老年人营养状况对髋部骨折术后切口愈合的影响

Effects of nutritional status on wound healing after hip fracture in the elderly

目的探讨老年患者营养状况对髋部手术切口愈合的影响。方法2002年7月～2004年12月我院行手术治疗老年髋部骨折患者127例,男69例,女58例;年龄65～99岁,平均72.7岁;其中股骨颈骨折60例,股骨转子间骨折67例。分别于入院时测量血清白蛋白、血清转铁蛋白、总淋巴细胞计数,并计算出RaineyMcDonald营养学指数。术后切口均住院观察2周后拆线。结果31例切口愈合出现并发症。切口延迟愈合组血清转铁蛋白明显低于正常组,对预测切口延迟愈合差异有极显著性意义(P<0.01),RaineyMcDonald营养学指数对预测切口愈合有显著性意义(P<0.05)。通过预防性应用抗生素和严格无菌操作等,切口最后均甲级愈合。结论老年患者营养不良可对髋部骨折术后结果产生影响。血清转铁蛋白和RaineyMcDonald营养学指数对预测切口愈合有意义。鼓励老年髋部骨折患者术后早期活动有助于改善营养状态。

Objective To evaluate the effects of nutritional status on wound healing after hip fracture in the elderly. Methods From July 2002 to December 2004, 127 patients with hip fracture who were older than 65 years were treated surgically in our department. Their preoperative nutritional status was reviewed. There were 69 males and 58 females, with an average age of 72.7 years （from 65 to 99 years）. 60 cases had femoral neck fractures, and 67 cases had intertrochanteric fractures. The parameters indicative of nutritional status （serum albumin, serum transferrin and total lymphocyte count levels） at the time of admission were assessed, along with Rainey McDonald nutritional index and age. Suture removal was performed on postoperative day 14. Results Delayed wound healing complicated 31 of the 127 cases. The preoperative serum transferrin levels were significantly lower in patients who subsequently had delayed wound healing. Only preoperative serum transferrin levels（ P 〈 0. 01 ） and Rainey MacDonald nutritional index（ P 〈 0. 05） showed significant value in predicting which patients would have delayed wound healing. Through prophylactic antibiotics and adherence to strict aseptic precautions, on follow-up, wound healing was normal in all the patients. Conclusions The malnourishment can influence the surgical outcome of older patients with hip fracture. Preoperative serum transferrin levels and Rainey MacDonald nutritional index show predictive value in wound healing results. Early postoperative exercise has positive effects on improving the malnoufishment of elderly patients with hip fracture.