Orthopaedic Institute at Mercy Hospital, 3659 S Miami Avenue, Suite 4008, Miami, FL, 33133, USA,
Clin Orthop Relat Res. 2014 Feb;472(2):681-6. doi: 10.1007/s11999-013-3172-7.
The consequences of vitamin D insufficiency in the elderly remain controversial. The prevalence and potential effects of its chronic insufficiency on quality of life and physical function in patients undergoing THA have received little attention.
QUESTION/PURPOSES: We determined (1) prevalence of preoperative vitamin D insufficiency in patients undergoing THA and (2) relationships of insufficiency to patient-perceived outcomes (PPOs) and hip scores.
We retrospectively reviewed 62 consecutive patients who underwent 66 primary THAs. We excluded two patients with missing data and the second hip of bilateral THAs, leaving 60 patients (60 hips) for final inclusion. Based on preoperative plasma 25-hydroxyvitamin-D3 levels, patients were retrospectively assigned into a normal or insufficient group. We used two different thresholds (20 and 30 ng/mL) to define insufficiency; groups were set twice. We compared demographics, BMI, American Society of Anesthesiologists score, Charlson Comorbidity Index; albumin, transferrin, calcium levels; and total lymphocyte count between groups. The insufficient group had a higher mean BMI with the 20-ng/mL cutoff but not with the 30-ng/mL cutoff. We compared the 20-ng/mL cutoff groups (adjusting for BMI) and the 30-ng/mL cutoff groups in terms of preoperative and postoperative Quality of Well-being Scale, SF-36, WOMAC, Harris hip, and Merle d'Aubigné-Postel scores. Mean followup was 11 months (range, 3-24 months).
The prevalence of vitamin D insufficiency was 30% (using 20 ng/mL) and 65% (using 30 ng/mL). Preoperative and postoperative Harris hip and Merle d'Aubigné-Postel scores were lower in patients with insufficiency using 30 ng/mL. No differences in PPOs or hip scores were found using 20 ng/mL.
Hypovitaminosis D was common in patients with THA and associated with lower hip scores. Standardization of the definition of hypovitaminosis D is urgently needed so that further studies can properly evaluate its real prevalence, potential negative effects on function, and therapeutic effects of reversing insufficiency before THA.
老年人维生素 D 不足的后果仍存在争议。维生素 D 慢性不足对接受 THA 治疗的患者生活质量和身体功能的潜在影响尚未得到重视。
问题/目的：我们确定了（1）接受 THA 治疗的患者术前维生素 D 不足的发生率，以及（2）不足与患者感知结果（PPO）和髋关节评分的关系。
我们回顾性分析了 62 例连续接受 66 例初次 THA 治疗的患者。我们排除了两名数据缺失的患者和双侧 THA 的第二髋部，最终纳入 60 名患者（60 髋）进行最终分析。根据术前血浆 25-羟维生素 D3 水平，患者被回顾性分为正常或不足组。我们使用了两个不同的阈值（20 和 30ng/mL）来定义不足；组被设置了两次。我们比较了两组之间的人口统计学数据、BMI、美国麻醉医师协会评分、Charlson 合并症指数、白蛋白、转铁蛋白、钙水平和总淋巴细胞计数。20ng/mL 截断值时不足组的平均 BMI 较高，但 30ng/mL 截断值时则不然。我们比较了 20ng/mL 截断值组（根据 BMI 调整）和 30ng/mL 截断值组在术前和术后生活质量量表、SF-36、WOMAC、Harris 髋关节和 Merle d'Aubigné-Postel 评分方面的差异。平均随访时间为 11 个月（3-24 个月）。
维生素 D 不足的发生率为 30%（使用 20ng/mL）和 65%（使用 30ng/mL）。使用 30ng/mL 时，不足患者的术前和术后 Harris 髋关节和 Merle d'Aubigné-Postel 评分较低。使用 20ng/mL 时，PPO 或髋关节评分无差异。
THA 患者普遍存在维生素 D 缺乏，与髋关节评分较低有关。迫切需要标准化维生素 D 缺乏的定义，以便进一步研究能够正确评估其在 THA 前的真实发生率、对功能的潜在负面影响以及纠正不足的治疗效果。
