术前营养状况对老年股骨颈骨折关节置换手术结局的影响
Influence of Preoperative Nutritional Status on Surgical Outcomes of Arthroplasty in Geriatric Femoral Neck Fractures.
作者信息
Lakha Singh Sarbhjit Singh, Theveraja Khanchana Devi, Ho Jade Pei Yuik, Palaniappan Sangitaa P, Subramaniam Sanjay Raj, Lakha Singh Sarbhan Singh, Ganthel Kunalan
机构信息
Department of Orthopaedic Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
Biomedical Epidemiology Unit, Institute for Medical Research (IMR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia.
出版信息
Geriatr Orthop Surg Rehabil. 2025 Mar 27;16:21514593251327914. doi: 10.1177/21514593251327914. eCollection 2025.
BACKGROUND
Patients with geriatric neck of femur (NOF) fractures often have multiple medical conditions and compromised baseline nutrition, impacting arthroplasty outcomes. Indicators like BMI, albumin, hemoglobin, urea, creatinine, CRP, and HbA1c influence nutritional status and postoperative results. This study evaluates the impact of preoperative nutrition on surgical outcomes, including postoperative complications, mobility, and pain scores in geriatric femoral neck fractures.
METHODS
A retrospective study of 141 geriatric patients with NOF fractures admitted to Kuala Lumpur General Hospital between 2022-2023, treated operatively, was conducted. Associations of age, gender, ethnicity, BMI, education, smoking status, comorbidity, pre-fracture mobility, American Society of Anesthesiologists (ASA) level, and perioperative nutritional parameters with post-surgical complications, mobility, and WOMAC scores 1-year post-surgery were analyzed using logistic regression.
RESULTS
Higher BMI (AOR = 1.21, 95% CI: 1.07-1.42, = 0.03) and ASA levels ≥2 (AOR = 2.53, 95% CI: 1.30-4.91, = 0.01) were significant predictors of post-surgical complications. Abnormal hematological variables, including hemoglobin (AOR = 1.78, 95% CI: 1.45-2.45, < 0.001), urea (AOR = 1.35, 95% CI: 1.15-1.60, = 0.002), creatinine (AOR = 1.20, 95% CI: 1.00-1.52, = 0.04), and HbA1c (AOR = 1.40, 95% CI: 1.25-1.67, = 0.004), were also associated with complications. BMI (AOR = 1.12, 95% CI: 1.06-1.30, = 0.049) and abnormal hematological variables, including hemoglobin (AOR = 1.99, 95% CI: 1.05-2.70, = 0.003), urea (AOR = 1.58, 95% CI: 1.06-1.95, = 0.006), creatinine (AOR = 1.21, 95% CI: 1.09-1.38, = 0.048), and HbA1c (AOR = 1.98, 95% CI: 1.25-2.57, = 0.002), were significant predictors of reduced post-surgical mobility. No significant factors were associated with WOMAC scores at 1 year.
CONCLUSION
Preoperative nutritional status significantly impacts outcomes in geriatric patients undergoing arthroplasty for femoral neck fractures. Comprehensive preoperative nutritional assessments are essential for improving postoperative outcomes.
背景
老年股骨颈骨折患者通常存在多种疾病且基线营养状况不佳，这会影响关节置换手术的效果。身体质量指数（BMI）、白蛋白、血红蛋白、尿素、肌酐、C反应蛋白（CRP）和糖化血红蛋白（HbA1c）等指标会影响营养状况和术后结果。本研究评估术前营养对老年股骨颈骨折手术结果的影响，包括术后并发症、活动能力和疼痛评分。
方法
对2022年至2023年期间入住吉隆坡总医院并接受手术治疗的141例老年股骨颈骨折患者进行回顾性研究。使用逻辑回归分析年龄、性别、种族、BMI、教育程度、吸烟状况、合并症、骨折前活动能力、美国麻醉医师协会（ASA）分级以及围手术期营养参数与术后并发症、活动能力和术后1年的Western Ontario和McMaster大学骨关节炎指数（WOMAC）评分之间的关联。
结果
较高的BMI（比值比[AOR]=1.21，95%置信区间[CI]：1.07 - 1.42，P = 0.03）和ASA分级≥2（AOR = 2.53，95% CI：1.30 - 4.91，P = 0.01）是术后并发症的显著预测因素。包括血红蛋白（AOR = 1.78，95% CI：1.45 - 2.45，P < 0.001）、尿素（AOR = 1.35，95% CI：1.15 - 1.60，P = 0.002）、肌酐（AOR = 1.20，95% CI：1.00 - 1.52，P = 0.04）和HbA1c（AOR = 1.40，95% CI：1.25 - 1.67，P = 0.004）在内的血液学变量异常也与并发症相关。BMI（AOR = 1.12，95% CI：1.06 - 1.30，P = 0.049）以及包括血红蛋白（AOR = 1.99，95% CI：1.05 - 2.70，P = 0.003）、尿素（AOR = 1.58，95% CI：1.06 - 1.95，P = 0.006）、肌酐（AOR = 1.21，95% CI：1.09 - 1.38，P = 0.048）和HbA1c（AOR = 1.98，95% CI：1.25 - 2.57，P = 0.002）在内的血液学变量异常是术后活动能力下降的显著预测因素。没有显著因素与术后1年的WOMAC评分相关。
结论
术前营养状况对老年股骨颈骨折关节置换患者的手术结果有显著影响。全面的术前营养评估对于改善术后结果至关重要。
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