Prowse James, Jaiswal Sharlene, Gentle Jack, Sorial Antony K, Witham Miles D
AGE Research Group, Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle Upon Tyne, UK.
Eur Geriatr Med. 2024 Dec;15(6):1603-1614. doi: 10.1007/s41999-024-01102-x. Epub 2024 Nov 29.
Sarcopenia is diagnosed on the basis of low muscle strength, with low muscle mass used to confirm diagnosis. The added value of measuring muscle mass is unclear. We undertook a systematic review to assess whether muscle mass measurement in patients with hip fracture was acceptable, feasible and independently associated with adverse outcomes.
Electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL, Clinicaltrials.gov) were searched for studies of patients with hip fracture aged ≥ 60 with perioperative muscle mass or strength assessments. Associations with postoperative outcomes including death, length of stay and activities of daily living were extracted. Risk-of-bias was assessed using the AXIS and ROBINS-I tools. Due to the degree of study heterogeneity, data were analysed by narrative synthesis.
The search strategy identified 3317 records. 36 studies were included with 7860 participants. Acceptability of muscle mass measurement was not assessed, but measurement appeared feasible using biompedance, dual energy x-ray absorptiometry and computed tomography. Univariate analyses indicated that lower muscle mass was associated with higher death rates at 30 days, worse mobility, worse activity of daily living metrics and worse physical performance but there was no significant association with length of stay or postoperative complications. Four studies included both muscle mass and strength in multivariable analyses; muscle mass was a significant independent predictor of only one adverse outcome in a single study after adjustment for muscle strength and other predictor variables.
Current data suggest that muscle mass assessment offers no additional prognostic information to muscle strength measures in patients with hip fracture.
肌少症是根据肌肉力量低下进行诊断的，低肌肉量用于确诊。测量肌肉量的附加价值尚不清楚。我们进行了一项系统评价，以评估髋部骨折患者测量肌肉量是否可接受、可行，以及是否与不良结局独立相关。
检索电子数据库（MEDLINE、EMBASE、CENTRAL、CINAHL、Clinicaltrials.gov），查找年龄≥60岁且进行围手术期肌肉量或力量评估的髋部骨折患者的研究。提取与术后结局（包括死亡、住院时间和日常生活活动）的关联。使用AXIS和ROBINS-I工具评估偏倚风险。由于研究异质性程度，采用叙述性综合分析数据。
检索策略共识别出3317条记录。纳入36项研究，共7860名参与者。未评估肌肉量测量的可接受性，但使用生物电阻抗、双能X线吸收法和计算机断层扫描测量似乎是可行的。单因素分析表明，较低的肌肉量与30天死亡率较高、 mobility较差、日常生活活动指标较差和身体表现较差相关，但与住院时间或术后并发症无显著关联。四项研究在多变量分析中同时纳入了肌肉量和力量；在对肌肉力量和其他预测变量进行调整后，在一项研究中，肌肉量仅是一个不良结局的显著独立预测因素。
目前的数据表明，对于髋部骨折患者，肌肉量评估并不能为肌肉力量测量提供额外的预后信息。
