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营养状况与人工股骨头置换术后伤口愈合的相关性研究
作者:王丽平  柏天婷  付丹妹  刘国印 
单位:南京医科大学金陵临床医学院 骨科, 江苏 南京 210000
关键词:股骨颈骨折 营养不良 糖尿病 人工股骨头置换术 伤口延迟愈合 
分类号:R687.4;R683.42
出版年·卷·期(页码):2023·42·第六期(831-840)
摘要:

目的:探讨老年股骨颈骨折患者的营养状况与人工股骨头置换术后伤口愈合之间的关联性。方法:前瞻性研究2017年6月至2021年6月接诊的股骨颈骨折患者170例,均采用人工股骨头置换治疗,平均年龄(83.16±8.57)岁。根据微型营养评价精法(MNA-SF)评分和糖尿病筛查分为营养正常组(42例)、营养正常+糖尿病组(36例)、营养不良组(52例)和营养不良+糖尿病组(40例)。研究MNA-SF评分与血清学指标评价营养不良发生率(IM) 间的相关性,并分析伤口愈合延迟与血清学指标和MNA-SF评分间的相关性。结果:白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRA)和淋巴细胞百分比(TLP)在评估营养不良上与MNA-SF评分结果呈正相关(P<0.05)。术前合并营养不良的患者在行人工股骨头置换术后血清学指标会进一步降低,且ALB、PA、TRA和TLP下降更明显(P<0.05)。术后伤口延迟愈合总共发生52例,其中营养正常组2例(4.76%),营养正常+糖尿病组3例(8.33%),营养不良组21例(40.38%),营养不良+糖尿病组26例(65.00%),各组之间差异有统计学意义(P<0.05)。经手术前的MNA-SF和ALB、PA、TRA、TLP评估的IM,在延迟愈合组中均明显高于正常愈合组(P<0.05);延迟愈合组手术后经所有血清学指标评定的IM,较术前及正常愈合组均有显著改善(P<0.05)。伤口延迟愈合的发生与MNA-SF评分及ALB、PA、TRA和TLP评估之间具有正性关系(P<0.05)。结论:MNA-SF评分和ALB、PA、TRA、TLP可以作为评估营养状况和预测伤口愈合情况的重要指标。

Objective: To investigate the relationship between nutritional status and wound healing after artificial femoral head replacement in elderly patients with femoral neck fracture. Methods: The medical records of 170 patients with femoral neck fracture admitted from June 2017 to June 2021 were prospectively analyzed. All patients were treated with artificial femoral head replacement, and with an average age of(83.16±8.57) years. According to mini-nutritional assessment short-form(MNA-SF) score and screening for diabetes, patients were divided into normal nutrition group(n=42), normal nutrition and diabetes group(n=36), malnutrition group(n=52), and malnutrition and diabetes group(n=40). The correlation between the MNA-SF score and the incidence of malnutrition(IM) assessed by serological indicators was studied in each group, and the correlation between delayed wound healing and MNA-SF score or serum nutritional indicators was analyzed. Results: The ALB, PA, TRA and TLP were positively correlated with MNA-SF score in the assessment of malnutrition(P<0.05). The serological indicators of patients with preoperative malnutrition after artificial femoral head replacement were further decreased, and the ALB, PA, TRA and TLP decreased more significantly(P<0.05). A total of 52 cases of delayed wound healing occurred, including 2 cases(4.76%) in the normal nutrition group, 3 cases(8.33%) in the normal nutrition and diabetes group, 21 cases(40.38%) in the malnutrition group, and 26 cases(65.00%) in the malnutrition and diabetes group, and the differences among the groups were significant(P<0.05). The IM assessed by preoperative MNA-SF and ALB, PA, TRA,TLP in the delayed wound healing group was significantly higher than that in the normal healing group(P<0.05). The postoperative IM in the delayed healing group was significantly higher than that in preoperative and normal healing group(P<0.05). The occurrence of delayed wound healing was positively correlated with MNA-SF score, ALB, PA, TRA and TLP assessment(P<0.05). Conclusion: MNA-SF score, ALB, PA, TRA and TLP can be used as important indicators to evaluate nutritional status and to predict wound healing.

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