生理功能和手术应激评分系统评估髋部骨折手术风险的临床价值  

Value of E-PASS scoring system in predicting surgical risk for hip fracture in aged patients

作　　者：骆洪涛[1] 王金强[1] 闫伟[1] 张浩 郑力通[1] 张旭[1] 张建政 孙天胜 

机构地区：[1]空军航空医学研究所附属医院骨科,北京100142 [2]解放军陆军总医院骨科,北京100700

出　　处：《中华关节外科杂志（电子版）》2017年第1期46-49,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的采用生理能力与手术应激评分系统(E-PASS)预测老年髋部骨折患者手术风险并探讨其应用价值。方法前瞻性选择267例年龄大于65岁的髋部骨折手术患者,病理性骨折及6个月内有其他手术史的患者除外,按照E-PASS评分系统评估其手术风险,选用2检验和非配对t检验评估其预测术后并发症及死亡的有效性,采用Spearman等级相关分析评价术前风险分数(PRS)、手术应激分数(SSS)和综合风险分数(CRS)与预后的相关性。结果 E-PASS评分系统预测住院期间并发症75例(28.1%),实际发生并发症71例(26.6%),组间差异无统计学意义(2=2.562,P>0.05),观察值与预测值比值(O/E)为0.94;预测住院期间死亡12例(7.2%),实际死亡8例(3.9%),组间差异无统计学意义(2=1.773,P>0.05),O/E为0.67;并发症组及死亡组患者PRS(t=18.7,P<0.01;t=8.489,P<0.01)及CRS(t=18.45,P<0.01;t=19.83,P<0.01),明显高于无并发症组及非死亡组,而SSS则无明显差异(P>0.05);PRS和CRS与术后并发症率(rs=0.18,P<0.01;rs=0.15,P<0.01)和死亡率(rs=0.16,P<0.01,rs=0.17,P<0.01)具有明显相关性。结论E-PASS评分系统使用方便,操作简单,能够较准确、有效地评估老年髋部骨折术后住院期间并发症和死亡。Objective To evaluate the value of E-PASS scoring system in predicting postoperative course of the patients with hip fractures. Methods The clinical data of 267 cases with hip fracture （ age 〉 65, pathologic fracture and the patients who had undergone surgery in six months were excluded ） were analyzed prospectively. E-PASS scoring system was applied to evaluate the surgical risks and the validity of prediction was explored by χ2 test and t test, the correlation between preoperative risk score （PRS） , surgical stress score （SSS）, comprehensive risk score （CRS） and actual postoperative outcomes were analyzed by Spearman analysis. Results E-PASS predicted 75 cases （28.1% ） of complications, which showed no statistically significant difference with the observed morbidity of 26. 6% （71 cases）, （χ2 = 2. 562, P 〉 0.05, O/E = 0.94 ）. The estimated incidence of deaths was 7.2% （ 12 cases） , which showed no statistically significant difference with the observed mortality 3.9% （eight cases） （χ2 = 1. 773, P 〉 0.05, O/E=0.67）. ThePRS （t=18.7, P〈0.01;t=8.489, P〈0.01） and CRS （t=18.45, P〈 0. 01 ;t = 19. 83, P 〈 0. 01 ） of the complication group and the death group were significantly higher than the non-complication group and the non-death group, the SSS showed no significant difference （ P 〉 0. 05 ）. The PRS and CRS were significantly associated with morbidity （ rs = 0. 18, P 〈 0. 01 ; rs = 0. 15, P 〈0.01） and mortality （rs =0. 16, P〈0.01, rs =0. 17, P〈0.01）. Conclusion E-PASS system is easy to use and simple to operate, which can predict the postoperative morbidity and mortality rates accurately and effectively.

关 键 词：危险性评估 髋骨折 老年人 死亡率 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]