Department of Orthopaedic Surgery, Tone Chuo Hospital, Gunma, Japan; Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
Department of Rehabilitation, Gunma University Graduate School of Health Sciences, Gunma, Japan.
J Hand Surg Am. 2024 Nov;49(11):1112-1118. doi: 10.1016/j.jhsa.2024.07.007. Epub 2024 Aug 12.
Distal radius fracture (DRF), sarcopenia, and malnutrition have been reported to be interrelated. However, there are few reports on the effects of sarcopenia and malnutrition on DRF patients' postoperative outcomes. This study examined the healthy-side grip strength and preoperative blood tests to determine the presence of possible sarcopenia (PS) and malnutrition in geriatric women with DRF and their impact on postoperative functional outcomes.
Fifty-five woman older than 60 years treated with volar-locking plate fixation for low-energy DRF from standing-level falls were retrospectively studied. Based on the criteria of The Asian Working Group for Sarcopenia 2019, patients with a healthy-side grip strength <18 kg were defined as PS. Nutritional assessment was performed using Onodera's Prognostic Nutritional Index (PNI) before surgery, with a value <50 defined as malnutrition. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) was used for functional assessment at 1 year after surgery. Patients were divided into two groups according to PS, and patient demographic data and postoperative outcomes were compared. Multiple regression analysis was performed to estimate the regression coefficient and 95% confidence intervals for 1-year QuickDASH after surgery with adjustment for age, PS, and malnutrition.
Possible sarcopenia was present in 10 patients (18.2%), and malnutrition in 24 patients (43.6%). Possible sarcopenia patients were older, had lower PNI, serum albumin, and both sides grip strength, and worse QuickDASH compared with non-PS patients. In multiple regression analysis, age, PS, and malnutrition were significant predictors of QuickDASH (standardized coefficient β, 0.35, 0.34, and 0.24; 95% confidence interval, 0.22-1.02, 3.52-16.49, and 0.50-10.78).
Possible sarcopenia with a healthy-side grip strength <18 kg and malnutrition with a PNI <50 were associated with worse 1-year QuickDASH after surgery in women DRF patients over 60 years.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic Ⅳ.
已报道桡骨远端骨折（DRF）、肌肉减少症和营养不良之间存在相互关系。然而，关于肌肉减少症和营养不良对 DRF 患者术后结局的影响的报道较少。本研究检查了老年 DRF 女性的健侧握力和术前血液检查，以确定是否存在可能的肌肉减少症（PS）和营养不良，并评估其对术后功能结局的影响。
回顾性分析了 55 例因站立位跌倒导致低能量 DRF 而接受掌侧锁定钢板固定治疗的 60 岁以上女性患者。根据 2019 年亚洲肌肉减少症工作组的标准，健侧握力＜18kg 的患者定义为 PS。在手术前使用小野预后营养指数（PNI）进行营养评估，PNI＜50 定义为营养不良。术后 1 年采用快速上肢和手功能测试（QuickDASH）进行功能评估。根据 PS 将患者分为两组，并比较患者的人口统计学数据和术后结局。采用多元回归分析，调整年龄、PS 和营养不良后，估计术后 1 年 QuickDASH 的回归系数和 95%置信区间。
10 例（18.2%）患者存在可能的肌肉减少症，24 例（43.6%）患者存在营养不良。与非 PS 患者相比，可能的肌肉减少症患者年龄更大，PNI、血清白蛋白和双侧握力更低，QuickDASH 更差。在多元回归分析中，年龄、PS 和营养不良是 QuickDASH 的显著预测因素（标准化系数β分别为 0.35、0.34 和 0.24；95%置信区间分别为 0.22-1.02、3.52-16.49 和 0.50-10.78）。
60 岁以上女性 DRF 患者，健侧握力＜18kg 存在可能的肌肉减少症，PNI＜50 存在营养不良，与术后 1 年 QuickDASH 较差相关。
研究类型/证据水平：预后Ⅳ级。
