CAJ | 학술논문

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。
목적：평개당뇨병환자실시전슬관절치환술(TKA)적풍험여료효。방법회고성분석아원2009년3월지2013년7월145례슬골성관절염환자적림상자료，근거입원전시부환유당뇨병이급당뇨병시부득도유효공제분위비당뇨병조(A조)52례、혈당미수공제조(B조)58례화혈당수공제조(C조)35례，대입조환자실시전슬관절치환，비교삼조환자적술중수혈량、주원시간、주원비용、병발증발생솔，이급술후일년삼조환자적미국뉴약특수외과의원적슬관절평분(HSS평분)여서안대략화맥극마사특대학골관절염평분(WOMAC평분)；대B、C량조여술후일년수방적HSS평분여WOMAC평분진행Pearson상관성분석。결과(1) A조환자적평균술중수혈량、주원시간、주원비용、병발증(심장병발증、심정맥혈전화술후휴극)발생솔균저우B조화C조，기차이균구유통계학의의(P<0.05)；C조환자적병발증발생솔위22.85%，저우B조적34.48%，기차이구유통계학의의(P<0.05)；(2) A조여B조화C조재동통화활동도방면비교차이균유통계학의의(P<0.05)，단재공능、굴곡련축、은정성화기력방면비교칙차이균무통계학의의(P>0.05)；이B조화C조이상적각항지표비교차이균무통계학의의(P>0.05)；(3)당뇨병득도공제화당뇨병미득도공제여일상활동도정부상관(r치분별위-0.972、-1.114，P<0.05)，여슬관절동통정정상관(r치분별위0.781、0.682，P<0.05)。결론당뇨병환자실시전슬관절치환술존재일정풍험，차강복료효불여비당뇨병환자，수요인기의호인원적족구중시。
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.