不同程度肝功能损伤对中老年股骨颈骨折患者术后效果及代谢指标水平的影响

Influence of different degrees of liver function injury on postoperative effect and metabolic marker levels in middle-aged and elderly patients with femoral neck fracture

目的分析不同程度肝功能损伤对中老年股骨颈骨折患者术后效果及代谢指标水平的影响。方法74例中老年股骨颈骨折患者,根据肝功能情况不同分为肝功能正常组(31例)、肝功能轻度损伤组(26例)、肝功能中度损伤组(17例)。比较三组患者的手术期间情况(手术时间、手术出血量、并发症发生情况),临床治疗效果情况(下地行走时间、首次负重时间、骨折愈合时间、Harris评分、生活质量评分),代谢指标[甲状旁腺激素(PTH)、血清骨钙素(OC)、碱性磷酸酶(ALP)、白蛋白(ALB)]水平。结果肝功能正常组手术时间为(83.42±15.63)min、手术出血量为(82.56±25.01)ml、并发症发生率为12.90%;肝功能轻度损伤组分别为(91.28±13.69)min、(93.64±21.33)ml、23.08%;肝功能中度损伤组分别为(87.02±11.94)min、(122.80±31.58)ml、29.41%。三组患者的手术出血量比较,差异具有统计学意义(P<0.01)。肝功能中度损伤组的手术出血量大于肝功能正常组及肝功能轻度损伤组,差异均具有统计学意义(P<0.01)。肝功能正常组的下地行走时间为(47.57±5.23)d、首次负重时间为(67.95±10.77)d、骨折愈合时间为(71.73±9.81)d、Harris评分为(88.62±4.68)分、生活质量评分为(78.65±3.12)分;肝功能轻度损伤组分别为(50.12±7.06)d、(75.54±12.81)d、(77.68±8.94)d、(84.57±5.66)分、(71.34±2.89)分;肝功能中度损伤组分别为(55.78±9.65)d、(86.37±14.10)d、(94.47±17.02)d、(67.61±3.54)分、(62.23±3.64)分。三组患者的下地行走时间、首次负重时间、骨折愈合时间、Harris评分、生活质量评分比较,差异均具有统计学意义(P<0.01)。肝功能中度损伤组的下地行走时间、首次负重时间、骨折愈合时间长于肝功能正常组及肝功能轻度损伤组,Harris评分、生活质量评分低于肝功能正常组及肝功能轻度损伤组,差异均具有统计学意义(P<0.01)。肝功能正常组的首次负重时间、骨折愈合时间短于肝功能轻度损伤组,Harris评分、生活质量评分高于肝功能轻度损伤组,差异具有统计学意义(P<0.05)。肝功能正常组的PTH为(34.91±8.86)ng/L、OC为(27.06±6.68)ng/ml、ALP为(84.87±28.35)U/L、ALB为(47.38±3.11)g/L;肝功能轻度损伤组分别为(39.57±9.71)ng/L、(23.85±5.42)ng/ml、(103.84±42.86)U/L、(43.86±4.07)g/L;肝功能中度损伤组分别为(49.83±11.04)ng/L、(16.18±5.93)ng/ml、(177.52±37.19)U/L、(31.24±4.88)g/L。三组患者的PTH、OC、ALP、ALB比较,差异均具有统计学意义(P<0.01)。肝功能中度损伤组的PTH、ALP高于肝功能正常组及肝功能轻度损伤组,OC、ALB低于肝功能正常组及肝功能轻度损伤组,差异均具有统计学意义(P<0.01)。肝功能正常组的ALB高于肝功能轻度损伤组,差异具有统计学意义(P<0.01)。结论不同程度肝功能损伤的中老年股骨颈骨折患者愈后有一定差异,肝功能中度损伤情况下,对于患者下地行走时间、骨折愈合时间等骨折愈合方面存在显著影响,其代谢指标也有相应改变,对骨折愈合效果具有一定的提示作用。

