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中华老年骨科与康复电子杂志

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
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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]. 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]. 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。

关键词: 肌少症, 髋骨折, 死亡率
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.

Key words: Sarcopenia, Hip fractures, Mortality
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（%）]
组别 例数 术后6个月 术后24个月
存活数 死亡数 死亡率 存活数 死亡数 死亡率
肌少症组 45 41（90.2） 4（9.8） 9.80% 26（56.8） 19（42.2） 42.20%
非肌少症组 48 45（93.7） 3（96.3） 6.30% 39（81.2） 9（18.8） 18.80%
χ2值   0.008 6.081
P值   0.929 0.014
表2 髋部骨折术后24个月死亡率多变量Cox回归分析
项目 多变量分析
HR（95% CI） P值
年龄 0.062（1.004，1.128） 0.036
性别 -1.867（0.014，1.752） 0.132
患有肌少症 2.015（2.690，20.904） <0.01
ASA等级 -1.785（0.018，1.536） 0.114
骨折类型 -0.503（0.256，1.430） 0.252
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