腰大肌-腰椎指数与老年髋部骨折术后并发症风险的关系

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摘要目的评估腰大肌-腰椎指数(PLVI)与老年髋部骨折术后并发症风险的关系。方法回顾性分析了2016-03至2020-12在联勤保障部队第943医院接受髋部骨折手术的686例老年患者。采用计算机断层扫描(CT)计算腰大肌横截面积和L₄椎体面积,PLVI定义为左右腰肌平均横截面积和L₄椎体面积之间的比值。根据男性和女性PLVI中位数将患者分为两组(低PLVI组和高PLVI组)。主要结局为手术后6个月内并发症(包括愈合不良、谵妄、肺炎、尿路感染、深静脉血栓、心力衰竭、呼吸衰竭、脓毒症)。次要研究终点为1年死亡率和总死亡率。结果术后6个月内122例(17.78%)患者出现并发症,这部分患者术前PLVI更低(P＜0.05)。与高PLVI组相比,低PLVI组患者愈合不良、谵妄、肺炎的发生率高,同时血清白蛋白(ALB)水平降低,而血清C反应蛋白水平升高(P＜0.05)。在多因素Logistic回归分析中,合并慢性肾脏疾病(OR=3.500,95% CI:1.484～8.252)、骨折至手术间隔延迟(OR=1.711,95% CI:1.044～2.804)、术前ALB水平降低(OR=4.922,95% CI:2.633～9.202),以及低PLVI(OR=0.136,95% CI:0.074～0.249)都是影响老年患者髋部骨折手术后并发症(包括愈合不良、谵妄、肺炎)发病风险的独立预测因子(P＜0.05)。经Kaplan-Meier曲线分析,低PLVI组患者总死亡率(11.37%,39/343)高于高PLVI组(1.75%,6/343),差异有统计学意义(log rank=24.610,P＜0.001)。结论术前PLVI可独立预测老年患者髋部骨折手术后愈合不良、谵妄、肺炎的发生风险及死亡率。

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关键词 ：腰大肌-腰椎指数, 老年, 髋部骨折, 术后并发症, 死亡率

Abstract：Objective To investigate the association between psoas-to-lumbar vertebral index (PLVI) and postoperative complications in elderly patients with hip fractures.Methods A retrospective analysis was conducted on 686 elderly patients who underwent hip fracture surgery at the 943 th Hospital of PLA Joint Logistics Support Force from March 2016 to December 2020. The cross-sectional area of lumbar muscles and the L4 vertebral body area were calculated by computed tomography (CT). PLVI was defined as the ratio between the average cross-sectional area of the left and right lumbar muscles and the L4 vertebral body area. The patients were divided into two groups according to the median value of male and female PLVI (low-PLVI group and high-PLVI group). The main outcome was complications within 6 months after operation (poor healing, delirium, pneumonia, urinary tract infection, deep vein thrombosis, heart failure, respiratory failure, sepsis). The secondary end points were 1-year mortality and total mortality.Results Complications occurred in 122 patients (17.78%) within 6 months after surgery, and PLVI was lower in these patients before surgery (P<0.05). Compared with the high PLVI group, patients in the low PLVI group had a higher incidence of poor healing, delirium, and pneumonia, while serum albumin (ALB) levels were decreased and serum C-reactive protein levels were increased (P<0.05). In multivariate Logistic regression analysis adjusting for confounders, risk factors associated with chronic kidney disease (OR=3.500, 95% CI: 1.484-8.252), delayed fracture to surgical interval (OR=1.711, 95% CI: 1.044-2.804), decreased preoperative ALB level (OR=4.922, 95% CI: 2.633-9.202) and low PLVI (OR=0.136, 95% CI: 0.074-0.249) were independent predictors of the risk of postoperative complications including poor healing, delirium, and pneumonia in elderly patients (P<0.05). According to Kaplan-Meier curve analysis, the total mortality of patients in the low PLVI group (11.37%, 39/343) was higher than that in the high PLVI group (1.75%, 6/343), with statistical significance (log rank=24.610, P<0.001).Conclusions Preoperative PLVI can independently predict the risk of poor healing, delirium, pneumonia and mortality after hip fracture surgery in elderly patients.

Key words： psoas-to-lumbar vertebral index elderly hip fractures postoperative complications mortality

收稿日期: 2023-04-20

ZTFLH:

R683

基金资助:甘肃省武威市市列科技计划项目(WW1902002)

通讯作者: 郭二鹏,E-mail:guoerpeng111@163.com

作者简介: 常德海,本科学历,主任医师。

引用本文:

常德海, 杜广哲, 郭二鹏, 侯作宝, 康万年, 徐砜. 腰大肌-腰椎指数与老年髋部骨折术后并发症风险的关系[J]. 武警医学, 2024, 35(2): 144-149. CHANG Dehai, DU Guangzhe, GUO Erpeng, HOU Zuobao, KANG Wannian, XU feng. Association between psoas-to-lumbar vertebral index and postoperative complications in elderly patients with hip fractures. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(2): 144-149.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2024/V35/I2/144

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