Correlation between CT imaging-derived hip muscle factors and recovery of independent mobility within 1 year after surgery in older adults with hip fractures
Objective To explore the correlation between hip muscle factors measured with CT imaging and recovery of independent mobility within 1 year after surgery in elderly patients with hip fractures.Methods A prospective cohort study was conducted on the clinical data of 680 elderly patients with hip fractures admitted to Beijing Jishuitan Hospital of Capital Medical University from November 2018 to December 2019.The patients were assigned to dependent group and assistant group according to whether they regained pre-injury independent mobility within 1 year after surgery.Gender,age,body mass index,personal history,living habits,past diseases,Charlson comorbidity index,laboratory test indicators,fracture types,anesthesia types,surgical methods,rehabilitation training,time from injury to surgery,and hip muscle parameters in both groups were recorded.OsiriX software was employed in the measurement of the hip muscles to measure the muscle area and density of the gluteus maximus and gluteus medius/minimus on CT images,and the average values were calculated as hip muscle area and density.Then the variables of hip muscle area and density were converted seperately to gender-normalized Z-scores,and were divided into high-area group(Z≥0)and low-area group(Z＜0),and high-density group(Z≥0)and low-density group(Z＜0)respectively.Observable variables were primarily analyzed using univariate analysis between the independent group and assistant group.Those variables with statistically significant differences in the univariate analysis or would potentially affect mobility recovery according to previous researches although there were no statistical significance were included in a multivariate Logistic regression analysis.Three Logistic regression models were designed(Model 1 uncorrected,Model 2 corrected for gender,age and body mass index,Model 3 corrected for variables in Model 2 and other variables included after above-mentioned analysis)to analyze whether muscle parameters were risk factors for recovery of independent mobility.Additionally,generalized estimating equations were used for repeated measurement to analyze the correlation between hip muscle area and recovery of independent mobility after surgery.Results Compared to the assistant group,the independent group were younger in age,with lower rate of living alone,being housebound,cognitive impairment,and Charlson comorbidity index,lower level of hemoglobin and albumin,higher rate of femoral neck fractures,lower rate of internal fixation,shorter time from injury to surgery,larger hip muscle area,and higher hip muscle density(P＜0.05 or 0.01).Multivariate Logistic regression analysis showed that,in the fully corrected Model 3,only hip muscle area remained significantly correlated with recovery of independent mobility(P＜0.05),while no significant difference was found between the high-density group and low-density group(P＞0.05).In the repeated measurement,patients in the high-area group were 1.84 times more likely to restore independent mobility than those in the low-area group(OR=1.84,95％CI 1.33,2.53,P＜0.01).Conclusions Hip muscle area measured with CT imaging is closely correlated to the recovery of independent mobility within 1 year after surgery in elderly patients with hip fractures.Moreover,larger hip muscle area indicates a larger likelihood of recovery of independent mobility.
Hip fracturesTomography,spiral computedMusclesWalkingAged
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