应用改良衰弱指数与预后营养指数对老年髋关节置换术后并发症的预测价值分析

The predictive value of modified frailty index and prognostic nutritional index for complications after hip replacement in the elderly

目的分析应用改良衰弱指数(mFI)与预后营养指数(PNI)在老年髋关节置换术后并发症中的预测价值。方法选取2022年7月~2023年12月在联勤保障部队第九〇八医院治疗的163例老年髋关节置换术患者的病历资料进行回顾性分析,统计其术后并发症发生情况,包括假体松动、假体周围骨折、下肢深静脉血栓等,按其是否发生并发症将所有患者划分成发生并发症组(n=21)与未发生并发症组(n=142),统计对比两组mFI与PNI差异;通过logistic回归分析mFI、PNI与老年髋关节置换术后并发症的关系,另绘制受试者工作特征曲线,分析mFI、PNI单独或联合预测老年髋关节置换术后并发症的效能。结果发生并发症组患者的mFI为(3.41±0.26)分,高于未发生并发症组的(1.75±0.31)分;PNI为(41.38±4.26),低于未发生并发症组的(50.71±5.31),差异均有统计学意义(t=22.338、7.687,P<0.05)。经logistic回归分析结果显示,mFI、PNI与老年髋关节置换术后并发症的发生有关(P<0.05);ROC结果显示:mFI、PNI两者联合预测老年髋关节置换术后并发症的曲线下面积(AUC)为0.949(95%CI=0.908~0.989),高于两组单独预测的0.898(95%CI=0.842~0.954)、0.929(95%CI=0.889~0.970)。结论老年髋关节置换术后发生并发症患者的mFI处于高水平,PNI处于低水平,应用mFI、PNI可有效预测患者术后是否发生并发症,临床应用价值较高,可进行大力的推行。

Objective To analyze the predictive value of modified frailty index(mFI)and prognostic nutritional index(PNI)in complications after hip replacement in the elderly.Methods The medical records of 163 elderly patients who underwent hip arthroplasty at the 908th Hospital of PLA Joint Logistic Support Force from July 2022 to December 2023 were retrospectively analyzed,and the occurrence of postoperative complications,including prosthesis loosening,periprosthetic fractures,and lower extremity deep venous thrombosis,was recorded.Patients were divided into complication group(n=21)and no complication group(n=142)based on the occurrence of complications,and the differences in mFI and PNI between the two groups were statistically compared.Logistic regression was used to analyze the relationship between mFI,PNI,and postoperative complications of elderly hip arthroplasty,and the receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of mFI and PNI alone or in combination to predict postoperative complications of elderly hip arthroplasty.Results The mFI of the complication group was(3.41±0.26),which was higher than that of the non-complication group(1.75±0.31),and the PNI was(41.38±4.26),which was lower than that of the non-complication group(50.71±5.31),with statistically significant differences(t=22.338,7.687,P<0.05).Logistic regression analysis showed that mFI and PNI were related to the occurrence of complications after hip arthroplasty in the elderly(P<0.05).The ROC results showed that the area under the curve(AUC)of mFI and PNI combined to predict complications after hip arthroplasty in the elderly was 0.949(95%CI=0.908~0.989),which was higher than 0.898(95%CI=0.842~0.954)and 0.929(95%CI=0.889~0.970)predicted by the two groups alone.Conclusion The mFI and PNI of elderly patients with complications after hip replacement are at high and low levels,respectively.The application of mFI and PNI can effectively predict whether there are complications after hip replacement.The clinical application value is high,and it can be vigorously promoted.