老年股骨颈骨折患者关节置换术后死亡危险因素分析  

Analysis on risk factors for mortality in elderly patients with femoral neck fractures underwent hemiarthroplasty

作　　者：沈煜[1] 沈惠良[1] 方秀统[2] 

机构地区：[1]首都医科大学宣武医院骨科,北京100053 [2]首都医科大学世纪坛医院骨科,北京100038

出　　处：《吉林大学学报（医学版）》2013年第3期574-577,共4页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金资助课题(31040029)

摘　　要：目的:探讨老年股骨颈骨折患者术后死亡的危险因素,阐明危险因素与老年股骨颈骨折患者术后发生死亡的关系。方法:选择196例年龄大于65岁的股骨颈骨折行关节置换术患者(男性64例,女性132例),收集所有患者的临床资料,分析患者入院时年龄、性别、受伤至手术的间隔时间、血清白蛋白水平、血红蛋白水平、术前并发疾病、美国麻醉学会(ASA)术前身体状况分级和淋巴细胞数量与术后随访1年期间死亡率的关系。结果:13例患者死于术后和随访1年期间,其中1例患者死于住院期间,其余12例患者死于随访期间;术后3个月患者生存率为99.5%,术后6个月生存率为96.9%,术后1年生存率为94.8%;12例死亡患者ASA评分为Ⅲ级或Ⅳ级(8例为ASAⅢ级,4例为ASAⅣ级),11例患者血清白蛋白<35g.L-1,12例患者血清淋巴细胞数量<1 500mL-1。死亡患者与存活患者血清白蛋白水平、血红蛋白水平、淋巴细胞数量ASA分级比较差异有统计学意义(P<0.05),死亡患者与存活患者平均年龄比较差异无统计学意义(P>0.05)。受伤至手术间隔时间5d内手术者与5d后手术者死亡患者构成比比较差异统计学意义(P>0.05)。结论:低血清淋巴细胞数量、并存2种以上疾病、血清白蛋白<35g.L-1、血红蛋白<10g.L-1和ASA术前身体状况Ⅲ级或Ⅳ级是老年股颈骨折患者关节置换术后和随访1年期间发生死亡的重要危险因素;年龄、性别和受伤至手术的间隔时间长短与术后及随访1年期间死亡发生无关联。Objective To investigate the risk factors for mortality in elderly patients with femoral neck fractures during one year period and to clarify the relationships between the risk factors and postoperative mortality.Methods 196（64 male,132 female） patients with consecutive isolated nonpathologic hip fractures were chosen.All patients were more than 65 years old.The patients were treated with hemiarthroplasty.The clinical data of patients was collected.The relationship between age,gender,American Society of Anaesthesiologists（ASA） rating of operative risk,the time from injury to surgery,blood albumin level,haemoglobin level,total lymphocyte count and mortality during 1 year after operation was investigated.Results In total,13 patients died during one year,among them 1 patient in hospital,and 12 patients in follow-up period;the survival rates were 99.5% after 3 months,96.9% after 6 months,and 94.8% after 1 year;the ASA scores were Ⅲ-Ⅳ grades in 12 patients including 8 patients with ASA Ⅲ grade and 4 patients with ASA Ⅳ grade;there were 11 patients with preoperative blood albumin level35 g·L-1,and 12 patients with preoperative lymphocyte count1 500 mL-1.The comparisons of blood albumin level,haemoglobin level,ASA score,and lymphocyte count between the death patients and the survival patients had statistical differences（P0.05）.There was no significant difference of ages between the death patients and the survival patients（P0.05）.There were no significant differences of constituent ratio between the patients with the time from injury to surgery less than 5 d and the patients with the time from injury to surgery more than 5 d（P0.05）.Conclusion A lower lymphocyte count,more than two comorbidities,blood albumin level35 g·L-1,haemoglobin level 10 g·L-1,and ASA Ⅲ-Ⅳ grade are significant factors in assessing the one-year mortality in elderly patients with femoral neck fractures;age,gender and the time from injury to surgery are not significant factors in assessing the one-year mortality in el

关 键 词：股骨颈骨折 血清白蛋白 血红蛋白 

分 类 号：R683[医药卫生—骨科学]