摘要
目的 研究改良衰弱指数(mFI-5)对老年全膝关节置换术(TKA)术后早期并发症的应用价值,为老年TKA围手术期患者的干预提供参考依据,减少TKA术后早期并发症的发生率。方法 回顾性分析2021年1月至2023年2月河北大学附属医院骨科年龄≥65岁的238例老年TKA患者的病例资料。根据mFI-5量表分为mFI-5≥2分为衰弱组(n=70),mFI-5<2分为非衰弱组(n=168)。比较2组患者性别、BMI、吸烟、饮酒、手术部位和手术时间等基础资料,对差异具有统计学意义的基础资料与术后并发症进行多因素logistic回归分析与ROC曲线的绘制。比较2组患者mFI-5变量(COPD或慢性肺炎既往史、心衰既往史、需服用药物的高血压病史、2型糖尿病、非独立功能状态)、术后肿胀程度、视觉模拟评分法(VAS)和美国膝关节协会评分(AKS),对术后早期并发症进行单因素分析与多因素logistic回归分析,并对差异具有统计学意义的早期并发症绘制ROC曲线。结果 手术时间是术后感染和术后谵妄的独立危险因素(P<0.05)。ROC曲线显示:术后谵妄ROC曲线下与坐标轴围成的面积(AUC)=0.933,术后感染AUC=0.908(P<0.05)。衰弱组mFI-5的5个变量的发生情况、VAS评分和肿胀程度评分高于非衰弱组,AKS评分低于非衰弱组(P<0.05)。多因素logistic回归分析显示,衰弱是深静脉血栓(DVT)、术后感染、术后谵妄的独立危险因素(P<0.05)。ROC曲线显示术后谵妄AUC=0.670、术后感染AUC=0.758、DVT的AUC=0.746,具有统计学意义(P<0.05)。结论 mFI-5对老年TKA患者术后早期并发症有临床预测与应用价值,可以为老年TKA患者术前干预及评估预后提供参考,且mFI-5≥2分是预测TKA术后早期并发症的有效指标。
Objective Research on the application value of the Modified Frailty Index(mFI-5)for early postoperative com-plications of total knee arthroplasty(TKA)in elderly patients,providing reference for perioperative intervention of TKA patients and reducing the incidence of early postoperative complications.Methods Retrospective analysis of case data from 238 elderly TKA pa-tients aged 65 years or older in the Department of Orthopedics at Hebei University Affiliated Hospital from January 2021 to February 2023.According to the mFI-5 scale,patients with mFI-5≥2 were classified as the frailty group(n=70),while those with mFI-5<2 were classified as the non frailty group(n=168).Basic data such as gender,BMI,smoking,drinking,surgical site and operation time were compared between the two groups,and the basic data with statistical significance and postoperative complications were analyzed by multi-variate logistic regression analysis and ROC curve was drawn.mFI-5 variables(previous history of COPD or chronic pneumonia,previous history of heart failure,history of hypertension requiring medication,type 2 diabetes,independent functional status),postoperative swell-ing,visual analogue scale(VAS),and American Knee Association score(AKS)were compared between the two groups.Univariate analy-sis and multivariate logistic regression analysis were performed for ear-ly postoperative complications,and ROC curves were drawn for early complications with statistically significant differences.Results Surgical time is an independent risk factor for postoperative infection and postoperative delirium(P<0.05).The ROC curve showed that the area enclosed by the coordinate axis under the ROC curve for postoperative delirium(AUC)was 0.933,and the AUC for post-operative infection was 0.908(P<0.05).The incidence,VAS score,and swelling degree score of the five variables of mFI-5 in the frail-ty group were higher than those in the non frailty group,while AKS score was lower than that in the non frailty group(P<0.05).Multi-variate logistic regression analysis showed that frailty was an independent risk factor for deep vein thrombosis(DVT),postoperative in-fection,and postoperative delirium(P<0.05).The ROC curve showed postoperative delirium AUC=0.670,postoperative infection AUC=0.758,and DVT AUC=0.746,with statistical significance(P<0.05).Conclusion MFI-5 has clinical prediction and application val-ue for early postoperative complications in elderly TKA patients,which can provide reference for preoperative intervention and progno-sis evaluation of elderly TKA patients.Moreover,mFI-5 score≥2 is an effective indicator for predicting early postoperative complica-tions in TKA patients.
作者
张印恩
马铮
倪国骅
焦建宝
ZHANG Yinen;MA Zheng;NI Guohua;JIAO Jianbao(Department of Orthopaedics,The First Affiliated Hospital of Henan University of Technology,Jiaozuo 454001,Henan,China;Department of Orthopaedics,Affiliated Hospital of Hebei University,Baoding 071000,Hebei,China)
出处
《医学研究与战创伤救治》
CAS
北大核心
2024年第6期593-597,共5页
Journal of Medical Research & Combat Trauma Care
基金
河北省卫健委青年科技项目(20220638)。
关键词
改良衰弱指数
全膝关节置换术
并发症
the modified 5-item frailty index
total knee arthroplasty
complication
