摘要
目的 探讨 CT 评估胸大肌参数对老年肋骨骨折术后肺部并发症的预测价值.方法 选取 2021 年 1 月—2023 年 10 月因肋骨骨折于天津市天津医院行手术治疗的105 例老年患者,术后根据是否发生肺部并发症分为并发症组(28 例)和无并发症组(77 例),利用 CT 测算患者的胸大肌参数,包括胸大肌指数(PMI)及胸大肌密度(PMD);采用多因素 logistic 回归分析老年肋骨骨折患者一般资料及胸大肌参数对老年肋骨骨折术后肺部并发症发生的预测价值.结果 术后发生肺部并发症的有 28 例,发生率为 26.7%.单因素 logistic 回归模型分析结果显示,年龄≥70 岁、有吸烟史、有肺部基础疾病史、病程≥72 h、肋骨骨折≥5 根均可导致老年肋骨骨折患者术后产生肺部并发症(P<0.05);多因素 logistic 回归分析结果显示,年龄≥70 岁、有吸烟史、有肺部基础疾病史、病程≥72 h、肋骨骨折数量≥5 根,双侧肋骨骨折及 PMI、PMD 均是导致老年肋骨骨折患者术后出现肺部并发症的独立危险因素(P<0.05).ROC曲线分析结果表明,PMD预测肋骨骨折术后发生肺部并发症的曲线下面积为0.832(95%CI:0.746～0.918),PMI 预测肋骨骨折术后发生肺部并发症的曲线下面积为 0.732(95%CI:0.773～0.937),两者对于患者肋骨骨折术后是否发生肺部并发症均有不错的预测效果.结论 通过 CT 评估患者的胸大肌参数是预测患者术后是否发生肺部并发症的有效工具,根据患者的预测结果及时调整患者的治疗方案对于改善患者预后具有重要意义.
Abstract
Objective To investigate the predictive value of CT evaluation of pectoralis major muscle parameters for pul-monary complications after rib fracture surgery in the elderly.Methods A total of 105 elderly patients who underwent surgical treat-ment for rib fracture at Tianjin Hospital in Tianjin,China,from January 2021 to October 2023 were selected.Postoperatively,pa-tients were divided into a complication group(28 cases)and a non-complication group(77 cases)based on whether pulmonary complications occurred.Upon admission,general information such as gender,age,height,smoking history,presence of underlying respiratory diseases,and disease course were recorded for both groups.The pectoralis major index and density(PMI,PMD)were measured using CT scans.Multivariate logistic regression analysis was used to investigate the predictive value of general patient infor-mation and pectoralis major muscle parameters for postoperative pulmonary complications in elderly patients with rib fracture.Results Postoperative pulmonary complications occurred in 28 patients(26.7%).Univariate logistic regression model analysis showed that age≥70 years,smoking history,history of underlying pulmonary diseases,disease duration≥72 hours,and rib fractures≥5 could lead to postoperative pulmonary complications in elderly patients with rib fractures(P<0.05);multivariate logistic regression analysis showed that age≥70 years,smoking history,history of underlying pulmonary diseases,disease duration≥72 hours,and number of rib fractures≥5,bilateral rib fractures and PMI and PMD were all independent risk factors leading to postoperative pul-monary complications in elderly patients with rib fractures(P<0.05).The results of ROC curve analysis showed that the area un-der the curve of PMD in predicting pulmonary complications after rib fracture surgery was 0.832(95%CI:0.746-0.918),and the area under the curve of PMI in predicting pulmonary complications after rib fracture surgery was 0.732(95%CI:0.773-0.937),both of which had a good predictive effect on whether pulmonary complications occurred after rib fracture surgery in pa-tients.Conclusion Assessing pectoralis major muscle parameters by CT is an effective tool to predict whether patients develop pul-monary complications after surgery,and timely adjustment of patients'treatment options according to patients'prediction results is of great significance in improving patients'prognosis.
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