肌少症对老年骨质疏松性胸腰段脊柱压缩性骨折的影响

Effect of Sarcopenia on Compression Fracture of Thoracolumbar Spine in Elderly Patients With Osteoporosis

目的探讨肌少症对老年患者骨质疏松性胸腰段脊柱压缩性骨折的影响。方法回顾性分析昆山市锦溪人民医院2021年2月—2022年1月收治的老年患者骨质疏松性胸腰段脊柱压缩性骨折患者88例的临床资料。全部患者均采用电子握力器对优势手握力测量,由此提示肌少症可能,诊断标准:女性<18 kg,男性<28 kg,采用生物电阻测量法(bio-impedance analysis,BIA)测量人体四肢肌肉量,后根据身高平方的比例获取骨骼肌指数(skeletal muscle mass index,SMI),男性<7.0 kg/m^(2)、女性<5.7kg/m^(2),将握力及SMI值同时小于诊断界值时诊断为肌少症。将该组患者分为肌少症组(n=43)及非肌少症组(n=45),对比两组患者预后结局指标、视觉模拟评分法(visual analogue scale,VAS)评分及Oswestry功能障碍指数(Oswestrydisabilityindex,ODI),同时对比两组患者术后1年的再骨折发生率及死亡率。结果肌少症组与非肌少症组相比,住院天数较长,下床时间更长,术后1个月VAS评分较高,术后1个月内ODI较高,术后1年内死亡率较高,差异有统计学意义(P<0.05)。肌少症组与非肌少症组相比,手术时间、出血量、随访1年内的再骨折发生率比较,差异无统计学意义(P>0.05)。结论肌少症可增加老年患者骨质疏松性胸腰段脊柱压缩性骨折的住院时间,术后疼痛程度及功能障碍较为严重。

Objective To explore the effect of myopenia on the osteoporotic thoracolumbar spinal compression fracture in elderly patients.Methods Retrospective analysis was performed on the clinical data of 88 cases of elderly patients with osteoporotic thoracollumbar vertebral compression fracture admitted to Kunshan Jinxi People's Hospital from February 2021 to February 2022.All patients adopted electronic grip apparatus to measure the dominant hand grip strength,suggesting the possibility of sarcopenia.Diagnostic criteria:female<18 kg,male<28 kg,limb muscle mass was measured by bio-impedance analysis(BIA),and skeletal muscle index(SMI)was obtained according to the ratio of height square,male<7.0 kg/m^(2),female<5.7 kg/m^(2).Sarcopenia was diagnosed when both grip strength and SMI were below the diagnostic threshold.Patients in this group were divided into sarcopenia group(n=43)score and non-sarcopenia group(n=45).Prognostic outcome indexes,visual analog scale(VAS)score and Oswestry disability index(ODI)of the two groups were compared.The incidence of refracture and mortality 1 year after surgery were also compared between the two groups.Results Compared with the non-myopic group,the myopic group had longer hospitalization days,had longer time to the ground,higher VAS score in 1 month after operation,higher ODI in 1 month after operation,and higher mortality in 1 year after operation,the differences were statistically significant(P<0.05).There was no statistically significant difference in the operation time,intraoperative bleeding volume,and the incidence of refracture within 1 year of follow-up between the myopenia group and the non-myopenia group(P>0.05).Conclusion Musculosis can increase the hospitalization time of elderly patients with osteoporotic thoracolumbar spinal compression fracture.The degree of postoperative pain is more serious,and the dysfunction is more serious.