老年股骨转子间骨折术后一年死亡率及其危险因素分析  

Risk factors for 1-year mortality in elderly patients after intertrochanteric fracture surgery： a retrospective study of 1854 cases

作　　者：孙奇[1] 童培建[1] 徐斌斌[2] 吕帅洁[2] 杨力 黄余亮[4] 江彬锋[5] 瞿杭波[6] 何帮剑 金红婷 

机构地区：[1]浙江中医药大学附属第一医院骨科,杭州310006 [2]浙江中医药大学 [3]浙江省富阳中医骨伤医院 [4]浙江省新华医院 [5]浙江省立同德医院 [6]杭州市第三人民医院 [7]浙江省中西医结合骨关节病研究重点科技创新团队 [8]浙江省骨伤研究所

出　　处：《中华创伤骨科杂志》2013年第5期371-376,共6页Chinese Journal of Orthopaedic Trauma

基　　金：浙江省科技厅优先主题重点社会发展项目（2009C03014.2）;浙江行自然科学基金（Y2111083）

摘　　要：目的 总结老年股骨转子间骨折患者术后1年的死亡率，并探讨与死亡相关的危险因开素。方法 回顾性分析2005年8月至2011年8月杭州地区6家医院经手术治疗且获得随访的1854例老年股骨转子间骨折患者资料，男705例，妇1149例；年龄65～98岁，平均79.4岁。统计患者术后1年内的死亡率及主要死亡原因，并应用logistic回归模型分析与术后1年死亡相关的危险因素。结果 术后1年内共有297例患者死亡，死亡率为16.0%（297/1854）。主要原因包括感染93例，心脏疾患38例，神经系统疾患53例，肿瘤63例。Logisitc回归分析结果显示：患者年龄[OR=5.053，95% CI（1.517，16.829），P=0.000]、性别[OR=0.376，95% CI（0.122，1.161），P=0.002]、术前内科合并病[OR=3.236，95% CI（1.553，6. 746），P=0.001]、美国麻醉医师协会（ASA）分级[OR=6.057，95% CI（1.968，18.641），P=0.000]、受伤至手术时间[OR=1.928，95% CI（0.979，3.796），P=0.009]和住院时间[OR=3.875，95% CI（0.638，6.542），P=0.001]是术后1年死亡的独立危险因素。结论 年龄、性别、术前内科合并症、ASA分级、受伤至手术时间及住院时间为老年股骨转子间骨折患者术后1年死亡的独立危险因素。Objective To investigale the risk factors for 1-year mortality in the elderly patients following inlertrochanteric fraclure surgery. Methods A retrospective study was conducted to analyze the elderly 1854 patients who had been treated for intertrochanteric fracture from August 2005 to August 2011 in 6 hospitals in Hangzllou district and completed their follow-ups. They were 1149 females and 705 males,aged from 65 to 98 years （average,79. 4 years）. Their 1-year mortailty and causes were documented .Logistic Regression was used to analyze the risk factors associated with tieir 1-year mortality. Results Altogether 297 patients died within one year after surgey,giving a martality of 16.0%（297/1854）. The causes included infection in 93 cases ,heart attack in 38, nervous system disease in 53, and tumor in 63. Logistic Regression analyses found advanced age [OR=5.053,95% CI（1.517,16.829）,P=0.000], gender [OR=0.376,95% CI（0.122,1.161）,P=0.002], number of comorbidities [OR=3.236,95% CI（1.553,6. 746）,P=0.001], AS A（ American Society of Anaesthesiologists ）score [OR=6.057,95% CI（1.968,18.641）,P=0.000],delay in surgery [OR=1.928,95% CI（0.979,3.796）,P=0.009] and length of hospital stay [OR=3.875,95% CI（0.638,6.542）,P=0.001] to be independent risk factors significantly associated with the 1-year mortality. Conclusion Advanced age, gender, ASA score, number of comorbidities ,delay in surgery and length of hospital stay may be the independent risk factors for 1-year mortality in the elderly patients following intertrochanteric fractrue surgery.

关 键 词：髋骨折 死亡率 危险因素 老年人 

分 类 号：R687.3[医药卫生—骨科学]