肌少症对股骨颈骨折行髋关节置换术后早期功能的影响分析

目的 :探讨肌少症与股骨颈骨折行髋关节置换术后早期功能的关系。方法 :对2014年5月至2017年1月行初次髋关节置换术的股骨颈骨折181例患者进行回顾性分析,其中男58例,女123例;年龄53~92岁。术前观察患者的一般情况,测量四肢骨骼肌质量指数(appendicular skeletal muscle index,ASMI)及握力。术后随访临床预后包括术后并发症,下地时间,Harris评分(术后2周及3、6个月),住院费用,住院时间等指标。根据握力和ASMI,将患者并分为肌少症组与非肌少症组;根据随访6个月时的Harris评分分为预后佳与预后不佳两组。采用单因素分析及多因素Logistic回归分析法探究肌少症是否是患者髋关节术后不佳的危险因素。结果:此研究共有181例完成随访,随访时间为第2周及3、6个月。结果显示,术后创口周围感染16例,下肢静脉血栓14例,无脱位、假体松动及假体周围感染。符合肌少症诊断患者82例(45%),与非肌少症组相比,肌少症组术后并发症发生率及住院费用更高,住院时间及下地时间更长,术后感染及血栓的发生率较高,早期关节功能评分相对较低具有统计学意义。随后进行多因素Logistic回归分析提示肌少症(P=0.008),半髋(P0.001),糖尿病(P=0.016),术后感染(P=0.018)是术后功能不佳的重要影响因素。结论:肌少症是股骨颈骨折术后早期预后不佳的重要危险因素,积极治疗肌少症可能是改善股骨颈骨折关节置换术后功能的重要措施。

Analysis of influence of sarcopenia on early postoperative function of femoral neck fracture by hip arthroplasty

Objective: To determine the association of sarcopenia with short-term postoperative function after hip replacement for femoral neck fractures.Methods: A prospective study of 181 consecutive patients with femoral neck fractures who underwent hip replacement from May 2014 to January 2017 were performed,including 58 males and 123 females aging from 53 to 92 years old. The general conditions were collected before surgery,skeletal muscle index(ASMI),handgrip strength were measured. Clinical outcomes were followed up including postoperative complications,time of on-site,Harris score (postoperative 2 weeks,3,6 months),hospitalization costs,and hospital stay. According to handgrip strength and ASMI,the patients were divided into the sarcopina group and the non-sarcopina group;according to the Harris score at the 6-month follow-up,the patients were divided into good prognosis group and poor prognosis group. Univariate analysis and binary logistic regression analysis were used to investigate whether sarcopenia was a risk factor for poor postoperative hip joint surgery.Results: All patients were followed up at 2 weeks,3 and 6 months,postoperative early complication included wound infection in 16 cases,thrombus of lower extremity veins in 14 cases,no dislocation,prosthetic loosening and prosthesis related infections occurred. Sarcopenia was present in 82 of 181 patients(45%),Compared with non-sarcopenic patients,sarcopenic patients had a higher risk of postoperative complications,longer postoperative hospital stay,more hospital costs and lower harris scores. In Binary logistic analysis revealed that sarcopenia(P=0.08),hemiarthroplasty(P<0.001),diabetes(P=0.016) and infection(P=0.018) were important predictors of unsatisfactory postoperative function.Conclusions: Sarcopenia is an important predictor of poor postoperative prognosis in patients with femoral neck fractures after hip replacement. The treatment for sarcopenia maybe an important way to protect patients with femoral neck fractures from poor prognosis after hip replacement.