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標題: | 糖尿病患者接受微創全膝關節置換術後其早期身體功能恢復和生活品質之探討 Early Physical Function Recovery and Quality of Life in Patients with Diabetes Mellitus after Minimally Invasive Total Knee Arthroplasty |
作者: | Yu-Hsuan Li 李雨軒 |
指導教授: | 簡盟月(Meng-Yuen Chien) |
關鍵字: | 糖尿病,微創全膝關節置換術,身體功能,生活品質,併發症, Diabetes mellitus,Minimally invasive total knee arthroplasty,Physical function,Quality of life,Complications, |
出版年 : | 2014 |
學位: | 碩士 |
摘要: | 研究背景與目的:糖尿病是一種代謝失調疾病,會損害肌肉骨骼系統使身體失能。預期合併糖尿病和退化性膝關節炎且需接受全膝關節置換術的患者將伴隨人口老化而增加。新型微創全膝關節置換術是近年來被廣泛使用的手術方式,過去研究顯示糖尿病患者接受全膝關節置換術後膝功能恢復較差,但少有研究報告糖尿病患者接受微創全膝關節置換術後實際身體功能和生活品質的情況。因此本研究目的為比較糖尿病患者和無糖尿病者接受微創全膝關節置換術後3個月的身體功能和生活品質,並分析影響術後身體功能和生活品質的因素。研究方法:93位符合收案條件的微創全膝關節置換術患者,其中糖尿病組46名和對照組47名。檢測項目包括:理學檢查(膝屈曲角度、股四頭肌肌力、手握力)、身體功能(功能性前伸測試、站姿平衡測試、5次坐到站測試、計時起走測試、六分鐘行走測試)、日常身體活動量、退化性關節炎指標及生活品質(36題簡短生活品質量表)。所有測試分別於術前一日和術後3個月進行評估。採用SPSS 17.0統計軟體進行資料分析,以獨立樣本t檢定、共變數分析和配對t檢定分析組間和組內差異,並使用皮爾森和史皮爾曼排列相關係數檢測各評估參數的相關性,以逐步多元線性迴歸分析影響術後身體功能和生活品質的相關因素。結果:在理學檢查方面,糖尿病組術後開刀側膝關節屈曲角度顯著較術前下降(p<0.001),對照組開刀側股四頭肌肌力(p=0.030)、非開刀側膝屈曲角度(p=0.036)和股四頭肌肌力(p=0.008)顯著較術前改善。在身體功能方面,對照組在倂腳1/2站立、5次坐到站測試、計時起走測試、六分鐘行走測試顯著較術前進步,但糖尿病組手術前後無明顯改變,且糖尿病組六分鐘行走測試距離的變化量更顯著低於對照組(p=0.001)。在退化性關節炎指標方面,糖尿病組的疼痛、功能面向有顯著進步,但僵硬指標無變化(p=0.872)。此外,糖尿病組在生活品質的生理角色限制、一般健康、生理總分面向進步幅度明顯低於對照組。迴歸分析結果顯示,術後身體功能和生活品質與術前功能狀態、術後股四頭肌肌力和膝屈曲角度顯著相關。結論:糖尿病患者經微創全膝關節置換術後三個月,在身體功能表現和生活品質明顯較無糖尿病者差。術後身體功能和生活品質會受到術前狀態、術後股四頭肌肌力和膝關節屈曲角度所影響。因此建議糖尿病患者術後三個月除加強膝關節活動度和股四頭肌肌力以改善身體功能外,宜持續門診物理治療和定期追蹤。 Background and Purpose: Diabetes mellitus (DM) is a metabolic disorder which may impair musculoskeletal system contributing to physical dysfunction. The number of patients combining DM with knee osteoarthritis (OA) who undergo total knee arthroplasty (TKA) should be expected to grow with aging. The new minimally invasive total knee arthroplasty (MIS-TKA) is widely used for treating knee OA recently. Diabetic patients have been showed to have worse knee functional recovery after TKA, but few studies reported the actual physical function and quality of life (QOL) after MIS-TKA. Therefore, the aims of the present study were to compare the physical function and QOL of diabetic patients with those of non-diabetic patients after MIS-TKA, and to determine the factors affecting these variables. Methods: Ninety-three patients undergoing MIS-TKA were divided into DM group (n=46) and control group (n=47). The physical examination including the knee flexion range of motion (ROM), quadriceps strength and grip strength, the physical functional tests including the functional reach test, the standing balance tests, the 5-repeated sit-to-stand test (STS), the timed up and go test (TUG) and the 6-minute walk test (6MWT), the daily physical activities, the osteoarthritis index and QOL (SF-36) were evaluated at the day before surgery and postoperative 3 months. SPSS 17.0 (SPSS Inc., Chicago, IL, USA) was used for statistical analyses. Independent sample t-test, analysis of covariance (ANCOVA) and paired t-test were used for between-groups and within-group comparisons at baseline and postoperative variables. Pearson and Spearman rank-order correlation coefficients were used for the relationships among the variables; stepwise multiple linear regression analyses were used for the factors affecting the postoperative physical function and QOL as well. Results: The operated knee flexion ROM (p<0.001) significantly decreased in DM group; the operated quadriceps strength (p=0.030), non-operated knee flexion ROM (p=0.030) and quadriceps strength (p=0.008) in control group all significantly increased after MIS-TKA. Control group had significant improvements in the semi-tandem stand, STS, TUG, and 6MWT after surgery, while DM group remained constant and had significantly less change of 6MWT compared with control group (p=0.001). On the aspect of WOMAC, both pain and function domains got significant postoperative improvements contrasting to the stiffness domain (p=0.872) in DM group. The changes of role physical, general health and physical component summary of SF-36 were significantly lower in DM group than in control group. The multiple linear regression analyses revealed that the physical function and QOL were significantly associated with the preoperative status, the postoperative quadriceps strength and knee flexion ROM. Conclusion: Diabetic patients had worse the physical function and QOL than non-diabetic patients at 3 months after MIS-TKA. Our results showed the postoperative physical function and QOL were influenced by the preoperative status, the postoperative quadriceps strength and knee flexion ROM. Therefore, outpatient physical therapy programs should be suggested to enhance knee ROM and quadriceps strength to improve the the physical function for diabetic patients after MIS-TKA. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/56751 |
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