關節置換術不會造成體重減輕


  【24drs.com】根據線上發表於9月7日臨床骨科及相關研究期刊的系統性回顧,有關全髖關節置換術(THA)和/或全膝關節置換術(TKA)對術後體重減輕的研究分析,尚不足以做出定論。
  
  聖地牙哥州立大學/加州大學的博士候選人Maria C.S. Inacio與研究夥伴結論指出,他們分析了一些品質坦白說並不是很好的研究,對於體重或身體組成在全關節置換術(TJA)之後增加、減少或不變,並無法提出具定論的證據。
  
  一般預期在THA或TKA之後體重會減輕,因為術後會減少疼痛與增加移動性,但是任職於Kaiser Permanente的Inacio等人,對體重是否真的如預期般減輕有所疑慮。
  
  肥胖本身是導致需要髖骨或膝蓋置換術的重要風險因素,TJA後體重減輕或許可以降低人工關節鬆動的併發症風險,而降低後續手術的可能。
  
  作者們發現,有12篇研究符合納入規範,包括1篇單一案例世代研究以及11篇案例系列報告,多數研究來自單一名外科醫師或單一所醫院。
  
  作者們寫道,因為這些研究的觀察性本質與嚴重的研究限制,依據推薦、評核、開發與評價等級規範分類皆為品質極低。
  
  在14%- 49%的病患曾有TJA後至少1年有某種程度之體重減輕的報告,但是在許多案例中,並未達美國食品藥物管理局定義的「具臨床意義之減重(至少減輕體重之5%)」。各研究有關體重減輕的範圍並不一致、加上研究設計的差異導致整體並無具結論性的模式。再者,體重增加(21% - 75%)的病患比減重(14% - 49%)者更多。
  
  在這份原稿的一篇CORR Insights評論中,史丹佛大學的Stuart B. Goodman博士表示,肥胖病患通常告訴醫師,自己是因為髖或膝關節疼痛限制了體能活動與消耗熱量的能力而導致過重;不幸的是,根據這篇新聞稿,統合分析資料之後,這個重要問題仍然無解。
  
  資料來源: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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