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中华老年骨科与康复电子杂志 ›› 2020, Vol. 06 ›› Issue (03) : 136 -141. doi: 10.3877/cma.j.issn.2096-0263.2020.03.003

所属专题: 文献

髋部骨折

肌少症对老年患者髋部骨折术后远近期死亡率的影响
侯传勇1, 刘新晖1, 张海龙1, 孙超1, 殷建1,()   
  1. 1. 211100 南京医科大学附属江宁医院骨科
  • 收稿日期:2019-07-01 出版日期:2020-06-05
  • 通信作者: 殷建
  • 基金资助:
    国家自然科学基金(81802198); 江苏省自然科学基金(SBK2019022658)

Effect of sarcopenia on short-term and long-term mortality of post-operative hip fracture in elderly patients

Chuanyong Hou1, Xinhui Liu1, Hailong Zhang1, Chao Sun1, Jian Yin1,()   

  1. 1. Department of Orthopedics, the Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing 211100, China
  • Received:2019-07-01 Published:2020-06-05
  • Corresponding author: Jian Yin
引用本文:

侯传勇, 刘新晖, 张海龙, 孙超, 殷建. 肌少症对老年患者髋部骨折术后远近期死亡率的影响[J/OL]. 中华老年骨科与康复电子杂志, 2020, 06(03): 136-141.

Chuanyong Hou, Xinhui Liu, Hailong Zhang, Chao Sun, Jian Yin. Effect of sarcopenia on short-term and long-term mortality of post-operative hip fracture in elderly patients[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(03): 136-141.

目的

探讨肌少症对老年患者髋部骨折术后近期及远期死亡率的影响。

方法

2014年2月至2017年2月,共93例符合纳入及排除标准的老年髋部骨折患者纳入本研究。利用胸部CT测量T12椎体(T12)椎弓根水平肌肉组织的横截面积。以T12椎弓根水平肌肉横截面积除以患者身高平方计算得到骨骼肌指数(SMI)。采用T12水平SMI截断值:42.6 cm2/m2(男性)和30.6 cm2/m2(女性),将患者分为肌少症组及非肌少症组,随访两组患者术后生存时间。采用Kaplan Meier分析两组患者的生存曲线,使用卡方检验对比两组在术后6个月和12个月的生存率差异。采用Cox比例风险模型分析肌少症、骨折类型(手术类型)、年龄、性别及ASA等级等多变量因素对髋部骨折术后死亡率的影响。

结果

肌少症组患者共45例,非肌少症组患者共48例。肌少症组4例患者在术后6个月内死亡,死亡率为9.8%,非肌少症组3例患者在术后6个月内死亡,死亡率为8.3%,组间术后6个月死亡率差异无统计学意义(χ2=0.008,P=0.929)。肌少症组19例患者在术后24个月内死亡,死亡率为42.2%,非肌少症组10例患者在术后24个月内死亡,死亡率为18.8%,组间术后24个月死亡率差异具有统计学意义(χ2=6.081,P=0.014)。Cox比例风险模型分析结果为:患有肌少症及患者年龄和术后24个月死亡率显著相关(HR=2.015,95% CI:2.690,20.904,P=0.000;HR=0.062,95% CI:1.004,1.128,P=0.036),患有肌少症及年龄较大的患者,术后24个月死亡率越高,而骨折类型(手术类型)、性别及ASA等级对术后24个月死亡率无明显影响。

结论

肌少症会增加髋部骨折患者术后远期(24个月)的死亡风险,对近期(6个月)患者死亡率无明显影响。

Objective

To investigate the effect of sarcopenia on short-term and long-term mortality of post-operative hip fracture in elderly patients.

Methods

A total of 93 elderly patients with hip fracturesfrom February 2014 to February 2017, who met the inclusion and exclusion criteria were enrolled in the study. The cross-sectional area (cm2) of the pedicle level of the thoracic 12 (T12) was measured by chest CT. The skeletal muscle index (SMI) was calculated by dividing the T12 pedicle level muscle cross-sectional area with the patient's height. SMI cut-off value at T12 level: 42.6 cm2/m2 (male) and 30.6 cm2/m2 (female) were used to diagnose sarcopenia.The patients were divided into sarcopenia group and non-sarcopenia group, and the postoperative survival time of the two groups was followed up. The survival curve of the two groups was analyzed by Kaplan Meier, and the difference in survival rates at 6 and 12 months after the operation was compared by the chi-square test. The effects of multivariate factors such as sarcopenia, fracture type (surgical type), age, gender and ASA grade on postoperative mortality of hip fracture were analyzed by Cox proportional hazard model.

