肌少症对合并骨质疏松的老年股骨颈骨折患者术后康复的影响

Impact of sarcopenia on the postoperative rehabilitation in elderly patients with femoral neck fracture complicated by osteoporosis

Key words:  肌少症  老年人  骨质疏松  股骨颈骨折  预后

Key words:  sarcopenia  elderly  osteoporosis  femoral neck fracture  prognosis

Abstract:

目的 探究肌少症对合并骨质疏松的老年股骨颈骨折患者术后康复的影响。 方法 本研究采用前瞻性队列研究方法，自2023年3—4月共纳入125例老年骨质疏松股骨颈骨折患者，其中合并肌少症64例作为暴露组，不合并肌少症者61例作为非暴露组。比较两组术前术后疼痛(VAS评分)、髋关节功能(Harris评分)、住院天数、负重下地行走时间及并发症发生率。利用14项变量构建LASSO回归分析模型预测术后康复效果，采用Pearson分析探讨观察指标与康复评分的相关性。 结果 研究共纳入125例患者，随访无漏脱。两组患者术前VAS评分与Harris评分差异均无统计学意义(P＞0.05)；术后7 d、3个月及1年VAS评分差异有统计学意义(P＜0.05)；术后3 d、3个月及1年Harris评分差异有统计学意义(P＜0.05)。使用LASSO回归分析构建的预测模型显示，除术后1年Harris评分外，是否合并肌少症是剩余术后各时间点VAS评分及Harris评分的重要预测因素。Pearson分析结果显示，全组术后各时间点VAS评分及Harris评分与是否合并肌少症显著相关，且暴露组及非暴露组术后Harris评分均与并发症发生率、负重下地行走时间及住院时间相关，差异均具有统计学意义(P＜0.05)。 结论 肌少症显著推迟老年骨质疏松性股骨颈骨折患者术后康复进程，增加术后并发症，影响关节功能。老年骨质疏松性股骨颈骨折患者合并肌少症需要积极干预。

Abstract:

Objective To investigate the impact of sarcopenia on the postoperative rehabilitation of elderly patients with femoral neck fracture complicated by osteoporosis. Methods It’s a prospective cohort study. A total of 125 elderly patients with osteoporotic femoral neck fractures were prospectively enrolled from March to April 2023, including 64 patients with sarcopenia(exposed group) and 61 patients without sarcopenia(non-exposed group). Preoperative and postoperative pain(VAS score), hip function(Harris score), length of hospital stay, weight-bearing walking time, and complication rate were compared between the two groups. A LASSO regression model was constructed using 14 variables to predict postoperative rehabilitation outcomes, and Pearson analysis was used to explore the correlation between observation indicators and rehabilitation scores. Results A total of 125 patients were included in the study, and no patient was lost to follow-up. There was no significant difference in preoperative VAS score and Harris score between the two groups(both P＞0.05). There were significant differences in VAS score at 7 days, 3 months, and 1 year after surgery between the two groups(all P<0.05). There were significant differences in Harris score at 3 days, 3 months, and 1 year after surgery between the two groups(all P<0.05). The prediction model constructed by LASSO analysis showed that, except for Harris score at 1 year after surgery, whether sarcopenia was present was an important predictor for VAS score and Harris score at all remaining postoperative time points. Pearson analysis showed that VAS score and Harris score at all postoperative time points in the whole group were significantly correlated with whether sarcopenia was present. In addition, Harris score in the exposed group and non-exposed group was correlated with the incidence of complications, weight-bearing ambulation time, and length of hospital stay(all P＜0.05). Conclusion Sarcopenia significantly delays postoperative rehabilitation process among elderly patients suffering from osteoporotic femoral neck fracture，increases postoperative complications, and affects joint function. Active intervention is necessary for elderly individuals with osteoporotic femoral neck fractures complicated by sarcopenia.