来源：304关节学术

译者：马云青

整理：骨科在线

来自美国的Keeney BJ, Austin DC等发表于《J Bone Joint Surg Am》杂志的一项研究显示，病理性肥胖患者(BMI≥40kg/m)在全膝关节置换术前至少要减掉20磅（约9公斤）体重，才会与较短的住院时间和较低的出院后需要后续治疗的可能性有关。虽然在手术时间或功能改善方面没有差异，但这对患者的自身负担和降低成本有相当大的影响。

许多医生在患者接受全膝关节置换术前要求病理性肥胖患者减肥。因此作者通过本实验，探究究竟患者需要在术前减少多少体重，才能减少手术和住院时间，减少安全出院的后续治疗，以及明显改善关节功能。

研究人员通过对2011年至2016年在1所三级医疗机构的前瞻性队列研究数据进行回顾性分析，共纳入了203名在术前至少90天患有病态肥胖的患者，并在术前再次测量他们的BMI。所有的身高和体重都是通过临床实地测量的，使用Logistic和线性回归分析，根据患者术前年龄、性别、手术时间、双侧关节的状态、全身功能(PROMIS-10身体评分（PCS）、心理功能PROMIS-10心理评分（MCS）)和Charlson共患病指数进行调整。

结果显示，203名患者中，41%在术前至少减掉5磅（2.27公斤)，29%至少减掉10磅(4.54公斤)，14%至少减掉20磅(9.07公斤）。在病态肥胖患者中，全膝关节置换术前减掉20磅与出院后需要接受继续治疗的比率较低有关(OR、0.28[95%CI、0.09-0.94]；p=0.039)、与住院时间延长至少4天的相关性较低(OR，0.24[95%CI，0.07-0.88]；p=0.031)和绝对较短的住院时间有明显相关性(-0.87天[95%CI，-1.39--0.36天]；p=0.001)，与手术时间或PCS改善无相关性。减轻5或10磅与任何结果的差异无相关性。

作者通过本研究，建议患者和医生应关注更大的术前减肥目标。

原文摘要

Preoperative Weight Loss for Morbidly Obese Patients Undergoing Total Knee Arthroplasty: Determining the Necessary Amount

Background:

Many surgeons require or request weight loss among morbidly obese patients (those with a body mass index [BMI] of ≥40 kg/m) before undergoing total knee arthroplasty. We sought to determine how much weight reduction was necessary to improve operative time, length of stay, discharge to a facility, and physical function improvement.

Methods:

Using a retrospective review of cohort data that were prospectively collected from 2011 to 2016 at 1 tertiary institution, we identified 203 patients who were morbidly obese at least 90 days before the surgical procedure and had their BMI measured again at the immediate preoperative visit. All heights and weights were clinically measured. We used logistic and linear regression models that adjusted for preoperative age, sex, year of the surgical procedure, bilateral status, physical function (Patient-Reported Outcomes Measurement Information System [PROMIS]-10 physical component score [PCS]), mental function (PROMIS-10 mental component score [MCS]), and the Charlson Comorbidity Index.

Results:

Of the 203 patients in the study, 41% lost at least 5 pounds (2.27 kg) before the surgical procedure, 29% lost at least 10 pounds (4.54 kg), and 14% lost at least 20 pounds (9.07 kg). Among morbidly obese patients, losing 20 pounds before a total knee arthroplasty was associated with lower adjusted odds of discharge to a facility (odds ratio [OR], 0.28 [95% confidence interval (CI), 0.09 to 0.94]; p = 0.039), lower odds of extended length of stay of at least 4 days (OR, 0.24 [95% CI, 0.07 to 0.88]; p = 0.031), and an absolute shorter length of stay (mean difference, -0.87 day [95% CI, -1.39 to -0.36 days]; p = 0.001). There were no differences in operative time or PCS improvement. Losing 5 or 10 pounds was not associated with differences in any outcome.

Conclusions:

Losing at least 20 pounds before total knee arthroplasty was associated with shorter length of stay and lower odds of facility discharge for morbidly obese patients, even while most patients remained morbidly or severely obese. Although there were no differences in operative time or physical function improvement, this has considerable implications for patient burden and cost reduction. Patients and providers may want to focus on larger preoperative weight loss targets.

文献出处：Keeney BJ, Austin DC, Jevsevar DS. Preoperative Weight Loss for Morbidly Obese Patients Undergoing Total Knee Arthroplasty: Determining the Necessary Amount. J Bone Joint Surg Am. 2019;101(16):1440-1450. doi:10.2106/JBJS.18.01136