Results

There were 45 patients in sarcopenia group and 48 patients in non-sarcopenia group. Four and three patients died within 6 months after operation in the sarcopenia group and the non-sarcopenia group, respectively, and the mortality rate was 8.8% and 8.3%, respectively. There was no significant difference in the mortality rate between the two groups at 6 months after operation (P=0.929). Nineteen and ten patients died within 24 months after operation in the sarcopenia group and the non-sarcopenia group, respectively, and the mortality rate was 42.2% and 18.8%, respectively. There was significant difference in the mortality rate between the two groups at 24 months after operation (P=0.014). Results of cox proportional risk model analysis revealed that sarcopenia (HR=2.015, 95% CI: 2.690, 20.904, P=0.000) and age (HR=0.062, 95% CI: 1.004, 1.128, P=0.036) is significantly related with 24 months postoperative mortality. Patients with sarcopenia and advanced age had a higher postoperative 24-month mortality rate, while fracture type (type of surgery), gender and ASA had no significant effect on postoperative 24-month mortality.

Conclusions

Patients with sarcopenia and older patients had higher mortality at 24 months postoperative hip fracture. The fracture type (surgical type), gender and ASA grade had no significant effect on mortality at 24 months postoperatively.

图1~6 纳入患者T12椎体椎弓根水平CT资料。图1 男性,78岁,肌少症患者,左股骨颈骨折,SMI 40.2 cm2/m2;图2 女性,81岁,肌少症患者,右股骨粗隆间骨折,SMI 28.3 cm2/m2;图3 女性,86岁,肌少症患者,左股骨粗隆间骨折,SMI 24.5 cm2/m2;图4 男性,75岁,非肌少症患者,右股骨颈骨折,SMI 47.8 cm2/m2;图5 女性,78岁,非肌少症患者,右股骨粗隆间骨折,SMI 39.2 cm2/m2;图6 女性,84岁,非肌少症患者,左股骨粗隆间骨折,SMI 38.5 cm2/m2
图2 肌少症组和非肌少症组患者髋部骨折术后生存曲线。
表1 肌少症组和非肌少症组患者髋部骨折术后6个月和24个月死亡率比较[例(%)]
表2 髋部骨折术后24个月死亡率多变量Cox回归分析
1
Rosenberg IH. Sarcopenia: origins and clinical relevance [J]. J Nutr, 1997, 127(5 Suppl): 990S-991S.
2
高悠水,施慧鹏,李晓林,等.老年肌肉减少症与脆性骨折的研究进展[J].中华老年骨科与康复电子杂志, 2015 (2): 48-52.
3
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People [J]. Age Ageing, 2010, 39(4): 412-423.
4
Morley JE, Abbatecola AM, Argiles JM, et al. Sarcopenia with limited mobility: an international consensus [J]. J Am Med Dir Assoc, 2011, 12(6): 403-409.
5
Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian working group for sarcopenia [J]. J Am Med Dir Assoc, 2014, 15(2): 95-101.
6
齐萌,张思伟,刘波.肌少症的CT,MR诊断及临床意义[J].中国骨质疏松杂志, 2018, 24(11): 135-139.
7
Sabel MS, Terjimanian M, Conlon AS, et al. Analytic morphometric assessment of patients undergoing colectomy for colon cancer [J]. J Surg Oncol, 2013, 108(3): 169-175.
8
Krell RW, Kaul DR, Martin AR, et al. Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation [J]. Liver Transplantation, 2013, 19(12): 1396-1402.
9
Sheetz KH, Zhao L, Holcombe SA, et al. Decreased core muscle size is associated with worse patient survival following esophagectomy for cancer [J]. Diseases of the Esophagus, 2013, 26(7): 716-722.
10
Vetrano DL, Landi F, Volpato SA, et al. Association of sarcopenia with short- and long-term mortality in older adults admitted to acute care wards: results from the CRIME study [J]. J Gerontol A Biol Sci Med Sci, 2014, 69(9): 1154-1161.
11
Sjoblom B, Gronberg BH, Wentzel-Larsen TA, et al. Skeletal muscle radiodensity is prognostic for survival in patients with advanced non-small cell lung cancer [J]. Clin Nutr, 2016, 35(6): 1386-1393.
12
Boutin RD, Yao L, Canter RJ, et al. Sarcopenia: current concepts and imaging implications [J]. AJR Am J Roentgenol, 2015, 205(3):W255-W266.
