【摘要】 目的探究FRAIL衰弱量表在行初次全膝关节置换术(total knee arthroplasty, TKA)老年患者中的临床应用效果。方法回顾性分析2017年1月至2020年11月于北京市海淀医院骨科行初次TKA手术治疗的518例老年患者的临床资料,其中男311例,女207例;年龄60～79岁,平均(69.4±6.1)岁,随访患者术后30 d内并发症(切口感染、假体周围感染、心肌梗死、恶性心律失常、肺栓塞、脑梗死、肺炎、术后谵妄和泌尿系感染)发生情况。采用FRAIL量表评估老年患者入院时的衰弱状况。采用logistic回归模型分析FRAIL量表各组评分以及FRAIL量表诊断的衰弱与短期并发症发生风险的关系。结果 93例(18.0%)患者经FRAIL量表评估为衰弱,182例(35.1%)患者为衰弱前期,243例(46.9%)患者为健康。共16例(3.1%)患者出现术后短期并发症,其中衰弱组7例(7.5%),衰弱前期组5例(2.7%),健康组4例(1.6%)。多因素logistic回归分析显示,FRAIL衰弱组评分中,阻力增加/耐力减退(OR=1.52,95%CI:1.02～2.28)、疾病情况(OR=1.75,95%CI:1.08～2.82)和体重下降(OR=1.66,95%CI:1.00～2.76)均与术后短期并发症的发生显著相关;衰弱患者发生术后短期并发症的风险显著增加(OR=4.86,95%CI:1.39～17.03)。结论在行初次TKA的老年患者中,衰弱患者发生术后短期并发症的风险显著增高。FRAIL量表可应用于行初次TKA的老年患者中以识别术后发生短期并发症的高危人群。更多还原

【Abstract】 Objective To explore the clinical use of FRAIL scale mong older patients of primary total knee arthroplasty(total knee arthroplasty, TKA).Methods Aretrospective analysis of clinical data of 518 older patients(311 males, 207 females, age range 60～79 years, and mean age(69.4±6.1)years, who received treatment of primary TKA between Jan 2017 and November 2020 in orthopedics department of Beijing Haidian Hospital was performed.A 30 days follow-up work for complications(incisional infection, periprosthetic infection, myocardial infarction, malignant arrhythmias, pulmonary embolism, cerebral infarction, pneumonia, postoperative delirium, and urinary infection)after surgery was conducted for all included patients.FRAIL scale was used to assess the frail status of included patientson admission.Logistic regression analysis was performed to examine the association between components of FRAIL scale and frailty diagnosed by FRAIL scale with the risk of short-term complications.Results 93 patients(18.0%)were diagnosed with frailty, 182 patients(35.1%)were pre-frail and 243 patients(46.9%)were robust.In total, 16 patients(3.1%)experienced short-term complications.Among them, 7 patients(7.5%)belonged to frail group, 5 patients(2.7%)belonged to pre-frail group and 4 patients(1.6%)belonged to robust group.The multivariate logistic regression analyses showed that resistance(OR=1.52,95%CI:1.02～2.28),illnesses(OR=1.75,95%CI:1.08～2.82)and loss of weight(OR=1.66,95%CI:1.00～2.76)were associated with higher risk of short-term complications after primary TKA.Frail patients(OR=4.86,95%CI:1.39～17.03)had significantly higher risk of short-term complications after primary TKA.Conclusion Among older patients received primary TKA,those frail patients have higher risk of short-term complications.FRAIL scale can be used in clinical practice for older patients of primary TKA to identify those have higher risk of short-term complications.更多还原