 38    
  高中以上 76 8    
假体厂家(例)     χ2＝1.728a 0.189a
  史赛克 249 27    
  强生 226 35    
定期复诊(例)     χ2＝39.725 <0.001a
  是 100 36    
  否 375 26    
术后跪姿(例)     χ2＝0.315 0.575b
  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)
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