13
Ooi PH, Hager A, Mazurak VC, et al. Sarcopenia in chronic liver disease: impact on outcomes [J]. Liver Transplantation, 2019, 25(9): 1422-1438.
14
Kurumisawa S, Kawahito K. The psoas muscle index as a predictor of long-term survival after cardiac surgery for hemodialysis-dependent patients [J]. Journal of artificial organs: the official journal of the Japanese Society for Artificial Organs, 2019, 22(3): 214-221.
15
Cederholm T, Cruz-Jentoft AJ, Maggi S. Sarcopenia and fragility fractures [J]. Eur J Phys Rehabil Med, 2013, 49(1): 111-117.
16
Sjöblom S, Suuronen J, Rikkonen T, et al. Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia [J]. Maturitas, 2013, 75(2): 175-180.
17
Yoo JI, Yc H, Kwon HB, et al. High prevalence of sarcopenia in korean patients after hip fracture:a Case-Control study [J]. J Korean Med Sci, 2016, 31(9): 1479-1484.
18
Di Monaco M, Castiglioni C, Vallero F, et al. Sarcopenia is more prevalent in men than in women after hip fracture: a cross-sectional study of 591 inpatients [J]. Arch Gerontol Geriatr, 2012, 55(2): e48-e52.
19
Landi F, Calvani R, Ortolani E, et al. The association between sarcopenia and functional outcomes among older patients with hip fracture undergoing in-hospital rehabilitation [J]. Osteoporosis International, 2017, 28(5): 1569-1576.
20
Yoo JI, Kim H, Ha YC, et al. Osteosarcopenia in Patients with Hip Fracture Is Related with High Mortality [J]. Journal of Korean Medical Science, 2018, 33(4): e27-.
21
贡歌,万文辉,张兴虎,等.肌少症用于评估老年股骨粗隆间骨折手术风险及预后[J].中华老年多器官疾病杂志, 2018, 17(11): 825-828.
22
贡歌,万文辉,王斌,等.肌少症对老年股骨颈骨折患者手术疗效的影响[J].中华老年医学杂志, 2019, 38(2): 191-195.
23
Gallagher D, Visser M, De Meersman RE, et al. Appendicular skeletal muscle mass:effects of age,gender,and ethnicity [J]. J Appl Physiol, 1997, 83(1): 229-239.
24
Nemec U, Heidinger B, Sokas C, et al. Diagnosing sarcopenia on thoracic computed tomography: quantitative assessment of skeletal muscle mass in patients undergoing transcatheter aortic valve replacement [J]. Acad Radiol, 2017, 24(9): 1154-1161.
25
王爱民,杜全印.重视老年髋部骨折的救治[J].创伤外科杂志, 2014 (6): 481-483.
26
齐士格,王志会,王丽敏,等. 2013年中国老年居民跌倒伤害流行状况分析[J].中华流行病学杂志, 2018, 39(4): 439-442.
27
Boddaert J, Cohen-Bittan J, Khiami F, et al. Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture [J]. PLoS One, 2014, 9(1): e83795.
28
Landi F, Calvani R, Cesari M, et al. Sarcopenia as the biological substrate of physical frailty [J]. Clin Geriatr Med, 2015, 31(3): 367-374.
29
Antoniou GA, Rojoa D, Antoniou SA, et al. Effect of low skeletal muscle mass on post-operative survival of patients with abdominal aortic aneurysm: a prognostic factor review and Meta-Analysis of Time-to-Event data [J]. Eur J Vasc Endovasc Surg, 2019, 58(2): 190-198.
30
Stone L, Olson B, Mowery A, et al. Association Between Sarcopenia and Mortality in Patients Undergoing Surgical Excision of Head and Neck Cancer [J]. JAMA otolaryngology-- head & neck surgery, 2019, 145(7): 647-654.
31
Clynes MA, Edwards MH, Buehring B, et al. Definitions of sarcopenia: associations with previous falls and fracture in a population sample [J]. Calcif Tissue Int, 2015, 97(5): 445-452.
32
Cruz-Jentoft AJ, Sayer AA. Sarcopenia [J]. Lancet(London,England), 2019, 393(10191): 2636-2646.
33
Robinson SM, Reginster JY, Rizzoli R, et al. Does nutrition play a role in the prevention and management of sarcopenia? [J]. Clinical Nutrition, 2018, 37(4): 1121-1132.
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