股骨粗隆间骨折高龄患者经PFNA内固定术治疗后肠内营养状态评分及其预后预测价值研究  

Nutritional status assessment and prognostic value in elderly patients with intertrochanteric femur fractures undergoing PFNA internal fixation

作　　者：张爽 刘杨 王晓玲 Zhang Shuang;Liu Yang;Wang Xiaoling(Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100000,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100000 [2]北京市海淀区妇幼保健院超声科

出　　处：《中华保健医学杂志》2024年第2期206-210,共5页Chinese Journal of Health Care and Medicine

基　　金：吴阶平医学基金会临床科研专项资助基金课题(320.6750.18528)。

摘　　要：目的探究股骨粗隆间骨折高龄(≥80岁)患者经股骨近端钉抗扭转系统(PFNA)内固定术治疗后肠内营养状态评分及其预后预测价值。方法选取2020~2022年首都医科大学附属北京友谊医院收治的86例股骨粗隆间骨折老年PFNA内固定术患者。回顾性收集所有患者临床相关资料,对患者进行营养风险和营养不足、综合评价患者手术最近1周的进食量是否下降及其感染性并发症评估。统计老年高龄患者的不良预后,对死亡组与生存组进行单因素分析,并且进行危险因素分析,对营养风险筛查工具(numerical rating scale 2002,NRS 2002)、单核细胞与淋巴细胞比值(monocyte-to-lymphocyte ratio,MLR)的预测价值进行评价。结果60~69岁、70~79岁和≥80岁3个年龄组中有营养风险的患者分别为8、16、39例,其中,≥80岁组中有营养风险患者人数占比最多,达到了90.70%(3943)。较高的营养风险等级与感染性并发症的发生以及延长的住院时间密切相关(P<0.05)。43例老年高龄患者预后死亡9例,占20.93%,单因素结果显示,死亡组患者年龄、APACHEⅡ评分、NRS 2002评分、MLR和冠心病比例明显高于生存组(P<0.05)。NRS 2002评分、MLR对高龄患者不良预后的曲线下面积(AUC)分别为0.801和0.816,而两者联合对不良预后的AUC值达0.915。结论股骨粗隆间骨折高龄患者经PFNA内固定术治疗后普遍存在营养不良。年龄、疾病严重程度、营养风险和炎症反应与不良预后存在密切关联。临床应充分考虑患者的年龄、健康状况和营养状况,采取个性化的治疗和康复措施,以提高预后和生存质量。同时,NRS 2002评分和MLR在预测接受PFNA内固定术治疗的高龄股骨粗隆间骨折患者术后死亡方面具有较好的预测价值,联合应用这两个指标可以更准确地评估患者的预后风险。Objective This study aimed to explore the nutritional status assessment and prognostic value in elderly patients with intertrochanteric femur fractures undergoing PFNA(proximal femoral nail antirotation)internal fixation.Methods 86 elderly patients with intertrochanteric fractures treated with PFNA internal fixation from 2020 to 2022 in our hospital were selected for prognosis observation.A retrospective study was conducted to collect clinical data,assess nutritional risk and deficiency,comprehensively evaluate the decrease in food intake in the past week before surgery,and assess infectious complications.The adverse prognosis of elderly patients was also recorded.Single-factor analysis was performed on the survival group and the death group,and risk factors were analyzed.The predictive value of NRS 2002(numerical rating scale 2002)was evaluated.Results In the three age groups of 60~69 years,70~79 years and≥80 years,the proportion of patients at nutritional risk is 9.30%(886),18.60%(1686)and 45.34%(3986)respectively.Among them,≥80 years old group has the highest proportion of patients at nutritional risk,reaching 90.70%(3943).At the same time,the older the age,the more patients at nutritional risk tend to increase.,respectively.Higher nutritional risk was closely related to the occurrence of infectious complications and prolonged hospital stays(P<0.05).Prognosis statistics for elderly patients showed that 9 patients died,accounting for 20.93%.Single-factor analysis showed that in the death group,age,APACHEⅡscore,NRS 2002 score,and MLR were significantly higher than in the survival group(P<0.05),and the incidence of coronary heart disease was also slightly higher than in the survival group(P<0.05).The NRS 2002 score and MLR had good predictive value for adverse prognosis.The AUC of the NRS 2002 score and MLR were 0.801 and 0.816,respectively,with high sensitivity and specificity.In addition,when these two indicators were combined together,their predictive value was further improved,with an AUC of 0.915.Concl

关 键 词：股骨粗隆间骨折 高龄 股骨近端钉抗扭转系统内固定术内固定术 营养状态评分 预后 

分 类 号：R68[医药卫生—骨科学]