身体质量指数对全膝关节置换患者膝关节功能的影响

目的采用Meta分析的方法，评价非肥胖组、超重组、肥胖组及病理性肥胖组患者全膝关节置换膝关节功能的差异。 方法计算机检索PubMed、荷兰医学文摘数据库(EMBASE)、知网、万方等中英文数据库从1989年1月至2017年12月关于不同身体质量指数全膝关节置换患者膝关节功能的文献。纳入回顾性或前瞻性纵向研究、按世界卫生组织身体质量指数(BMI)分组的全膝关节置换术(TKA)患者、膝关节功能评价采用纽约特种外科医院膝关节评分标准(HSS)或美国膝关节协会评分(KSS)、效应指标为样本量、均数和标准差的文献，排除文献重复或资料相似、BMI分组未落上述分组范围内及未提供样本量、均数和标准差的文献。由2名研究者独立对文献进行筛选、资料提取和质量评价后，用Stata 12.0软件进行Meta分析。 结果最终纳入13篇文献。Meta分析结果示，非肥胖组、超重组、肥胖组及病理性肥胖组患者的术后膝关节功能评分均高于术前(P<0.01)，另外，肥胖组患者的术前膝关节功能评分低于非肥胖组SMD ＝0.32，95%CI(0.07，0.58)，P＝0.012]，术后膝关节功能评分低于超重组SMD ＝0.18，95%CI(0.04，0.32)，P＝0.013]。 结论全膝关节置换术后不同体质指数患者膝关节功能评分均有大幅提高，但27 ≤体质指数<30则可能对术前及术后膝关节功能造成负面影响。

Meta-analysis of function influenced by body mass index during perioperative total knee arthroplasty

ObjectiveTo evaluate the pre- and post-operative knee function after total knee arthroplasty among the non-obese patients, overweight patients, obesity patients and morbidly obesity patients. MethodsPubMed, Dutch Excerpta Medica Database (EMBASE), China National Knowledge Infrastructure (CNKI) and Wan Fang database were systematically searched for studies on the function influenced by body mass index after total knee arthroplasty from January 1989 to December 2017. Inclusion criteria: retrospective or prospective longitudinal studies, total knee arthroplasty (TKA) patients grouped according to the World Health Organization’s body mass index (BMI), knee function assessment using the New York Hospital for Special Surgery score (HSS) or American Knee Society Score (KSS), effect indicators were sample size, mean and standard deviation. Exclusion criteria: duplication literatures or similar data, BMI groups not falling within the above group standards, and effect indicators were not sample size, mean or standard deviation. The quality of studies was critically evaluated and the data were extracted by two reviewers independently. Meta-analysis was conducted by Stata 12.0. ResultsThirteen studies were finally identified. Pooling analysis noted that knee function scores among patients in the non-obese group, the overweight group, the obesity group and the morbidly obesity group were significantly higher post-operatively than the pre-operative ones (P<0.01). The obese patients had a lower score in preoperative knee function than the non-obese patients SMD =0.32, 95%CI (0.07, 0.58), P=0.012], and had a lower score in postoperative knee function than the overweight patients SMD =0.18, 95%CI (0.04, 0.32), P=0.013]. ConclusionThe knee function increases in all the patients after total knee arthroplasty, but BMI greater than or equal to 27 and less than 30 may show negative effect on the preoperative and postoperative knee function.