摘要
目的探讨基于CT影像测量的髋部肌肉因素与老年髋部骨折术后1年内独立行动能力恢复的相关性。方法采用前瞻性队列研究分析2018年11月至2019年12月首都医科大学附属北京积水潭医院收治的680例老年髋部骨折患者的临床资料。根据患者术后1年内是否恢复至伤前独立行动能力分为独立组和辅助组。记录两组性别、年龄、体重指数、个人史、居住习惯、既往疾病、Charlson合并症指数、实验室检验指标、骨折类型、麻醉类型、手术方式、参与康复训练、受伤至手术时间、髋部肌肉参数。髋部肌肉测量时,采用Osirix软件分别测量CT影像中臀大肌及臀中小肌的肌肉面积和密度,计算平均值并记作为髋部肌肉面积和肌肉密度;后将两类参数分别作性别校正后的Z-score标准化处理,以Z=0将髋部肌肉面积和密度分别分为高面积组(Z≥0)、低面积组(Z<0)和高密度组(Z≥0)、低密度组(Z<0)。首先,按照独立组和辅助组对观察变量进行单因素分析,将差异有统计学意义的变量,或者差异无统计意义但根据前期研究仍可能影响行动能力恢复的变量纳入多因素Logistic回归模型。设计三组Logistic回归模型[模型1不校正,模型2对性别、年龄及体重指数进行校正,模型3对模型2中变量及上述分析后纳入的变量进行校正]分析肌肉参数是否为独立行动能力恢复的危险因素。采用经广义估计方程的重复测量分析髋部肌肉面积与术后独立行动能力恢复的相关性。结果与辅助组比较,独立组年龄更小,独居和长期居家不出比率、认知损害比率、Charlson合并症指数比率及血红蛋白和白蛋白水平更低,股骨颈骨折比率更高,内固定术比率更低,受伤至手术时间更短,髋部肌肉面积更大,髋部肌肉密度值更高(P<0.05或0.01)。多因素Logistic回归分析结果表明,在充分校正混杂变量的模型3中,仅有髋部肌肉面积仍保持与�
Objective To explore the correlation between hip muscle factors measured with CT imaging and recovery of independent mobility within 1 year after surgery in elderly patients with hip fractures.Methods A prospective cohort study was conducted on the clinical data of 680 elderly patients with hip fractures admitted to Beijing Jishuitan Hospital of Capital Medical University from November 2018 to December 2019.The patients were assigned to dependent group and assistant group according to whether they regained pre-injury independent mobility within 1 year after surgery.Gender,age,body mass index,personal history,living habits,past diseases,Charlson comorbidity index,laboratory test indicators,fracture types,anesthesia types,surgical methods,rehabilitation training,time from injury to surgery,and hip muscle parameters in both groups were recorded.OsiriX software was employed in the measurement of the hip muscles to measure the muscle area and density of the gluteus maximus and gluteus medius/minimus on CT images,and the average values were calculated as hip muscle area and density.Then the variables of hip muscle area and density were converted seperately to gender-normalized Z-scores,and were divided into high-area group(Z≥0)and low-area group(Z<0),and high-density group(Z≥0)and low-density group(Z<0)respectively.Observable variables were primarily analyzed using univariate analysis between the independent group and assistant group.Those variables with statistically significant differences in the univariate analysis or would potentially affect mobility recovery according to previous researches although there were no statistical significance were included in a multivariate Logistic regression analysis.Three Logistic regression models were designed(Model 1 uncorrected,Model 2 corrected for gender,age and body mass index,Model 3 corrected for variables in Model 2 and other variables included after above-mentioned analysis)to analyze whether muscle parameters were risk factors for recovery of independent mobility.Add
作者
葛宇峰
高峰
涂超
王玲
刘刚
张雯双
朱仕文
杨明辉
吴新宝
Ge Yufeng;Gao Feng;Tu Chao;Wang Ling;Liu Gang;Zhang Wenshuang;Zhu Shiwen;Yang Minghui;Wu Xinbao(Department of Orthopedics and Traumatology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Department of Radiology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2024年第6期531-538,共8页
Chinese Journal of Trauma
基金
首都卫生发展科研专项(2018-1-2071,2022-1-2071)
北京市卫生健康委员会第五批北京市属医学科研院所公益发展改革试点项目(京医研2023-11,京医研2023-8)
国家自然科学基金(82072445)。
