目的:探讨超高龄髋部骨折术后患者预后情况及1年内死亡的相关危险因素。方法:回顾性分析2015年1月至2023年1月接受髋关节置换术或股骨近端髓内钉固定术治疗的332例90岁以上股骨颈骨折或转子间骨折患者的临床资料，其中男128例，女204例;年龄90～103(92。2±2。5)岁;股骨颈骨折90例，股骨转子间骨折242例。术后1年内死亡92例，分析年龄、性别、身体质量指数、骨折类型、手术方法、手术时机、手术时间、术前血红蛋白和血清白蛋白水平、受伤前行走能力、麻醉方式、伴有的基础疾病以及国际麻醉医师协会(American Society of Anesthesiology，ASA)分级等与死亡的相关性，采用单因素分析筛选出术后1年内死亡的危险因素，再将有统计学意义的危险因素纳入多因素Logostic回归分析，筛选出独立危险因素。结果:90岁及以上超高龄髋部骨折患者术后1年内死亡人数占27。7％(92/332)，单因素分析结果显示死亡组身体质量指数高，伤后至手术时间间隔长，术前血清白蛋白水平低，受伤前不可独立行走，伴有肺部感染、阻塞性肺疾病、脑卒中以及心功能分级为C-D级、ASA分级Ⅲ-Ⅳ级的比例较高。多因素Logistic回归分析结果发现术前血清白蛋白＜30g·L-1[OR=2。973，95％CI(2。461，5。344)，P=0。039]、伤前不可独立行走[OR=3。519，95％CI(2。224，5。413)，P=0。018]、心功能分级为 C-D 级[OR=4。213，95％CI(2。952，6。993)，P=0。021]、肺部感染[OR=3。927，95％CI(2。187，7。731)，P=0。016]以及 ASA 分级为 Ⅲ-Ⅳ 级[OR=5。124，95％CI(3。092，8。235)，P=0。032]是术后1年内死亡的独立危险因素。结论:术前血清白蛋白水平＜30g·L-1、伤前不能独立行走、心功能分级为C-D级、肺部感染以及ASA分级Ⅲ-Ⅳ级是90岁及以上超高龄髋部骨折术后患者术后1年内死亡的独立危险因素。
Risk factors for postoperative mortality within 1 year in more than 90-year-old super advanced age patients with hip fractures
Objective To investigate the 1 year mortality after hip fractures in super advanced age patients and summarize the death associated risk factors in order to provide basis for targeted intervention countermeasures.Methods The clinical data of 332 super advanced age patients with femoral neck or intertrochanteric fractures treated by hip replacement or in-tramedullary femoral nail fixation from January 2015 to January 2023 were retrospectively analyzed.There were 128 males and 204 females with the mean age of(92.2±2.5)years ranging from 90 to 103 years old.Among them,92 cases died within 1 year after surgery.Correlation with the occurrence of death on age,gender,body mass index,fracture type,treatment method,timing of operation,preoperative hemoglobin and serum albumin level,operation time,combined medical diseases,pre-injury mobil-ityand American Society of Anesthesiology(ASA)classification were analyzed.The risk factors of death within 1 year after op-eration were screened by univariate analysis.The results were entered into the multivariate Logistic regression analysis,screen-ing the high risk factors for 1 year mortality after hip fractures.Results The mortality of super advanced age patients with hip fracture within 1 year after surgery accounted for 27.7％(92/332).Univariate analysis showed high body mass index,long in-terval from injury to surgery,low preoperative serum albumin levels,inability to walk independently before injury,accompanied by heart failure,pulmonary infection,obstructive pulmonary disease,stroke,and a higher proportion of ASA grades Ⅲ-Ⅳ.Multivariate Logistic regression analysis showed preoperative serum albumin below 30g g L-1[OR=2.973,95％CI(2.461,5.344),P=0.039],inability to walk independently before injury[OR=3.519,95％CI(2.224,5.413),P=0.018],heart function grade C-D[OR=4.213,95％CI(2.952,6.99),P=0.021],pulmonary infection[OR=3.927,95％CI(2.187,7.731),P=0.016]and ASA Ⅲ-1V[OR=5.124,95％CI(3.092,8.235),P=0.032]were the independent risk factors for death within 1 year in super advanced age patients with hip fractures.Conclusion Preoperative serum albumin below 30g.L-l,poor preinjury ac-tivity,heart function grade C-D,pulmonary infection,and ASA grade Ⅲ-Ⅳ are independent risk factors for postoperative mortality in super advanced age patients with hip fractures.
万方数据
维普
