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要旨
目的:膝OA患者の身体機能に関連する因子を検討し,術前の機能低下の実態を明らかにすることである.
方法:TKA前の重度膝OA患者467名を対象とし,背景因子(性別・年齢・BMI・K-L分類・疼痛)と身体機能(筋力・ROM)の調査・測定を行った.背景因子を独立変数,身体機能を従属変数とした重回帰分析を行い,有意に関連する因子を基に階級分けをしたうえで術前機能の中央値を算出した.
結果:膝関節筋力の関連因子は性別・BMI・K-L分類・疼痛であった.膝屈曲ROMの関連因子は性別とBMIであり,膝伸展ROMの関連因子はK-L分類であった.膝伸展筋力の中央値は男性0.98/0.92 Nm/kg(Grade 3/Grade 4),女性0.70/0.59 Nm/kgであり,膝屈曲筋力の中央値は男性0.53/0.45 Nm/kg,女性0.36/0.30 Nm/kgであった.膝屈曲ROMの中央値は男性130°,女性120°であり,膝伸展ROMの中央値は−5/−10°(Grade 3/Grade 4)であった.
結論:TKA前の筋力低下とROM制限の程度を明らかにした.本研究で得られた知見は,膝OA患者の機能低下を解釈する際の一助になると考える.
Abstract
Objective:To elucidate factors associated with physical function and clarify the actual condition of functional deterioration in patients with knee osteoarthritis (OA) prior to total knee arthroplasty (TKA).
Methods:We enrolled 467 patients with severe knee OA and preoperatively assessed the following parameters:background factors (sex, age, BMI, K-L grade, and pain) and physical function (muscle strength of knee extensors and flexors, and knee joint angles). A multiple regression analysis was performed to determine the relationship between the independent background factors and dependent physical functions. The median of preoperative function based on selected factors of physical function was calculated.
Results:Based on the multiple regression analysis, sex, BMI, K-L grade, and pain statistically significantly correlated with muscle strength of knee extensors and flexors. Sex and BMI statistically significantly correlated with knee joint flexion angle. K-L grade statistically significantly correlated with knee joint extension angle. The median of muscle strength for knee extension was 0.98/0.92 Nm/kg (Grade 3/Grade 4) for males and 0.70/0.59 Nm/kg for females. The median of muscle strength for knee flexion was 0.53/0.45 Nm/kg for males, 0.36/0.30 Nm/kg for females. The median for knee joint flexion angle was 130° for males and 120° for females. The median for knee joint extension angle was -5°/-10° (Grade 3/Grade 4).
Conclusion:We clarified the degree of muscle strength and range of motion before TKA in patients with knee OA. We believe that the findings obtained in this study will contribute to explaining the functional deterioration of patients with knee OA.
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