术前衰弱对老年患者全髋关节置换术后转归的影响

Effect of frailty on outcome after total hip replacement in elderly patients

目的探讨术前衰弱对老年患者全髋关节置换术后转归的影响。方法以2020年1月至2023年9月江苏省于徐州医科大学附属医院收治的116例行全髋关节置换术的老年患者为研究对象,并根据衰弱筛查量表(FRAIL)分为衰弱组(37例)和非衰弱组(79例),比较两组患者不同时间点膝关节功能恢复情况、疼痛情况、膝关节屈曲度、血清白介素1β(IL⁃1β),白介素21(IL⁃21)水平。分析FRAIL水平与膝关节功能恢复情况、AKS、膝关节屈曲度、疼痛情况、IL⁃1β、IL⁃21水平相关性。结果术后第14 d、1个月、3个月,两组美国膝关节协会评分表(AKS)评分及膝关节屈曲度均有所增加(P<0.05),且各时间点衰弱组AKS评分及膝关节屈曲度均低于非衰弱组,差异有统计学意义(P<0.05);术后第3 d、7 d、14 d、1个月、3个月,两组修订版面部表情疼痛量表(FPS⁃R)评分有所下降(P<0.05),且各时间点衰弱组FPS⁃R评分低于非衰弱组,差异有统计学意义(P<0.05);术前两组IL⁃1β及IL⁃21水平比较差异无统计学意义(P<0.05);术后3 d、7 d,两组IL⁃1β、IL⁃21水平有所上升,而术后第14 d、1个月、3个月,两组IL⁃1β、IL⁃21水平有所下降,差异有统计学意义(P<0.05),且术后3 d、7 d、14 d、1个月衰弱组水平与非衰弱组水平差异有统计学意义(P<0.05);各时间点,FRAIL评分与AKS评分、膝关节屈曲度呈负相关(P<0.05),而与FRS⁃R、IL⁃1β、Il⁃21水平呈正相关(P<0.05)。结论衰弱与老年患者全髋关节置换术后疼痛感及炎性反应存在相关性,提示全髋关节置换术患者需及时行术前衰弱评估。

Objective To investigate the effect of preoperative frailty on the outcome of total hip arthroplasty in elderly patients.Methods A total of 116 elderly patients undergoing total hip replacement at the Affiliated Hospital of Xuzhou Medical University from January 2020 to September 2023 were divided into the FRAIL group(37 cases)and the non⁃frail group(79 cases)based on the Frail screening Scale(FRAIL).Knee functional recovery,pain levels,knee flexion and serum interleukin⁃1β(IL⁃1β)and interleukin⁃21(IL⁃21)levels were compared between the two groups at different time points.The correlations between the FRAIL level and knee functional recovery,AKS,knee flexion,pain,IL⁃1βand IL⁃21 levels were analyzed.Results The American Knee Association Rating Scale(AKS)scores and knee flexion increased in both groups at 14 days,1 month and 3 months after surgery(P<0.05).The AKS score and knee flexion in the asthenic group were lower than those in the non⁃asthenic group at all time points,with statistical significance(P<0.05).The scores of the revised Facial Expression Pain Scale(FPS⁃R)decreased in both groups at 3 days,7 days,14 days,1 month,and 3 months after surgery(P<0.05).The FPS⁃R scores in the asthenic group were lower than those in the non⁃asthenic group at each time point.The difference was statistically significant(P<0.05).There was no significant difference in IL⁃1βand IL⁃21 levels between the two groups before surgery(P<0.05).However,the levels of IL⁃1βand IL⁃21 in the two groups increased at 3 and 7 days after surgery,while the levels of IL⁃1βand IL⁃21 in the two groups decreased at 14 days,1 month,and 3 months after surgery,and the difference was statistically significant(P<0.05).There were statistically significant differences between the level of the asthenic group and the non⁃asthenic group at 3d,7d,14d and 1 month after surgery(P<0.05).The FRAIL score was negatively correlated with AKS score and knee flexion at each time point(P<0.05),while the levels of FRS⁃R,IL⁃1βand Il⁃21 were positively correlated(P<0.05).Conclusion Frailty is associated with pain and an inflammatory response after total hip replacement in elderly patients.This suggests that an evaluation of frailty should be performed prior to the total hip replacement procedure.