改良POSSUM及P-POSSUM评分在老年髋部骨折手术风险评估中的应用价值  

Value of Modified POSSUM and P-POSSUM Scoring System in Predicting Mortality and Morbidity of Aged Patients Underwent Hip Fracture Operation

作　　者：吴云峰[1] 李锋[2] 孙志颖[1] 彭海洲[1] 赵文[1] 

机构地区：[1]北京航天总医院骨科,北京市100076 [2]华中科技大学同济医学院附属同济医院

出　　处：《中国骨与关节损伤杂志》2011年第6期481-483,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的应用改良的生理学和手术严重度评分系统(POSSUM及P-POSSUM)对老年髋部骨折手术死亡率和并发症率进行评估,探讨对手术风险评估的价值。方法应用POSSUM及P-POSSUM,预测191例老年髋部骨折术后30 d内并发症率及死亡率,比较其预测价值。以并发症率50%为界,分为中低风险组(101例)及高风险组(90例),比较两组差异性。结果应用POSSUM评分预测:并发症实际80例,预测93例,无统计学差异(P>0.05)。对死亡率预测,预测24例,实际3例,差异有显著统计学意义(P<0.05),高估了死亡率。P-POSSUM评分预测死亡率,预测7例,实际3例,两者相比无统计学差异(P>0.05),准确预测死亡率。中低风险组与高风险组的评分,有极其显著的统计学差异(P<0.01)。结论对于老年髋部骨折手术病人,POSSUM评分能准确的预测并发症发生率,高估了死亡率;P-POSSUM能准确的预测术后死亡率。手术治疗老年髋部骨折,中低风险组短期内尽早手术,高风险组调整后大部分仍然可以手术。Objective To evaluate the value of modified POSSUM and P-POSSUM scoring system in predicting the mortality and morbidity of aged patients underwent hip fracture operation. Methods One hundred and ninety one patients with trochanteric fracture or femoral neck hip fracture,except pathologic fractures and a minimum age of 60 years, were studied retrospectively using P-POSSUM and POSSUM scoring system to predict their mortality and morbidity within 30 days after operation. The predictor equation was used to compare the risk of mortality and morbidity between the observed and the predicted ,and the chi-square test was employed to analyze whether there was statistically difference between them. The chi-square test was used to analyze whether there was statistically difference between the low or middle risk group and high risk group, which was separated by 50% morbidity. Results One hundred and ninety one cases were evaluated with modified POSSUM scoring system, There was no statistical difference between the predicted morbidity and that of the observed （93 and 80, P 〉0.05）. The predicted mortality was higher than that of the observed （24 and 3）.The difference was significant （P 〈 0.05）. P-POSSUM was used to predict mortality in the group, the predicted deaths number agreed well with the observed calculated （7 and 3） without significant difference （P 〉0.05）. The difference between the low or middle risk group and high risk group was significant（P 〈0.01）. Conclusion The modified POSSUM may have better predictive ability of morbidity, but overestimate mortality; P-POSSUM could accurately predict mortality than POSSUM. The patient with low or middle risk can be operated as soon as possible, those with high risk, who had clinical abnormalities corrected prior to surgery, can also undergo the operation.

关 键 词：老年髋部骨折 POSSUM P—POSSUM 死亡率 并发症率 

分 类 号：R735[医药卫生—肿瘤]