Hedström Margareta, Ljungqvist Olle, Cederholm Tommy
Division of Orthopedics, Karolinska University Hospital, Huddinge, Sweden.
Acta Orthop. 2006 Oct;77(5):741-7. doi: 10.1080/17453670610012926.
Patients suffering from hip fracture are known to be at risk of catabolism and protein-energy malnutrition. In this review we discuss the pathogenesis of hip fracture-related catabolism per- and postoperatively. We also describe the consequences of malnutrition after a hip fracture and summarize studies that have evaluated the effect of nutritional or anabolic treatment of these patients. There has been relatively little published on the effects of nutritional and anabolic pharmacological interventions for improvement of nutritional status and on the role of nutritional status in clinical outcomes. Even so, there have been 19 randomized studies in this field. 12 studies evaluated nutritional supplementation or protein supplementation. 6 found improved clinical outcome with fewer complications, faster recovery and shorter length of hospital stay, whereas the others reported no difference in clinical outcome. For pharmacological interventions, the outcomes have been even less clear. Supplementation studies in general appear to be underpowered or suffer logistic problems. Studies of higher scientific quality are needed, and enteral feeding, anabolic treatment and multimodal approaches need to be evaluated in greater depth.
众所周知，髋部骨折患者存在分解代谢和蛋白质能量营养不良的风险。在本综述中，我们讨论髋部骨折相关分解代谢在术前和术后的发病机制。我们还描述了髋部骨折后营养不良的后果，并总结了评估这些患者营养或合成代谢治疗效果的研究。关于营养和合成代谢药物干预对改善营养状况的影响以及营养状况在临床结局中的作用，相对较少有相关报道。即便如此，该领域已有19项随机研究。12项研究评估了营养补充或蛋白质补充。6项研究发现临床结局得到改善，并发症减少、恢复更快且住院时间缩短，而其他研究报告临床结局无差异。对于药物干预，结果甚至更不明确。一般来说，补充研究似乎缺乏足够的效力或存在后勤问题。需要开展更高科学质量的研究，并且需要更深入地评估肠内喂养、合成代谢治疗和多模式方法。
