The 88 patients with intertrochanteric hip fractures (IHF) were divided into two clinical groups: Group I (main group) consisted of 56 patients with type 2 diabetes mellitus (DM) combined with obesity of varying severity; Group II (comparison group) consisted of 32 patients without type 2 DM and obesity. Patients with IHF of Group I with type 2 DM and obesity were divided into subgroups depending on the presence or absence of exocrine insufficiency (EI) of the pancreas (P) and chronic pancreatitis (CP), namely: subgroup IA consisted of 30 patients with clinical signs of CP and IHF; subgroup IB consisted of 26 patients with type 2 DM, obesity and normal exocrine function of the pancreas.
In the majority of patients of both groups, multifragmentary (31A2) transacetabular fractures were diagnosed more often: in 64.3% of patients of Group I and in 62.5% of patients of Group II. At the time of admission to the hospital with acetabular fracture, all patients in Group I had confirmed type 2 DM (mostly mild and moderate). In the examined patients of Group I, class 2 obesity was diagnosed in 39.3% of cases, while class 3 obesity was detected in 32.1% of patients, while class 1 obesity was detected only in 28.6% of the examined patients. In Group II, overweight individuals (37.5% of cases) and patients with normal body weight (25.0% of patients) predominated.
In patients of the IA subgroup, a more pronounced accumulation of fat mass of the body was detected, which is more pronounced in females, as well as an overload of the body with the fluid component, which is also significantly more pronounced in female patients. A significant deficit of muscle mass was diagnosed in patients with type 2 DM and obesity with EPI. In patients of the IA subgroup, a deficit of bone mass was also detected, regardless of gender.
In patients with IHF, a decrease in the level of calcium (Ca++) and 25(OH)D (an indicator of vitamin D3 supply in the body) in the blood serum was detected. Moreover, more pronounced deviations from the norm were diagnosed in patients of Group I (with type 2 DM and obesity, especially in combination with chronic kidney disease).
A significant increase in the level of somatostatin (SST) in the blood serum of patients of Group I was established (by 0.142±0.005 pg/ml – p<0.01 compared to the control group). In patients of Group II, the level of SST in the blood serum increased only by 0.030±0.011 pg/ml (p<0.05). A decrease in ghrelin in the blood serum of patients of Group I was diagnosed (by 38.35±1.56 ng/ml – p<0.05), while in patients of Group II, on the contrary, an increase in the level of ghrelin was detected (by 71.46±1.50 ng/ml – p<0.01) compared to the control group. In Group I patients with IHF, the decrease in serum calcium and 25(OH)D levels depends on the serum SST level regardless of the severity of obesity.
All 88 examined patients with IHF underwent hemiarthroplasty with single-pole endoprostheses. To assess the results of the hip joint endoprosthesis, the Harris Hip Score (HHS) was used. Pulmonary thromboembolism (PTE) was detected with the same frequency in patients in both groups after surgical treatment. This was PTE of the small branches of the pulmonary artery and did not threaten the patients' lives. Deep vein thrombosis of the legs was detected after endoprosthesis surgery only among patients in Group I. Surgical treatment contributed to an increase in the activity of aminotransferases in the blood serum, and a decrease in the level of total protein and albumin was also determined in combination with a decrease in the indicators of immunological protection, which is the body's reaction to trauma. The vast majority of patients, namely in 82.1% of patients in Group I and 81.3% of patients in Group II, had a good result according to the Harris score on the 14th day after surgical treatment. Assessment of the functional state of the limb, as well as the general endurance of patients, indicates a predominance of patients in both groups with excellent indicators according to the Harris score, namely in 73.2% of patients in Group I and 65.6% of patients in Group II (p<0.01) 3 months after endoprosthesis.
Key words: intertrochanteric hip fractures, type 2 DM, body mass index, obesity, sarcopenia; exocrine pancreatic insufficiency, chronic pancreatitis, somatostatin, ghrelin, treatment (primary arthroplasty, endoprosthesis, drug therapy).
