肥胖对老年股骨转子间骨折术后早期疗效的影响

Effect of Obesity on Early Curative Effect of Elderly Femoral Intertrochanteric Fractures

目的探讨肥胖对老年股骨转子间骨折术后近期疗效的影响。方法回顾性分析2017年4月至2018年4月于我院行PFNA手术治疗的老年股骨转子间骨折患者67例,将全部患者根据体质指数(BMI)分为A组为BMI正常组(n=22,18.50.05);术前及术后各组IL-6、术前及术后第一天、术后第三天VAS评分水平比较C>B>A(P<0.05),CRP在术前及术后三组间差异无统计学意义(P<0.05);并发症方面肥胖组有1例发生切口并发症;肥胖组有2例、超重组有2例发生下肢静脉血栓经积极处理均末造成不良后果,肥胖及超重组各有1例出现术后恶心呕吐(PONV)。结论肥胖及超重转子间骨折患者术后疼痛症状较重,手术难度较大,围术期失血量较多术后并发症的发生率较高可能与肥胖患者炎性因子表达增高、机体处于慢性炎症状态有关。

Objective To investigate the effect of obesity on the short-term efficacy of elderly patients with femoral intertrochanteric fractures.Methods From April 2017 to April 2018,a retrospective analysis was used to evaluate 67 elderly patients with femoral intertrochanteric fractures who underwent PFNA surgery in our hospital.According to body mass index(BMI),all patients were divided into 3 groups:A group as normal BMI group(n=22,18.5<BMI<23.9kg/m 2),B group as hyper-recombinant group(n=24,24.0≤BMI<27.9kg/m 2)and C group as obese group(n=21,BMI≥28.0kg/m 2).There were some observation indexes as follows:①blood index,total blood loss,apparent blood loss,hidden blood loss,blood transfusion rate,operation time;②pain-related indicators:visual analog pain score,the expression levels of inflammatory factors(C-reactive protein,interleukin 6)on preoperative,the 1st and 3rd days after operation;③Postoperative complications:respiratory system,digestive system,nervous system,nervous system,DVT and incision complications.Results The total blood loss,dominant blood loss,blood transfusion rate and operation time of the three groups were significantly higher in the obese group than in the super-reconstituted and normal groups.However,there was no significant difference in the hidden blood loss among three groups(P>0.05).Comparison of IL-6,VAS scores before and after surgery on the 1st day and the 3rd day after surgery was C>B>A(P<0.05).There was no significant difference between three groups after surgery(P<0.05).Incision complication was occurred in 1 case of obese group.The lower extremity venous thrombosis was occurred in 2 cases of obese group and 2 cases of hyperrecombination.After active treatment,there were no adverse consequences.There was 1 case of postoperative nausea and vomiting(PONV)in obesity and 1 case of hyperrecombination.Conclusion Patients with obesity and overweight intertrochanteric fractures have more severe postoperative pain symptoms,more difficult surgery,more perioperative blood loss and a higher incidence of postoperative complications,which may be related to the increased expression of inflammatory factors in the obese patients and related to chronic inflammatory states.