Abstract: Background　Total knee arthroplasty（TKA） is an optimal method for advanced severe knee osteoarthritis（KOA）.However，high prevalence of complications such as postoperative pain and joint stiffness，and postoperative knee dysfunction and other problems，seriously affecting the surgical effect and postoperative recovery process.Rapid development of geriatric surgery has revealed that preoperative physiological reserve state（for example，frailty） may be more closely associated with postoperative outcome of elderly patients than the surgery.Objective　To explore the effect of preoperative frailty on knee function rehabilitation in elderly patients after unilateral total knee arthroplasty.Methods　By use of purposive sampling，totally 230 elderly osteoarthritis inpatients with initial unilateral TKA were selected from the Affiliated Hospital of Guizhou Medical University，Guizhou Orthopedics Hospital and the Fourth People's Hospital of Guiyang during November 2018 to April 2019.They were divided into frail group（n=156） and non-frail group（n=74） according to FRAIL Scale score（scoring>2 points indicates frailty）before surgery.The time of the first postoperative ambulation，incidence of early postoperative complications and postoperative use time of walking AIDS were recorded to compared between two groups.On the 3rd，and 7th days，at the 2nd week，1 and 3 months after surgery，postoperative FPS-R score and knee flexion of two groups were evaluated.And postoperative AKS function score was evaluated at the 2nd week after surgery.Results　Compared with non-frail group，frail group ambulated postoperatively much later，used walking AIDS longer postoperatively，and had higher incidence of early postoperative complications（P<0.05）.There was an interaction between treatment time and frailty status on the FPS-R score（P<0.001）.Both treatment time and frailty status exerted significant main effects on the FPS-R score（P<0.001）.The FPS-R score of the frail group was higher than that of non-frail group at each time point after operation（P<0.001）.There was an interaction between treatment time and frailty status on the knee flexion（P<0.001）.Both treatment time and frailty status exerted significant main effects on the knee flexion（P<0.001）.The knee flexion of the frail group was less than that of non-frail group at each time point after operation（P<0.001）.There was an interaction between time and group on the knee function AKS score（P<0.001）.Both treatment time and frailty status exerted significant main effects on the AKS function score（P<0.05）.The AKS function score of the frail group was lower than that of non-frail group at each time point after operation（P<0.001）.There was a positive correlation between preoperative FRAIL score and postoperative FPS-R score（P<0.001）.And there was a negative correlation between preoperative FRAIL score and postoperative knee flexion or AKS function score（P<0.001）.Conclusion　Preoperative frailty may have negative influence on the recovery process of the joint function after TKA，which could enhance postoperative knee pain and delay the recovery of knee flexion function.At the same time，it may increase the risk of early postoperative complications，delay the time of first postoperative ambulation and prolongate the time of postoperative use of walking AIDS.

Key words: Arthroplasty, replacement, knee；Aged；Frailty；Knee function

摘要： 背景　全膝关节置换术是目前治疗晚期严重膝关节骨性关节炎的最佳方法，但术后疼痛、关节僵硬等并发症以及术后膝关节功能障碍等问题的普遍存在，严重影响了手术疗效和术后康复进程，而随着老年外科手术的快速发展，许多学者逐渐认识到老年患者自身的生理储备状态（如衰弱）比手术更能影响术后疾病的转归。目的　探讨术前衰弱对单侧全膝关节置换术后老年患者膝关节功能康复的影响。方法　采用目的抽样法，选取2018年11月—2019年4月于贵州医科大学附属医院、贵州省骨科医院和贵阳市第四人民医院骨科病房初次接受单侧全膝关节置换术的230例骨性关节炎老年患者为调查对象，采用衰弱筛查量表（FRAIL）评估患者术前衰弱情况（FRAIL评分>2分即为衰弱），根据得分将患者分为衰弱组（156例）和非衰弱组（74例），记录并比较两组患者术后首次下床活动时间、术后早期并发症发生率、术后使用步行辅助工具时长；分别于术后第3天、第7天、第2周、1个月及3个月时评估两组患者术后修订版面部表情疼痛量表（FPS-R）评分和术后膝关节屈曲度，且于术后第2周、1个月、3个月采用美国膝关节协会评分表（AKS）评分评估患者膝关节功能。结果　衰弱组患者术后首次下床活动时间及术后使用步行辅助工具时长均较非衰弱组患者长，且术后早期并发症发生率也高于非衰弱组患者（P<0.05）。时间与组别在FPS-R评分上存在交互作用（P<0.001），时间、组别在FPS-R评分上主效应显著（P<0.001）；且衰弱组患者术后各个时间点FPS-R评分均高于非衰弱组（P<0.001）。时间与组别在膝关节屈曲度上存在交互作用（P<0.001），时间、组别在膝关节屈曲度上主效应显著（P<0.001）；且衰弱组患者术后各个时间点的膝关节屈曲度均低于非衰弱组（P<0.001）。时间与组别在膝关节功能AKS评分上存在交互作用（P<0.05），时间、组别在膝关节功能AKS评分上主效应显著（P<0.001）；且衰弱组患者术后各个时间点的膝关节功能AKS评分均低于非衰弱组（P<0.001）。术前衰弱得分与术后FPS-R评分呈正相关（P<0.001）、与术后膝关节屈曲度及AKS评分呈负相关（P<0.001）。结论　术前衰弱状态对患者术后膝关节功能康复存在负性影响，可致患者术后关节疼痛感增强以及关节屈曲功能恢复延迟，增加患者术后早期并发症的发生风险、延长患者术后首次下床活动时间及术后使用步行辅助工具时长。

关键词: 关节成形术, 置换, 膝；老年人；衰弱；关节功能