肌少症对股骨粗隆间骨折术后早期预后的影响

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摘要目的：探讨肌少症与股骨粗隆间骨折患者行内固定术后早期功能的关系。方法：回顾性分析2013年5月至2017年1月于温州医科大学附属第一医院行髓内固定手术的股骨粗隆间骨折患者201例。收集患者术前一般情况，包括四肢骨骼质量指数及握力，以及术后随访临床预后，包括术后并发症、Barthel指数（术后6个月）、住院费用、住院时间等。采用单因素及多因素logistic回归分析，并绘制ROC曲线，计算AUC。结果：201例患者中符合肌少症诊断者98例（占48.8%），与非肌少症组相比，肌少症组术后感染发生率更高（χ2=4.430，P=0.035），心肺并发症发生率更高（χ2=4.232，P=0.04），Barthel指数更低（Z=-8.804，P＜0.05）。根据术后6个月与术前Barthel指数比较结果将患者分为功能恢复组和未完全恢复组，组间比较显示，肌少症（χ2=23.213，P＜0.001）、低维生素D（t=-1.752，P=0.083）、低骨密度（t=2.774，P=0.006）、高龄（t=-4.678，P＜0.001）、下肢静脉血栓（χ2=5.635，P=0.018）为术后功能恢复不佳的可能相关因素，二元logistic回归分析提示肌少症（OR=2.918，95%CI=1.300～6.553，P=0.09）、高龄（OR=1.041，95%CI=1.009～1.074，P=0.012）、下肢静脉血栓（OR=5.177，95%CI=1.090～24.590，P=0.039）是术后功能不完全恢复的危险因素。ROC曲线分析显示肌少症及年龄的AUC分别为0.320（P＜0.001）和0.702（P＜0.001）。结论：粗隆骨折患者肌少症发病率较高，肌少症是粗隆间骨折患者术后早期预后不佳的危险因素。

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	郎俊哲
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	陈雷

关键词 ：肌少症, 粗隆间骨折, 髓内固定, 危险因素, ROC曲线

Abstract：Objective: To determine the association of sarcopenia with short-term postoperative function after internal fixation for femoral intertrochanteric fractures. Methods: A total of 201 patients with intertrochanteric fractures who underwent intramedullary fixation in the First Affiliated Hospital of Wenzhou Medical University from May 2013 to January 2017 were analyzed retrospectively. The general conditions of the patients were collected before surgery, and the appendicular skeletal muscle index and grip strength were measured. The clinical prognosis was followed up, including postoperative complications, Barthel index (6 months after surgery), hospitalization expenses, hospitalization time, etc. Univariate andmultivariate logistic regression analysis was used. Draw a ROC curve and calculate the area under the curve. Results: Sarcopenia was present in 98 patients (48.8%), who had a higher risk of postoperative infection (χ2=4.430, P=0.035), cardiopulmonary complication (χ2=4.232, P=0.04), and lower Barthel Index (Z=-8.804, P<0.05) compared with non-sarcopenic patients. According to the comparison between 6 months postoperative and preoperative Barthel index, the patients were divided into the functional recovery group and the incomplete recovery group. The comparison between the groups indicated that (χ2=23.213, P<0.001), low vitamin D (t=-1.752, P=0.083), low bone density (t=2.774, P=0.006), advanced age (t=-4.678, P<0.001), lower extremity venous thrombosis (χ2=5.635, P=0.018) were possible factors related to incomplete functional recovery. Binary logistic regression analysis suggested sarcopenia (OR=2.918, 95%CI=1.300-6.553, P=0.09), advanced age (OR=1.041, 95%CI=1.009-1.074, P=0.012) and thrombosis (OR=5.177, 95%CI=1.090-24.59, P=0.039) were risk factors for incomplete recovery of postoperative function. ROC curve analysis indicated the area under the curve of sarcopenia and age were 0.320 (P<0.001) and 0.702 (P<0.001) separately. Conclusion: Patients with trochanteric fracture have a higher incidence of sarcopenia, which is an important risk factor for poor prognosis in patients with intertrochanteric fractures.

Key words： sarcopenia femoral intertrochanteric fractures internal fixation risk factors ROC curve

收稿日期: 2018-04-03

通讯作者: 陈雷，主任医师，Email：chenlei689595@qq.com。

作者简介: 郎俊哲（1986-），男，浙江温州人，住院医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I11/822

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