在患有严重膝关节关节炎且没有正式的外科手术优化计划的患者中,致病性肥胖是可修改的风险因素吗?
Mina Botros1, Paul Guirguis1, Rishi Balkissoon1
1Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York.
The Journal of arthroplasty
|September 17, 2023
概括
大多数40以上体重指数 (BMI) 的患者在膝关节置换手术前都很难减轻显著的体重. 减肥手术提供了最好的减肥结果,但并没有显著增加膝盖关节整形术 (TKA) 率.
科学领域:
- 整形外科手术 整形外科手术
- 腹腔外科手术是什么意思
- 肥胖研究的研究.
背景情况:
- 肥胖是全膝关节整形术 (TKA) 的可修改风险因素,但证据有限.
- 体重指数 (BMI) >40的患者对TKA候选人和结果提出了独特的挑战.
研究的目的:
- 为了评估40以上BMI接受TKA的患者的体重减轻成功.
- 在没有正式优化计划的情况下,在这个队列中确定TKA的发病率.
主要方法:
- 对624名患有膝关节关节炎 (Kellgren和Lawrence等级3或4) 和BMI> 40.0的患者进行了回顾性单中心分析.
- 最少1年的随访 (平均45个月),评估人口统计,减肥干预措施 (腹腔手术与非手术),BMI变化和TKA追求.
- 多变量逻辑和线性回归分析了特征和结果之间的关联.
主要成果:
- 只有11%的患者追求TKA.
- 与非手术干预相比,腹部外科手术降低BMI至少10的可能性是3.7倍.
- 腹部外科手术的平均BMI变化为-3.3,明显高于非手术干预 (-2.6) 或没有干预 (0.4).
- 接受减肥手术 (3.1x) 和非手术干预 (2.4x) 的患者比没有干预的患者更有可能接受TKA.
- 与白人患者相比,非白人患者的BMI损失>5的可能性较低.
结论:
- 大多数患者 (BMI>40) 在没有正式的体重优化计划的情况下,在4年内实现了最小的BMI降低 (<5-10).
- 在这个队列中,腹部手术是减肥最有效的干预措施.
- 尽管进行了减肥干预,但在所有组中,对TKA的总体追求仍然很低.
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