肌少症对老年股骨颈骨折患者手术疗效的影响

Effect of sarcopenia on the efficiency of the treatment of femoral neck fracture in elderly patients

目的探讨肌少症对老年股骨颈骨折患者手术疗效的影响。方法2014年2月至2016年2月,65例符合纳入标准的老年股骨颈骨折患者纳入本研究。利用胸部CT测量胸12椎体(T12)椎弓根水平肌肉组织的横截面积(cm2)。以T12椎弓根水平肌肉横截面积除以患者身高平方计算得到骨骼肌指数(SMI)。采用T12水平SMI截断值:42.6cm2/m2(男性)和30.6cm2/m2(女性)用于诊断肌少症。采用线性回归法分析SMI与住院时间、在院期间输血量及术后1个月Harris髋关节功能评分之间的关系;t检验分析肌少症和非肌少症患者住院时间、输血量、并发症的发生率、围术期死亡率及术后1年死亡率之间的差异性。结果65例患者中共有28例诊断为肌少症,37例为非肌少症。肌少症组平均SMI为(30.3±5.2)cm2/m2,非肌少症组为(43.0±6.5)cm2/m2(t=-8.448,P<0.001)。平均住院时间分别为(14.7±5.8)d和(13.2±4.5)d(t=1.225,P=0.225);在院期间输血量分别为(1.7±1.4)单位和(0.92±1.0)单位(t=2.621,P=0.011);Harris评分分别为(81.1±4.4)分和(88.7±2.3)分(t=-8.219,P<0.001);并发症发生率分别为57.1%和16.2%(χ^2=11.923,P=0.001);围术期死亡率分别为7.1%和2.7%(P=0.573);1年病死率为35.7%和10.8%(χ^2=4.468,P=0.035)。结论肌少症延缓老年股骨颈骨折患者术后康复进程,肌少症患者具有较高的并发症发生率及远期死亡率。

Objective To investigate the effect of sarcopenia on the efficiency of the treatment of femoral neck fracture in elderly patients. Methods A total of 65 elderly patients aged ≥65 years with femoral neck fractures meeting the inclusion and exclusion criteria were investigated in our hospital from February 2014 to February 2016.The muscle cross-sectional area(cm2)at the thoracic 12 pedicle level was measured by chest CT.The skeletal muscle index(SMI)is calculated by the formula that the muscle cross-sectional area(cm2)at T12 pedicle level was divided by m2 of the patient's body height(meter). SMI cutoff values of 42.6 cm2/m2(males)and 30.6 cm2/m2(females)were used to diagnose sarcopenia.Linear regression analysis was used to analyze the relationship of SMI with the length of hospital stay, blood transfusion during hospitalization and Harris score one month after surgery.The difference between the patients with and without sarcopenia in the length of hospital stay, the volume of blood transfusion, incidence rate of complications, Harris score, the mortality rate of perioperative period and one-year mortality rate were analyzed by ttest. Results Among 65 elderly patients, 28 cases were diagnosed as sarcopenia.Their mean SMI was(30.3±5.2)cm2/m2 in the sarcopenia group and (43.0±6.5)cm2/m2 in the non-sarcopenia group, the difference was statistically significant (t=-8.448, P<0.001). There were significant differences between the sarcopenia group and the non-sarcopenia group in the mean hospital stay[(14.7±5.8)d vs.(13.2±4.5)d, t=1.225, P=0.225], the transfusion volume during hospitalization[(1.7±1.4)units vs.(0.92±1.0)units, t=2.621, P=0.011], Harris scores[(81.1±4.4) vs.(88.7±2.3), t=-8.219, P<0.001)], the incidence of complications(57.1% vs.16.2%, χ^2=11.923, P=0.001), the mortality of perioperative period(7.1% vs.2.7%, P=0.573)and the one-year mortality(35.7% vs.10.8%, χ^2=4.468, P=0.035). Conclusions Sarcopenia can delay postoperative rehabilitation in elderly patients with femoral neck fracture and increase the incidence of complications and late mortality rate.