[接受选择性部和膝关节关节整形手术的肥胖患者的术后管理]
P M Prodinger1,2, C H Gruber3, P Weber4
1Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert-Kerkel-Platz, 83734, Hausham, Deutschland. peter.prodinger@khagatharied.de.
Orthopadie (Heidelberg, Germany)
|January 20, 2025
概括
肥胖患者从关节塑造中获得的益处与正常体重患者相似,但面临更高的并发症风险,特别是感染. 在手术前减肥和代谢评估对于在关节置换手术前体重指数 (BMI) 高的患者至关重要.
科学领域:
- 整形外科手术 整形外科手术
- 肥胖医学 肥胖医学
- 公共卫生 公共卫生
背景情况:
- 肥胖是一个日益增长的全球健康挑战,越来越多地影响年轻人群体,并使关节整形手术程序复杂化.
- 肥胖患者的并发症率较高,往往导致推推迟手术,直到实现显著的体重减轻,特别是那些体重指数 (BMI) 超过40的人.
研究的目的:
- 系统地审查当前关于肥胖患者关节整形术的结果和风险的文献.
- 为管理接受关节置换手术的肥胖患者提供基于证据的建议.
主要方法:
- 对电子数据库进行系统审查,包括PubMed,Embase,Web of Science和Cochrane图书馆.
- 分析了49篇相关文章,并根据文献回答了预先定义的问题.
- 根据在共识会议上定义的证据水平,制定了建议.
主要成果:
- 肥胖患者 (BMI ≥30) 的术后风险增加了多达三倍,特别是感染和机械并发症.
- 尽管手术难度增加和位置错误的风险增加,肥胖患者在关节质整术后获得了相似的功能改善和生活质量.
- 术前减肥可以减轻风险,但需要长期的承诺;减肥手术和药物治疗对术后风险的影响尚不清楚. 管理并发症至关重要.
结论:
- 肥胖患者从关节塑性手术中获得的益处与正常体重患者相似,但他们面临更高的并发症风险,特别是感染.
- 对于BMI≥40的患者,建议进行手术前的饮食咨询和减肥,同时检查代谢状况,以减轻营养不良的风险.
- 如果体重减轻的目标没有实现,手术可能会在知情同意的情况下进行,以增加风险,并强调患者参与决策.
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