老年全膝关节置换术患者术后膝关节功能康复的潜在剖面特征及相关风险因素分析-现代医学

老年全膝关节置换术患者术后膝关节功能康复的潜在剖面特征及相关风险因素分析

单位：首都医科大学附属北京积水潭医院保膝外科, 北京 102208

分类号：R684

出版年·卷·期（页码）：2026·54·第七期（1147-1154）

摘要：

目的：探讨老年全膝关节置换术(TKA)患者术后膝关节功能康复的潜在剖面特征，并分析影响康复效果的相关风险因素，为制定个体化康复干预方案提供依据。方法：选取200例接受单侧TKA治疗的老年患者作为研究对象，采用美国膝关节协会评分(KSS)在术后1周、1个月、3个月及6个月对患者膝关节功能进行连续评估，运用潜在类别增长分析(LCGA)识别康复潜在剖面类型，通过单因素分析和多因素Logistic回归分析筛选影响康复效果的独立风险因素。结果：LCGA识别出老年TKA患者术后膝关节功能康复具有持续优良型(36.00%)、稳步进步型(44.50%)和迟缓困难型(19.50%)的3种潜在剖面类型。多因素Logistic回归分析结果显示，年龄、体质量指数(BMI)、小学及以下受教育程度、术前疼痛视觉模拟(VAS)评分、术前美国膝关节协会评分(KSS)、膝关节活动度(ROM)、Charlson合并症指数(CCI)、手术时长、术中出血量、术前GAD-7≥10分、术后康复训练依从性中等和术后康复训练依从性差是老年TKA患者术后膝关节功能康复迟缓困难的独立影响因素(P<0.05)。结论：老年TKA患者术后膝关节功能康复存在显著异质性，可分为持续优良、稳步进步和迟缓困难3种类型，多种生理、临床、心理及行为因素共同影响康复结局，其中术后康复训练依从性差是最主要的可干预风险因素，临床可基于这些风险因素实施早期风险分层与个体化康复干预，以改善患者康复效果。

Objective: To explore the latent profile characteristics of postoperative knee function rehabilitation in elderly patients undergoing total knee arthroplasty(TKA), and to identify associated risk factors, thereby providing evidence for the development of individualized rehabilitation intervention strategies. Methods: A total of 200 elderly patients who underwent unilateral TKA were enrolled in this study. Knee function was serially assessed using the Knee Society Score(KSS) at 1 week, 1 month, 3 months, and 6 months postoperatively. Latent class growth analysis(LCGA) was employed to identify distinct latent profiles of rehabilitation trajectories. Univariate analysis and multivariate Logistic regression analysis were performed to screen for independent risk factors affecting rehabilitation outcomes. Results: LCGA identified three distinct latent profiles of postoperative knee function recovery among elderly TKA patients: a sustained excellent group(36.00%), a steady progressive group(44.50%) and a delayed difficult group(19.50%). Multivariate Logistic regression analysis revealed that age, body mass index(BMI), primary school education or below, preoperative Visual Analogue Scale(VAS) score, preoperative Knee Society Score(KSS), range of motion(ROM), Charlson Comorbidity Index(CCI), operative time, intraoperative blood loss, preoperative GAD-7 score ≥10 and moderate and poor postoperative rehabilitation compliance were independent influencing factors for delayed difficult recovery(all P＜0.05). Conclusions: Postoperative knee function rehabilitation in elderly TKA patients exhibits significant heterogeneity, which can be categorized into three profiles: sustained excellent, steady progressive and delayed difficult. A combination of physiological, clinical, psychological and behavioral factors jointly influences rehabilitation outcomes. Notably, poor postoperative rehabilitation compliance emerges as the most critical modifiable risk factor. Clinically, early risk stratification and individualized rehabilitation interventions based on these identified factors may contribute to improving patient rehabilitation effect.

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