关节置换术不会造成体重减轻


  【24drs.com】根据在线发表于9月7日临床骨科及相关研究期刊的系统性回顾,有关全髋关节置换术(THA)和/或全膝关节置换术(TKA)对术后体重减轻的研究分析,尚不足以做出定论。
  
  圣地牙哥州立大学/加州大学的博士候选人Maria C.S. Inacio与研究伙伴结论指出,他们分析了一些质量坦白说并不是很好的研究,对于体重或身体组成在全关节置换术(TJA)之后增加、减少或不变,并无法提出具定论的证据。
  
  一般预期在THA或TKA之后体重会减轻,因为术后会减少疼痛与增加移动性,但是任职于Kaiser Permanente的Inacio等人,对体重是否真的如预期般减轻有所疑虑。
  
  肥胖本身是导致需要髋骨或膝盖置换术的重要风险因素,TJA后体重减轻或许可以降低人工关节松动的并发症风险,而降低后续手术的可能。
  
  作者们发现,有12篇研究符合纳入规范,包括1篇单一案例世代研究以及11篇案例系列报告,多数研究来自单一名外科医师或单一所医院。
  
  作者们写道,因为这些研究的观察性本质与严重的研究限制,依据推荐、评核、开发与评价等级规范分类皆为质量极低。
  
  在14%- 49%的病患曾有TJA后至少1年有某种程度之体重减轻的报告,但是在许多案例中,并未达美国食品药物管理局定义的「具临床意义之减重(至少减轻体重之5%)」。各研究有关体重减轻的范围并不一致、加上研究设计的差异导致整体并无具结论性的模式。再者,体重增加(21% - 75%)的病患比减重(14% - 49%)者更多。
  
  在这份原稿的一篇CORR Insights评论中,史丹佛大学的Stuart B. Goodman博士表示,肥胖病患通常告诉医师,自己是因为髋或膝关节疼痛限制了体能活动与消耗热量的能力而导致过重;不幸的是,根据这篇新闻稿,统合分析资料之后,这个重要问题仍然无解。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6943&x_classno=0&x_chkdelpoint=Y
  

Joint Replacement May Not Lead to Weight Loss

By Janis C. Kelly
Medscape Medical News

September 20, 2012 — Studies assessing the effect of total hip arthroplasty (THA) and/or total knee arthroplasty (TKA) on postsurgical weight loss are inadequate and inconclusive, according to a systematic review published online September 7 in Clinical Orthopedics and Related Research.

Maria C.S. Inacio, a doctoral candidate from San Diego State University/University of California, and colleagues conclude that the (admittedly low-quality) studies they analyzed provide "no conclusive evidence that weight or body composition increases, decreases, or remains the same after [total joint arthroplasty (TJA)]."

Weight loss might be expected to occur as a byproduct of THA or of TKA because of postsurgical reduction in pain and increased mobility, but Inacio, who is employed at Kaiser Permanente, and colleagues asked whether such weight loss actually happens.

Obesity itself is a major risk factor leading to the need for a hip or knee replacement, and weight loss after TJA might reduce the risk for complications such as prosthetic loosening, thus reducing the likelihood of further surgery.

The authors found 12 studies that met inclusion criteria, including a single case-cohort study and 11 case series. Most were from single-surgeon or single-hospital series.

"Owing to the observational nature of the studies and the serious limitations identified, all were considered very low quality according to [Grading of Recommendations, Assessment, Development, and Evaluation] criteria," the authors write.

Some degree of weight loss at least 1 year after TJA was reported in 14% to 49% of patients, but in many cases this did not meet the US Food and Drug Administration definition for clinically meaningful weight loss (at least 5% of body weight). The ranges of weight loss suggested inconsistent loss, and the differences in the study designs meant that overall there was no conclusive pattern. Furthermore, more patients gained weight (21% - 75%) than lost weight (14% - 49%).

In a CORR Insights commentary on the manuscript, Stuart B. Goodman, MD, PhD, of Stanford University in California, said, "Obese patients frequently tell clinicians that they are overweight because their painful hips or knees limit their physical activities and their capability to 'burn calories.' Unfortunately, after a comprehensive analysis of the data, the answer to this important question is still unknown," according to a news release.

The authors have disclosed no relevant financial relationships.

Clin Orthoped Rel Res. Published online September 7, 2012.

    
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