Department of Orthopedic Surgery, Tokai University School of Medicine Oiso Hospital, 21-1 Gekkyo, Oiso, Kanagawa, 259-0198, Japan.
Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
BMC Musculoskelet Disord. 2021 Dec 8;22(1):1027. doi: 10.1186/s12891-021-04913-2.
Although nutritional status is crucial in gait recovery after femoral neck fracture surgery, the relationship between preoperative nutritional status and postoperative outcomes remains unknown. This study examined the effects of preoperative nutritional status on postoperative outcomes in patients undergoing femoral neck fracture surgery.
Data regarding the joints of 137 patients (29 men, 108 women) who underwent bipolar hemiarthroplasty for femoral neck fractures at our hospital from January 2015 to December 2019 were retrospectively examined. The Geriatric Nutritional Risk Index (GNRI), an index of nutritional status, was used to classify patients into two groups: a normal group (GNRI ≥92; n = 62) and an undernourished group (GNRI < 92; n = 75). The study endpoints included age at surgery, sex, Mini Mental State Examination (MMSE), American Society of Anesthesiologists Physical Status (ASA) classification, preoperative waiting period, intraoperative blood loss, surgery time, perioperative hemoglobin levels, blood transfusion rate, complication rate, 6-month mortality rate, transfer rate, percentage of patients unable to walk at discharge or transfer, and inability to walk 6 months postoperatively.
The patients in the undernourished group was significantly older at surgery (p < 0.01) and had a lower perioperative hemoglobin levels (p < 0.01), a higher blood transfusion rate (p < 0.01), a lower MMSE (p < 0.01), a longer preoperative waiting period (p < 0.05), a higher transfer rate (p < 0.05), were more likely to be unable to walk 6 months postoperatively (p < 0.01), a higher complication rate (p < 0.05), and a higher 6-month mortality rate (p < 0.01) than the normal group. Patients in the undernourished group had worse rates of postoperative complications, transfer, mortality, and inability to walk 6-month after surgery than those in the normal group.
A poor nutritional status affects the gait function and systemic condition of patients undergoing femoral neck fracture surgery; therefore, early nutritional interventions may reduce mortality rates and shorten rehabilitation. These results suggest that the GNRI effectively predicts postoperative complications, mortality, and gait function.
尽管营养状况在股骨颈骨折手术后的步态恢复中至关重要，但术前营养状况与术后结果之间的关系尚不清楚。本研究探讨了术前营养状况对股骨颈骨折手术后患者术后结果的影响。
回顾性分析了 2015 年 1 月至 2019 年 12 月在我院接受双极半髋关节置换术的 137 例患者（29 名男性，108 名女性）的关节数据。使用营养状况的老年营养风险指数（GNRI）将患者分为两组：正常组（GNRI≥92；n=62）和营养不良组（GNRI<92；n=75）。研究终点包括手术时的年龄、性别、简易精神状态检查（MMSE）、美国麻醉医师协会身体状况（ASA）分级、术前等待期、术中失血量、手术时间、围手术期血红蛋白水平、输血率、并发症发生率、6 个月死亡率、转归率、出院或转归时无法行走的患者百分比以及术后 6 个月无法行走的患者百分比。
营养不良组患者的手术年龄明显更大（p<0.01），围手术期血红蛋白水平更低（p<0.01），输血率更高（p<0.01），简易精神状态检查得分更低（p<0.01），术前等待期更长（p<0.05），转归率更高（p<0.05），术后 6 个月无法行走的可能性更高（p<0.01），并发症发生率更高（p<0.05），6 个月死亡率更高（p<0.01）。与正常组相比，营养不良组患者术后并发症、转归、死亡率和术后 6 个月无法行走的发生率更高。
营养状况不良会影响股骨颈骨折手术患者的步态功能和全身状况；因此，早期营养干预可能降低死亡率并缩短康复时间。这些结果表明 GNRI 可有效预测术后并发症、死亡率和步态功能。
