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目的 分析老年膝关节骨性关节炎患者术前脂肪肌肉组织分布特征与全膝关节置换术后膝关节功能的相关性,筛选影响术后膝关节功能恢复的相关因素。方法 回顾性分析自2022-01—2025-01完成的157例老年全膝关节置换术,收集患者临床资料,术前1周内进行MRI检查,通过Image J图像分析软件测量患侧膝关节周围肌肉横截面积、脂肪组织横截面积,计算脂肪-肌肉面积比;将术后6个月膝关节功能Lysholm评分<70分的患者纳入预后不良组,其余患者纳入预后良好组。采用Pearson相关分析术前脂肪肌肉组织分布指标与术后膝关节功能Lysholm评分的相关性,采用多因素Logistic回归分析筛选影响老年患者全膝关节置换术后膝关节功能的独立危险因素。结果 Pearson相关性分析结果显示,术后膝关节功能Lysholm评分与术前肌肉横截面积呈正相关,与术前脂肪组织横截面积、术前脂肪-肌肉面积比呈负相关。157例中33例纳入预后不良组,其余124例纳入预后良好组。多因素Logistic回归分析结果显示,术前脂肪组织横截面积大、术前脂肪-肌肉面积比大是导致老年患者全膝关节置换术后膝关节功能较差的独立危险因素(P<0.05),术前膝关节功能Lysholm评分高、术前白蛋白水平高则是独立保护因素(P<0.05)。结论 术前脂肪肌肉组织分布特征与老年患者全膝关节置换术后膝关节功能相关,术前膝关节周围肌肉横截面积、脂肪-肌肉面积比可作为预后的预测因素,可作为临床医师评估患者康复潜力的参考指标。对于存在膝关节周围脂肪、肌肉组织分布异常的患者,需制定个体化干预措施改善患者术后膝关节功能。
Abstract：Objective To analyze the correlation between preoperative adipose and muscle tissue distribution characteristics and knee function in elderly patients with knee osteoarthritis after total knee arthroplasty, and to identify relevant factors affecting postoperative knee function recovery.Methods A retrospective analysis was conducted on 157 elderly patients who underwent total knee arthroplasty from January 2022 to January 2025. Clinical data were collected. MRI examination was performed within one week before surgery. The cross-sectional areas of muscle and adipose tissue around the affected knee were measured using Image J image analysis software, and the fat-muscle area ratio was calculated. Patients with a Lysholm knee function score <70 at 6 months postoperatively were included in the poor prognosis group, while the remaining patients were included in the good prognosis group. Pearson correlation analysis was used to evaluate the correlation between preoperative adipose and muscle tissue distribution indices and postoperative Lysholm score. Multivariate logistic regression analysis was performed to identify independent risk factors affecting postoperative knee function in elderly patients undergoing total knee arthroplasty.Results Pearson correlation analysis showed that postoperative Lysholm score was positively correlated with preoperative muscle cross-sectional area, and negatively correlated with preoperative adipose tissue cross-sectional area and preoperative fat-muscle area ratio. Among the 157 patients, 33 were included in the poor prognosis group and 124 in the good prognosis group. Multivariate logistic regression analysis revealed that large preoperative adipose tissue cross-sectional area and high preoperative fatmuscle area ratio were independent risk factors for poor postoperative knee function in elderly patients undergoing total knee arthroplasty(P<0.05), while high preoperative Lysholm score and high preoperative albumin level were independent protective factors(P<0.05).Conclusion Preoperative adipose and muscle tissue distribution characteristics are correlated with postoperative knee function in elderly patients undergoing total knee arthroplasty. Preoperative muscle cross-sectional area and fat-muscle area ratio around the knee can serve as prognostic predictors and reference indicators for clinicians to assess patients' rehabilitation potential. For patients with abnormal adipose and muscle tissue distribution around the knee, individualized interventions should be developed to improve postoperative knee function.
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基本信息:
中图分类号:R687.4
引用信息:
[1]毛俊超,成晓华,陈德生,等.脂肪肌肉组织特征与老年全膝关节置换术后膝关节功能的相关性分析[J].中国骨与关节损伤杂志,2026,41(04):357-362.
2026-04-15
2026-04-15