老年髋部骨折患者围术期特点及手术疗效的危险因素分析  

Perioperative management and risk factors affecting the prognosis of hip fracture surgery in elderly patients

作　　者：杨立辉[1] 安立琨[1] 柳伟[1] 孔晓川[1] 藏磊[1] 王瑞[1] 

机构地区：[1]首都医科大学北京朝阳医院京西院区骨科,100043

出　　处：《中华老年医学杂志》2014年第5期507-509,共3页Chinese Journal of Geriatrics

摘　　要：目的 分析老年髋部骨折围术期治疗特点及手术疗效的相关危险因素. 方法 对2009年1月至2013年1月采用手术治疗且获得随访的112例髋部骨折患者（年龄≥65岁）资料进行回顾性分析. 结果 术前有91％患者有内科合并疾病,术后并发症发生率为35.7％,术后1年死亡率21.4％,术后1年存活病例中47.6％日常生活能力完全恢复至伤前状况.经Logistic回归分析发现伤前健康状况（OR=13.36,P=0.047）、术后肺部并发症（OR=18.33,P=0.007）、术后并发症数量（OR=15.14,P=0.025）、肾衰竭（OR=11.26,P=0.034）是术后1年死亡的独立危险因素. 结论 老年髋部骨折患者术前合并疾病多,采取恰当的围术期处理、麻醉手术方法及康复治疗,可降低围术期并发症的发生率及死亡率,取得良好的预后.伤前健康状况、术后肺部并发症、并发症数量、肾衰竭是术后1年死亡的独立危险因素.Objective To analyze perioperative management and risk factors for the prognosis of hip fracture surgery in elderly patients.Methods The present study included 112 elderly patients （aged ≥65 years） who received hip fracture surgery from January 2009 to January 2013 in our department,and their clinical data were retrospectively analyzed.Results The percentage of cases with concomitant diseases before operation was 91.0 %,and the postoperative complications rates were 35.7%.One-year mortality after operation was 21.4%.The percentage of survival cases with daily living activities fully restored to pre injury status was 47.6%.Logistic regression analysis revealed that independent risk factors for the one-year mortality included general health before injury （OR=13.36,P =0.047）,pulmonary disease （OR =18.33,P =0.007）,number of postoperative complications （OR=15.14,P=0.025）,and renal failure （OR=11.26,P=0.034）.Conclusions Elderly hip fracture patients have many different concomitant diseases.By applying the qualified levels of perioperative management,anesthetic and operative methods,and postoperative rehabilitation measures according to the conditions of the patient,the incidence of perioperative complications and one year mortality can be decreased,and qualified surgical outcomes can be obtained.The independent risk factors for the one-year mortality include general health before injury,pulmonary disease,number of postoperative complications and renal failure.

关 键 词：髋部骨折 围术期处理 危险因素 

分 类 号：R687.3[医药卫生—骨科学]