| 孙延桃,方玮,杨文贵,等.股骨颈骨折病人行初次髋关节置换术前血红蛋白水平与住院时间的相关性.骨科,2026,17(2): 123-127. |
| 股骨颈骨折病人行初次髋关节置换术前血红蛋白水平与住院时间的相关性 |
| Correlation between hemoglobin level before primary hip replacement and hospital stay in patients with femoral neck fractures |
| 投稿时间：2025-04-22 |
| DOI：10.3969/j.issn.1674-8573.2026.02.005 |
| CN KeyWords: 髋关节置换术 血红蛋白 住院时间 术前贫血 年龄 糖尿病 非线性相关 阈值效应 围术期管理 |
| EN KeyWords: Hip arthroplasty Hemoglobin Hospital stay Preoperative anemia Age Diabetes Nonlinear correlation Threshold effect Perioperative management |
| Fund Project:南京市卫生科技发展专项资金资助项目（ZDXX25215）；南京市医学科技发展基金项目（YKK21216） |
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| CN Abstract: |
| 目的 探讨股骨颈骨折病人行初次髋关节置换术（HA）前血红蛋白（Hb）水平与住院时间的相关性，并分析其他潜在影响因素。方法 回顾性纳入2018年1月至2022年6月南京梅山医院213例初次HA手术病人。通过医院电子病历系统收集人口学资料（性别、年龄、身体质量指数、吸烟等）、临床指标（Hb水平、血糖、肌酐等）及住院时间。采用单因素和多因素线性回归分析来验证术前Hb水平与住院时间的相关性，并通过平滑曲线拟合和分段线性回归模型探索两者间的非线性关系及Hb的预测拐点。同时，评估年龄、糖尿病、手术时间等其他因素对住院时间的影响。结果 单因素分析显示，住院时间与术前Hb水平呈负相关（β=-0.05，P=0.006），与年龄（β=0.12，P=0.001）和糖尿病（β=1.55，P=0.016）呈正相关。多因素调整后，术前Hb水平仍与住院时间呈独立负相关（β=-0.39，P=0.038）；此外，贫血病人的住院时间较非贫血者延长1.27 d（P=0.026）。非线性分析发现，术前Hb水平与住院时间存在拐点（102 g/L）：当Hb＜102 g/L时，住院时间随Hb降低显著延长（β=-0.29，P=0.002），而在Hb≥102 g/L时无显著关联（P＞0.05）。其他因素中，手术时间与住院时间呈边缘正相关（β=0.01，P=0.083），但性别、身体质量指数、吸烟、手术类型（全髋/半髋）等与住院时间无显著关联（P＞0.05）。结论 术前Hb水平是HA病人住院时间的独立影响因素，且存在阈值效应（拐点102 g/L）。此外，年龄增长、糖尿病及手术时间延长可能间接延长住院时间。临床需重点关注术前贫血、老年及糖尿病病人，综合管理以优化住院时间。 |
| EN Abstract: |
| Objective To explore the correlation between the preoperative hemoglobin (Hb) level and hospital stay in patients with femoral neck fractures who underwent primary hip arthroplasty (HA), and to analyze other potential influencing factors. Methods A retrospective study was conducted on 213 patients with femoral neck fractures who underwent primary HA at Nanjing Meishan Hospital from January 2018 to June 2022. Demographic data (gender, age, body mass index, smoking), clinical indicators (Hb, blood glucose, creatinine), and hospital stay were collected via the hospital's electronic medical record system. Univariate and multivariate linear regression analyses were performed to assess the association between Hb and hospital stay. Smooth curve fitting and piecewise linear regression models were used to explore nonlinear relationships and identify Hb thresholds. Additionally, the impacts of age, diabetes, and surgical duration on hospital stay were evaluated. Results Univariate analysis revealed a negative correlation between Hb and hospital stay (β=-0.05, P=0.006), while age (β=0.12, P=0.001) and diabetes (β=1.55, P=0.016) were positively correlated with hospital stay. After multivariate adjustment, Hb remained independently associated with hospital stay (β=-0.39, P=0.038), and anemic patients had a 1.27-day longer length of hospital stay than non-anemic patients (P=0.026). Nonlinear analysis identified a threshold effect at Hb=102 g/L: when Hb＜102 g/L, length of hospital stay significantly prolonged with decreasing Hb (β=-0.29, P=0.002), but no significant association was observed when Hb ≥ 102 g/L (P＞0.05). Surgical duration showed a trend towards positive correlation with hospital stay (β=0.01, P=0.083), while gender, body mass index, smoking, and surgical type (total/partial hip replacement) were not significantly associated with hospital stay (P＞0.05). Conclusion Preoperative Hb is an independent predictor of hospital stay in HA patients, with a threshold effect at 102 g/L. Advanced age, diabetes, and prolonged surgical duration may indirectly extend hospital stay. Clinical management should prioritize preoperative anemia, elderly patients, and diabetics to optimize hospital stay through comprehensive interventions. |
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