老年髋部骨折术后1年死亡率及死亡危险因素的分析  

Risk Factorsfor 1-Year Mortality in Elderly Patients after Hip Fracture Surgery

作　　者：李成宇 张星晨 郑欣 芮敏 孙少松 庞勇 赵凤朝 郭开今 

机构地区：[1]徐州医科大学研究生院,江苏徐州221004 [2]徐州医科大学附属医院骨科,江苏徐州221004

出　　处：《实用骨科杂志》2017年第9期802-806,共5页Journal of Practical Orthopaedics

基　　金：江苏省卫生计生委面上科研课题(H201528);江苏省级重点研发专项资金项目(BE2015627);2016年度江苏省普通高校专业学位研究生实践创新计划项目(SJLX16_0658)

摘　　要：目的分析老年髋部骨折患者术后1年死亡率,探讨和总结老年髋部骨折患者术后死亡的危险因素。方法回顾性分析2013年1月至2014年12月在徐州医科大学附属医院治疗且获得随访的819例年龄超过60岁的髋部骨折患者资料,其中男性270例,女性549例;年龄60~96岁,平均年龄为(76.25±7.08)岁。统计患者的1年死亡率,分析与患者死亡相关的危险因素,包括年龄、性别、骨折类型、术前内科合并症数量,ASA评分、手术方式及多项血液学指标,并对影响因素进行单因素及二分类logistic回归分析。结果 819例患者术后1年的死亡率为16.97%(139/819)。单因素分析结果示有统计学意义的危险因素为:年龄、性别、术前内科并发症、ASA评分、入院时的白细胞计数、中性粒细胞/淋巴细胞比值、红细胞分布宽度、血小板计数、总蛋白、尿素、肌酐。logistics回归分析显示年龄[P=0.000,比值比(odds ratio,OR)=1.067,95%CI(1.033~1.102)]、性别[P=0.046,OR=0.630,95%CI(0.390~1.017)]、术前内科并发症[P=0.009,OR=4.757,95%CI(1.476~15.350)]、ASA评分[P=0.001,OR=6.127,95%CI(2.166~17.320)]、入院时红细胞分布宽度[P=0.017,OR=1.186,95%CI(1.031~1.364)]、尿素[P=0.001,OR=1.175,95%CI(1.072~1.288)]是老年髋部骨折患者死亡的独立危险因素。结论多种因素与髋部骨折死亡率有关,其中年龄、性别、术前内科并发症、ASA评分、入院时红细胞分布宽度、尿素是老年髋部骨折的独立危险因素。Objective To observe the 1-year mortality after hip fracture surgery and summarize the death-associated risk factors.Methods 270 men and 549 women aged from 60 to 96（mean,76.25±7.08）years old were followed up.The data of 819 elder patients who were over 60 years old with hip fracture and underwent surgical treatment in the affiliated hospital of xuzhou medical university form January 2013 to December 2014 were collected and retrospectivelystudied.1-year mortality of patients was calculated.Death-associated risk factors were analyzed including age,gender,number of preoperative systemic complications,ASA grade,surgical methodsand several indexes of hemotology.Univariate and binary logistic regression analysis were performed on relevant influencing factors.Results The 1-year mortality of the 819 patients was 16.97%.Univariate analysis showed that the risk factorsof mortalitywere including age,gender,number of preoperative systemic complications,ASA grade,white blood cell count,neutrophil-to-lymphocyte ratio,red cell distribution width,platelet count,total protein,serum urea and serum creatinine on admission.Logistic regression analysis revealed that the independent risk factorseffecting the mortality included age[P=0.000,OR=1.067,95%CI（1.033~1.102）],gender[P=0.046,OR=0.630,95%CI（0.390~1.017）],number of preoperative systemic complications[P=0.009,OR=4.757,95%CI（1.476~15.350）],ASA grade [P=0.001,OR=6.127,95%CI（2.166~17.320）],red cell distribution widthat admission[P=0.017,OR=1.186,95%CI（1.031~1.364）],serum ureaat admission[P=0.001,OR=1.175,95%CI（1.072~1.288）].Conclusion A number of factors was associated with mortality of hip fracture.age,gender,number of preoperative systemic complications,ASA grade,red cell distribution width and serum urea at admission were independent risk factors of 1-year mortality of elderly hip fracture.

关 键 词：髋部骨折 1年死亡率 血液学指标 危险因素 

分 类 号：R683.3[医药卫生—骨科学]