老年髋部骨折手术疗效的危险因素分析  

Risk factors related to prognosis following hip fracture surgery in the aged patients

作　　者：王晓伟[1] 孙天胜[1] 刘智[1] 张建政[1] 陈晓斌[1] 

机构地区：[1]北京军区总医院骨科,100700

出　　处：《中华创伤骨科杂志》2011年第9期811-816,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨影响老年髋部骨折手术疗效的相关危险因素。方法回顾性分析2006年1月至2008年1月采用手术治疗且获得随访的127例髋部骨折患者（年龄≥75岁）资料，以术后1年死亡情况和独立生活能力恢复情况作为评定手术疗效的指标，统计可能对疗效产生影响的因素。结果患者年龄、性别、骨折类型、心脏疾病、慢性呼吸系统疾病、合并症数量、伤前健康状况、伤前生活自理能力、认知状况、术后肺部并发症、术后心脏并发症、并发症数量对患者术后1年死亡有明显影响。影响老年髋部骨折术后1年独立生活能力恢复的危险因素有年龄、性别、骨折类型、伤前健康状况、伤前生活自理能力、受伤至手术时间、心脏疾病及手术方式。经多因素Logistic回归分析发现伤前健康状况（OR=11．258，P=0．034）、术后肺部并发症（OR=20．001，P=0．000）、并发症数量（OR=38．143，P=0．007）是术后1年死亡的独立危险因素；伤前生活自理能力（OR=7．090，P=0．001）、受伤至手术时间（OR=6．428，P=0．003）、伤前健康状况（OR=4．550，P=0．028）是影响术后1年独立生活能力恢复的危险因素。结论伤前健康状况、伤前生活自理能力、术后肺部并发症、并发症数量、受伤至手术时间是影响老年髋部骨折疗效的危险因素。改善术前健康情况，提高生活自理能力，防治术后并发症可以降低老年髋部骨折患者术后1年的死亡率．改善其功能。Objective To analyze risk factors affecting the prognosis following hip fracture surgery inthe aged patients. Methods The present study included 127 old patients （I〉75 years） who had received hip fracture surgery from January 2006 to January 2008 in our department. Their clinical data were analyzed to define risk factors related to one-year mortality and one-year recovery of self-care ability. Results Factors significantly affecting the one-year mortality included age, gender, fracture type, heart disease, pulmonary disease, number of preoperative complications, general health before injury, pre-fracture self-care ability, cognitive impairment, postoperative lung and heart complications, and number of postoperative complications. Factors affecting the one-year recovery of self-care ability included age, gender, fracture type, general health before injury, pre-fracture self-care ability, timing of surgery, heart disease, and type of fixation. A multi- variate Logistic regression analysis revealed that the independent risk factors affecting the one-year mortality included general health before injury （ OR = 11. 258, P =0. 034）, pulmonary disease （ OR =20. 001, P = 0. 000）, and number of postoperative complications （ OR = 38. 143, P = 0. 007） . The independent risk factors affecting the one-year functional recovery were pre-fraeture self-care ability （OR = 7. 090, P = 0. 001 ）, general health before injury （ OR = 4. 550, P = 0. 028）, and timing of surgery （ OR = 6. 428, P = 0. 003 ） . Conclusions The risk factors affecting outcomes of hip fracture surgery in the aged patients included general health before injury, pre-fracture self-care ability, postoperative pulmonary complication, number of postoperative complications, and timing of surgery. As a result, improvement of genera/ health condition and self-care ability before surgery and prevention of postoperative complications can reduce the one-year mortality and facilitate functional recovery after surgery.

关 键 词：髋骨折 外科手术 危险因素 老年人 

分 类 号：R687.3[医药卫生—骨科学]