Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Department of Orthopedic Surgery, Okayama University Hospital.
Acta Med Okayama. 2023 Oct;77(5):511-516. doi: 10.18926/AMO/65973.
Sarcopenia and malnutrition are increasing in older adults and are reported risk factors for functional impairment after hip fracture surgery. This study aimed to investigate the associations between skeletal muscle mass loss, malnutrition, and postoperative walking ability in patients with hip fracture. We retrospectively reviewed patients who underwent intertrochanteric fracture surgery at our institute. The psoas muscle index, controlling nutritional status score, and functional ambulation category (FAC) were used to evaluate skeletal muscle mass, nutritional status, and walking ability, respectively. Six months after surgery, walking ability was assessed as either "gait disturbance" or "independent gait". Multivariate binomial logistic regression analysis, with skeletal muscle mass, nutritional status, and other factors, was used to predict the risk of being assigned to the gait disturbance group. This study included 95 patients (mean age, 85.2 years; 70 women). Sixty-six patients had low skeletal muscle mass, 35 suffered from malnutrition, and 28 had both. Malnutrition and low skeletal muscle mass were significantly associated with postoperative gait disturbance (FAC < 3). Preoperative low skeletal muscle mass and malnutrition were risk factors for postoperative poor walking ability. Further preventive interventions focusing on skeletal muscle mass and nutritional status are required.
骨骼肌减少症和营养不良在老年人中日益增多，被报道为髋部骨折手术后功能障碍的危险因素。本研究旨在探讨髋部骨折患者的骨骼肌量损失、营养不良与术后行走能力之间的关系。我们回顾性分析了在我院接受股骨转子间骨折手术的患者。采用竖脊肌指数、控食状态评分和功能性步行分类（FAC）分别评估骨骼肌量、营养状况和行走能力。术后 6 个月，行走能力评估为“步态障碍”或“独立行走”。采用多变量二项逻辑回归分析，结合骨骼肌量、营养状况和其他因素，预测被分配到步态障碍组的风险。本研究共纳入 95 例患者（平均年龄 85.2 岁；70 例女性）。66 例患者存在骨骼肌量减少，35 例存在营养不良，28 例同时存在两种情况。营养不良和骨骼肌量减少与术后步态障碍（FAC<3）显著相关。术前骨骼肌量减少和营养不良是术后行走能力差的危险因素。需要进一步采取针对骨骼肌量和营养状况的预防干预措施。
