来源；304关节学术

译者：张轶超

整理：骨科在线

来自英国的Clement ND, Bardgett M, Weir D等发表于《Bone Joint J》的一项研究提示，TKA术后有三类不满意患者：术后1年就不满意的早期患者，长期随访都不满意的持续性患者和从早期满意发展来的晚期不满意患者。三组患者存在不同的满意度独立预测指标，对于每组患者可能需要采取不同的解决方法来改善患者的效果和满意度。

本研究的最初目的是评估全膝置换术（TKA）后满意的患者一年以后是否会有所改变。其次是找到那些最初一年时满意而在术后一年时满意，持续性不满意和晚期出现不满意的患者的预测指标。

研究者从建立好的置换数据库中选择了1369例因骨关节炎行初次TKA而未翻修的病人，并在术前、术后1年和术后5年时收集患者的一般情况资料、合并症情况、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分及短表12问卷评分（SF-12）。另外记录术后1年和术后5年时的患者的满意度调查。在术后1年和术后5年时采用逻辑回归分析方法来分析满意度的独立预测指标。

结果显示，从术后1年（91.7%，n=1255）到术后5年（90.1%，n=1234），整体的满意率没有改变（p=0.16）。有近一半（53/114）术后1年时对TKA手术不满意的患者到5年时变得满意，而有6%（74/1255）术后1年时对TKA手术满意的患者到5年时变得不满意。在术后1年时，那些伴有肺部疾病的（p=0.04）、抑郁的（p=0.001）、腰背痛的（p<0.001）、只做了一侧TKA的(p=0.001)或术前WOMAC评分差的(p=0.04)患者更趋向于对手术不满意。伴有胃部溃疡（p=0.04）和差的WOMAC僵硬度评分的(p=0.047)患者在术后5年时会有很大的持续性不满意风险。相反，术后1年时WOMAC疼痛评分差预示着早期不满意的患者术后5年时可能会变得满意。

原文摘要：

Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late

Aims:

The primary aim of this study was to assess whether patient satisfaction one year after total knee arthroplasty (TKA) changed with longer follow-up. The secondary aims were to identify predictors of satisfaction at one year, persistence of patient dissatisfaction, and late onset dissatisfaction in patients that were originally satisfied at one year.

Patients and Methods:

A retrospective cohort consisting of 1369 patients undergoing a primary TKA for osteoarthritis that had not undergone revision were identified from an established arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Short Form 12 (SF-12) questionnaire scores were collected preoperatively, and one and five years postoperatively. In addition, patient satisfaction was assessed at one and five years postoperatively. Logistic regression analysis was used to identify independent predictors of satisfaction at one and five years.

Results:

The overall rate of satisfaction did not change from one (91.7%, n = 1255) to five (90.1%, n = 1234) years (p = 0.16). Approximately half (n = 53/114) of the patients who were dissatisfied at one year became satisfied with their TKA at five years, whereas 6% (n = 74/1255) of those who were satisfied at one year became dissatisfied at five years. At one year, patients with lung disease (p = 0.04), with depression (p = 0.001), with back pain (p < 0.001), undergoing unilateral TKA (p = 0.001), or with a worse preoperative WOMAC pain score (p = 0.04) were more likely to be dissatisfied. Patients with gastric ulceration (p = 0.04) and a worse WOMAC stiffness score (p = 0.047) were at increased risk of persistent dissatisfaction at five years. In contrast, a worse WOMAC pain score (p = 0.01) at one year was a predictor of dissatisfaction in previously satisfied patients at five years.

Conclusion:

Three groups of dissatisfied patients exist after TKA: 'early' dissatisfaction at one year, 'persistent' dissatisfaction with longer follow-up, and 'late' dissatisfaction developing in previously satisfied patients at one year. All three groups have different independent predictors of satisfaction, and potentially addressing risk factors specific to these groups may improve patient outcome and their satisfaction.

文献出处：

Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ. Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late. Bone Joint J. 2018;100-B(2):161-169. doi:10.1302/0301-620X.100B2.BJJ-2017-1016.R1