李涛;史占军;王健;吴宣平;

• 1:南方医科大学南方医院关节与骨病外科

摘要(Abstract)：

关节置换围手术期营养状态长期被低估,为了总结现有的关节置换围手术期营养状态、并发症以及治疗现状,检索PubMed、MEDLINE、Cochrane、EMBASE、CINAHL数据库中现有的关节置换围手术期营养状态相关研究,评价分析关节置换术围手术期营养状态以及相关并发症。结果表明初次TJA患者的术前营养不良比例为15%～30%,翻修患者营养不良比例更高,大多超过50%。营养不良患者关节置换术后总并发症比例显著升高,包括切口愈合不良、手术部位感染以及假体周围感染等,增加严重并发症发生率、住院时间及二次入院率。围手术期应当重视关节置换患者营养状态,从而减少关节置换术后并发症发生率。应进一步探索关节置换围手术期营养治疗的随机临床研究。

关键词(KeyWords)： 关节置换;营养状态;并发症

Abstract:

Keywords:

基金项目(Foundation): 广东省自然科学基金(编号:2016A030310398);; 南方医科大学南方医院院长基金(编号:2015C014)

作者(Author): 李涛;史占军;王健;吴宣平;

Email:

DOI:

参考文献(References)：

• [1]Anoushiravani AA,Sayeed Z,Chambers MC,et al.Assessing inhospital outcomes and resource utilization after primary total joint arthroplasty among underweight patients[J].J Arthroplasty,2016,31(7):1407-1412.
• [2]Ihle C,Freude T,Bahrs C,et al.Malnutrition-An underestimated factor in the inpatient treatment of traumatology and orthopedic patients:a prospective evaluation of 1055 patients[J].Injury,2017,48(3):628-636.
• [3]Pitto RP.CORR Insights(R):Is potential malnutrition associated with septic failure and acute infection after revision total joint arthroplasty[J].Clin Orthop,2015,473(1):183-184.
• [4]Riaz O,Arshad R,Nisar S,et al.Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture[J].Ann R Coll Surg Engl,2016,98(6):376-379.
• [5]Borens O,Thein E,Tissot C,et al.Prevention of perioperative infections in orthopaedic surgery-Role of general practitioner[J].Rev Med Suisse,2016,12(543):2164-2167.
• [6]Morey VM,Song YD,Whang JS,et al.Can Serum albumin level and total lymphocyte count be surrogates for malnutrition to predict wound complications after total knee arthroplasty[J].J Arthroplasty,2016,31(6):1317-1321.
• [7]Moon MS,Kim SS,Lee SY,et al.Preoperative nutritional status of the surgical patients in Jeju[J].Clin Orthop Surg,2014,6(3):350-357.
• [8]Schwarzkopf R,Lavery JA,Hooper J,et al.Bariatric surgery and time to total joint arthroplasty:does it affect readmission and complication rates[J].Obes Surg,2017,6(1):21-29.
• [9]Kamath AF,McAuliffe CL,Kosseim LM,et al.Malnutrition in joint arthroplasty:prospective study indicates risk of unplanned ICU admission[J].Arch Bone Joint Surg,2016,4(2):128-131.
• [10]Nicholson JA,Dowrick AS,Liew SM.Nutritional status and shortterm outcome of hip arthroplasty[J].J Orthop Surg(Hong Kong),2012,20(3):331-335.
• [11]Yi PH,Frank RM,Vann E,et al.Is potential malnutrition associated with septic failure and acute infection after revision total joint arthroplasty[J].Clin Orthop,2015,473(1):175-182.
• [12]Gherini S,Vaughn BK,Lombardi AV,Jr.,et al.Delayed wound healing and nutritional deficiencies after total hip arthroplasty[J].Clin Orthop,1993,293):188-195.
• [13]Jaberi FM,Parvizi J,Haytmanek CT,et al.Procrastination of wound drainage and malnutrition affect the outcome of joint arthroplasty[J].Clin Orthop,2008,466(6):1368-1371.
• [14]Greene KA,Wilde AH,Stulberg BN.Preoperative nutritional status of total joint patients.Relationship to postoperative wound complications[J].J Arthroplasty,1991,6(4):321-325.
• [15]Ihle C,Weiss C,Blumenstock G,et al.Interview based malnutrition assessment can predict adverse events within 6 months after primary and revision arthroplasty-a prospective observational study of351 patients[J].BMC Musculoskelet Disord,2018,19(1):83.
• [16]Dowsey MM,Choong PFM,Paxton EW,et al.Body mass index is associated with all-cause mortality after THA and TKA[J].Clin Orthop,2018,476(6):1139-1148.
• [17]Witasp A,Nordfors L,Schalling M,et al.Expression of inflammatory and insulin signaling genes in adipose tissue in response to elective surgery[J].J Clin Endocrinol Metab,2010,95(7):3460-3469.
• [18]Christensen P,Henriksen M,Bartels EM,et al.Long-term weightloss maintenance in obese patients with knee osteoarthritis:a randomized trial[J].Am J Clin Nutr,2017,106(3):755-763.
• [19]Mourtzakis M,Wischmeyer P.Bedside ultrasound measurement of skeletal muscle[J].Curr Opin Clin Nutr Metab Care,2014,17(5):389-395.
• [20]Marin LA,Salido JA,Lopez A,et al.Preoperative nutritional evaluation as a prognostic tool for wound healing[J].Acta Orthop Scand,2002,73(1):2-5.
• [21]Font-Vizcarra L,Lozano L,Rios J,et al.Preoperative nutritional status and post-operative infection in total knee replacements:a prospective study of 213 patients[J].Int J Artif Organs,2011,34(9):876-881.
• [22]Blevins K,Aalirezaie A,Shohat N,et al.Malnutrition and the development of periprosthetic joint infection in patients undergoing primary elective total joint arthroplasty[J].J Arthroplasty,2018,29(1):120-121.
• [23]Bohl DD,Shen MR,Kayupov E,et al.Hypoalbuminemia independently predicts surgical site infection,pneumonia,length of stay,and readmission after total joint arthroplasty[J].J Arthroplasty,2016,31(1):15-21.
• [24]Kamath AF,Nelson CL,Elkassabany N,et al.Low Albumin is a risk factor for complications after revision total knee arthroplasty[J].J Knee Surg,2017,30(3):269-275.
• [25]Golladay GJ,Satpathy J,Jiranek WA.Patient optimization-strategies that work:malnutrition[J].J Arthroplasty,2016,31(8):1631-1634.
• [26]Purcell S,Thornberry R,Elliott SA,et al.Body composition,strength,and dietary intake of patients with hip or knee osteoarthritis[J].Can J Diet Pract Res,2016,77(2):98-102.
• [27]Sayeed Z,Anoushiravani AA,Chambers MC,et al.Comparing inhospital total joint arthroplasty outcomes and resource consumption among underweight and morbidly obese patients[J].J Arthroplasty,2016,31(10):2085-2090.
• [28]Ljunggren S,Hahn RG,Nystrom T.Insulin sensitivity and betacell function after carbohydrate oral loading in hip replacement surgery:a double-blind,randomised controlled clinical trial[J].Clin Nutr,2014,33(3):392-398.
• [29]Nishizaki K,Ikegami H,Tanaka Y,et al.Effects of supplementation with a combination of beta-hydroxy-beta-methyl butyrate,L-arginine,and L-glutamine on postoperative recovery of quadriceps muscle strength after total knee arthroplasty[J].Asia Pac J Clin Nutr,2015,24(3):412-420.