Objective To analyze the influence of different degrees of liver function injury on postoperative effect and metabolic marker levels in middle-aged and elderly patients with femoral neck fracture.Methods 74 middle-aged and elderly patients with femoral neck fracture were divided into normal liver function group(31 cases),mild liver function injury group(26 cases)and moderate liver function injury group(17 cases)according to different liver function conditions.Comparison was made on surgical conditions(operative time,amount of surgical blood loss,occurrence of complications),clinical therapeutic effects(walking time,first weight-bearing time,fracture healing time,Harris score,quality of life score),metabolic markers[parathyroid hormone(PTH),serum osteocalcin(OC),alkaline phosphatase(ALP),albumin(ALB)]levels.Results In the normal liver function group,the operative time was(83.42±15.63)min,the amount of surgical blood loss was(82.56±25.01)ml,and the incidence of complications was 12.90%;in the mild liver function injury group,the results were(91.28±13.69)min,(93.64±21.33)ml and 23.08%;in the moderate liver function injury group,the results were(87.02±11.94)min,(122.80±31.58)ml and 29.41%.There was statistically significant difference in the amount of surgical blood loss among the three groups(P<0.01).The amount of surgical blood loss in the moderate liver function injury group was higher than that in the normal liver function group and the mild liver function injury group,and the difference was statistically significant(P<0.01).In the normal liver function group,the walking time was(47.57±5.23)d,the first weight-bearing time was(67.95±10.77)d,the fracture healing time was(71.73±9.81)d,the Harris score was(88.62±4.68)points,and the quality of life score was(78.65±3.12)points;in the mild liver function injury group,the results were(50.12±7.06)d,(75.54±12.81)d,(77.68±8.94)d,(84.57±5.66)points,and(71.34±2.89)points;in the moderate liver function injury,the results were(55.78±9.65)d,(86.37±14.10)d,(94.47±17.02)d,(67.61±3.54)points,and(62.23±3.64)points.There were statistically significant differences in terms of walking time,first weight-bearing time,fracture healing time,Harris score and quality of life score among the three groups(P<0.01).The walking time,first weight-bearing time and fracture healing time of moderate liver function injury group were longer than those of normal liver function injury group and mild liver function injury group;the Harris score and quality of life score of moderate liver function injury group were lower than those of normal liver function injury group and mild liver function injury group;the differences were statistically significant(P<0.01).The first weight-bearing time and fracture healing time of normal liver function injury group were shorter than those of mild liver function injury group;the Harris score and quality of life score of normal liver function injury group were higher than those of mild liver function injury group;the differences were statistically significant(P<0.05).In the normal liver function injury group,PTH was(34.91±8.86)ng/L,OC was(27.06±6.68)ng/ml,ALP was(84.87±28.35)U/L,and ALB was(47.38±3.11)g/L;in the mild liver function injury group,the results were(39.57±9.71)ng/L,(23.85±5.42)ng/ml,(103.84±42.86)U/L,and(43.86±4.07)g/L;in the moderate liver function injury group,the results were(49.83±11.04)ng/L,(16.18±5.93)ng/ml,(177.52±37.19)U/L,and(31.24±4.88)g/L.There were statistically significant differences in PTH,OC,ALP and ALB among the three groups(P<0.01).PTH and ALP of the moderate liver function injury group were higher than those of the normal liver function injury group and the mild liver function injury group;OC and ALB in moderate live function injury group were lower than those in normal live function injury group and mild live function injury group;the differences were statistically significant(P<0.01).ALB of normal liver function injury group was higher than that of mild liver function injury group,and the difference was statistically significant(P<0.01).Conclusion There is a certain difference in the recovery of middle-aged and elderly patients with femoral neck fracture with different degrees of liver function injury.In the case of moderate liver function injury,there is a significant impact on walking time and fracture healing time of patients,and its metabolic indexes are also changed correspondingly,which has a certain suggestive effect on the fracture healing effect.