肌少症用于评估老年股骨粗隆间骨折手术风险及预后

Employment of sarcopenia in the assessment of the surgical risks and prognosis of intertrochanteric fracture in the elderly patients

目的探讨肌少症用于评估老年股骨粗隆间骨折手术风险及预后的价值。方法 2013年1月至2016年4月,将南京医科大学附属江宁医院骨科收治的96例老年股骨粗隆间骨折的患者纳入本研究。利用胸部CT测量T12椎弓根水平肌肉组织的横截面积(cm^2)。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. 6 cm^2/m^2(男性)和30. 6 cm^2/m^2(女性)用于诊断肌少症。采用线性回归法分析SMI和住院时间及在院期间输血量之间的关系;t检验分析肌少症和非肌少症患者住院时间、输血量、围手术期死亡率及术后1年死亡率之间的差异。结果 96例患者中共有45例诊断为肌少症。SMI对在院期间输血量的影响具有统计学意义(P <0. 05),而对住院时间的影响无统计学意义(P> 0. 05)。肌少症患者与非肌少症患者的住院时间及围手术期死亡率之间的差异无统计学意义(P> 0. 05),而住院期间输血量及术后1年死亡率之间的差异有统计学意义(P <0. 05)。股骨粗隆间骨折合并肌少症的老年患者在住院期间需要更多的输血量,手术后1年内死亡率也较高,但住院时间和围手术期死亡率没有明显增加。结论基于SMI诊断肌少症用于评估老年股骨粗隆间骨折的风险及预后具有一定的指导意义。

Objective To investigate the employment of sarcopenia in the assessment of the surgical risk and prognosis of intertrochanteric fracture in the elderly patients. Methods A total of 96 elderly patients were included in this study, who met the inclusion criteria and attended for intertrochanteric fractures from January 2013 to April 2016. The cross-sectional skeletal muscle area （cm 2） was measured at the pedicle of the 12 thoracic vertebra on the chest CT scan. The skeletal muscle index （SMI） was calculated by muscle cross-sectional area/square of height （cm 2/m 2）. Sarcopenia was defined by SMI cut-off values at T12 level 42.6 cm 2/m 2 for men and 30.6 cm 2/m 2 for women. Linear regression analysis was used to explore the relationship between SMI and the length of hospital stay and volume of blood transfusion, and t -test to analyze the difference in the length of hospital stay, volume of blood transfusion, peri- operative mortality and postoperative mortality at 1 year. Results Of 96 patients, 45 were diagnosed as sarcopenia, and SMI had statistically significant effect on the blood transfusion volume （ P 〈0.05）, but not on the length of hospital stay （ P 〈0.05）. There was no statistically significant difference between patients with and without sarcopenia in the length of hospital stay and perioperative mortality （ P 〉0.05）, but there was statistically significant difference in the volume of blood transfusion and postoperative mortality at 1 year （ P 〈0.05 ）. The intertrochanteric fracture patients with sarcopenia needed more blood transfusion with a higher postoperative mortality at 1 year; however, there was no significant increase in the length of hospital stay and perioperative mortality. Conclusion The diagnosis of sarcopenia based on SMI may be of some significance in assessing the surgical risks and prognosis of intertrochanteric fracture in the elderly patients.