老年髋部骨折患者术后髋关节功能恢复的影响因素及股骨颈强度指数和骨髓脂质分数的预测价值

Influencing factors of functional recovery of hip joint after operation in elderly patients with hip fracture and predictive value of FSI and LF

摘要:

目的 研究老年髋部骨折患者术后髋关节功能恢复的影响因素及股骨颈强度指数（FSI）和骨髓脂质分数（LF）的预测价值。方法 选取2016年10月—2019年2月河北省沧州中西医结合医院176例老年髋部骨折手术患者，参考Harris髋关节评分标准，分为恢复良好组90例，恢复不佳组86例。采用回顾性研究方法观察术后两组患者相关资料，监测FSI和LF变化，采用Logistic回归分析老年髋部骨折患者术后髋关节功能恢复的影响因素；绘制受试者工作特征（ROC）曲线，明确FSI和LF变化对老年髋部骨折患者术后髋关节功能恢复的早期预测价值。结果 恢复良好组患者年龄、骨折部位、基础疾病、巴塞尔评定、术后并发症、术后关节康复训练与恢复不佳组患者比较，差异有统计学意义（P <0.05）。恢复良好组患者术后3个月与术前的FSI和LF差值均大于恢复不佳组患者（P <0.05）。多因素Logistic回归分析结果显示：基础疾病［O^R=4.259（95% CI：1.712，10.595）］、巴塞尔评定［O^R=3.736（95% CI：1.159，12.039）］、术后并发症［O^R=6.297（95% CI：1.866，21.225）］，以及术后3个月的FSI［O^R=5.894（95% CI：1.567，22.175）］、LF［O^R=5.749（95% CI：1.679，19.685）］是影响老年髋部骨折患者术后髋关节功能恢复的风险因素（P <0.05），术后关节康复训练［O^R=0.103（95% CI：0.025，0.422）］是其保护因素（P <0.05）。ROC曲线分析结果显示，FSI早期预测老年髋部骨折患者术后髋关节功能恢复的AUC为0.790，截断值为1.01时，敏感性为70.0%（95% CI：0.593，0.790），特异性为69.8%（95% CI：0.588，0.790）；LF早期预测老年髋部骨折患者术后髋关节功能恢复的AUC为0.739，截断值为26.18％时，敏感性为70.0%（95% CI：0.593，0.790），特异性为67.4%（95% CI：0.564，0.769）；两者联合预测的AUC为0.833，敏感性为76.7%（95% CI：0.663，0.847），特异性为72.1%（95%CI：0.612，0.810）。结论 加强对具有风险因素人群监测并观察FSI和LF变化，利于早期预测老年髋部骨折患者术后髋关节功能恢复，从而制订相应防控措施，促进患者早日康复。

Abstract:

Objective To study the factors influencing the functional recovery of hip joint and the predictive value of femoral neck strength index (FSI) and bone marrow lipid fraction (LF) in elderly patients with hip fracture after operation.Methods Totally 176 elderly patients with hip fracture were selected from October 2016 to February 2019. According to Harris hip score, 90 patients with good recovery were in good recovery group, and 86 patients with poor recovery were in poor recovery group. A retrospective study was conducted to observe the related data of two groups of patients after operation, to monitor the changes of FSI and LF levels, and to analyze the influencing factors of hip function recovery in elderly patients with hip fracture by logistic analysis. The ROC curve was drawn to determine the early predictive value of FSI and LF for hip function recovery in elderly patients with hip fracture after operation.Results There were significant differences in age, fracture site, basic disease, Basel evaluation, postoperative complications, and types of joint rehabilitation training between patients with good recovery and those with poor recovery (P < 0.05). The difference value of FSI and LF levels in patients with good recovery after 3 months and before operation were higher than those in patients with poor recovery (P < 0.05). Binary logistic regression analysis showedthat basic diseases [O^R = 4.259 (95% CI: 1.712, 10.595) ], Basel assessment [O^R = 3.736 (95% CI：1.159, 12.039) ], post-operative complications [O^R = 6.297 (95% CI: 1.866, 21.225) ], FSI [O^R = 5.894 (95% CI: 1.567, 22.175) ], and LF levels changed [O^R = 5.749 (95% CI: 1.679, 19.685) ] at 3 months after surgery were risk factors affecting the recovery of hip function in elderly patients with hip fracture (P <0.05), and post-operative rehabilitation training [O^R = 0.103 (95% CI: 0.025, 0.422) ] was its protective factor (P < 0.05). ROC curve analysis results showed that the AUC of FSI difference value predicted in the early stage was 0.790. When the cutoff value was 1.01, the sensitivity and specificity were 70.0% (95% CI: 0.593, 0.790) and 69.8%(95% CI: 0.588, 0.790). The AUC of LF level difference value predicted in the early stage was 0.739. When the truncation value was 26.18%, the sensitivity and specificity were 70.0% (95% CI: 0.593, 0.790) and 67.4% (95% CI: 0.564, 0.769). The combined predicted AUC was 0.833, sensitivity and specificity were 76.7% (95% CI: 0.663, 0.847) and 72.1% (95% CI: 0.612, 0.810).Conclusion Strengthening the monitoring of risk factors and observing the changes of FSI and LF levels are helpful for early prediction of hip function recovery in elderly patients with hip fracture after operation, so as to formulate corresponding prevention and control measures and promote early recovery of patients.