代谢综合征与老年股骨转子间骨折内固定术后不良事件发生的相关性分析  

Correlation between metabolic syndrome and adverse events after internal fixation of femoral intertrochanteric fracture in the elderly

作　　者：张忠良[1] 费霖莉[1] 傅俊伟[1] 方立 ZHANG Zhong-liang;FEI Lin-li;FU Jun-wei;FANG Li(Department of Joint Surgery,Traditional Chinese Medical Hospital of Jinhua Affiliated to Zhejiang University of Chinese Medicine,Jinhua 321017,Zhejiang,China)

机构地区：[1]浙江中医药大学附属金华市中医医院关节外科,浙江金华321017

出　　处：《中国骨伤》2021年第10期900-905,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨代谢综合征对老年股骨转子间骨折内固定术后15 d不良事件发生的影响。方法:2011年1月至2019年6月,采用内固定治疗老年股骨转子间骨折986例,男312例,女674例,年龄(77.71±7.58)岁,其中伴有代谢综合征的患者97例,不伴代谢综合征的患者889例。通过电子病历系统收集患者年龄、性别、骨折分型、外伤原因、体重指数(body mass index,BMI),吸烟史,术前合并病,术前输血情况,手术时机,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级,麻醉方式,内固定类型,手术时间以及术后15 d内并发不良事件,包括术后15 d内手术部位感染,急性心功能衰竭,急性呼吸衰竭,肺部感染,急性肾功能衰竭,下肢深静脉血栓(deep venous thrombosis,DVT),心肺脑重要脏器栓塞,尿路感染,死亡,以及术后是否进行输血治疗。用t检验及单因素χ2检验对两组间患者术前、术中基线资料及术后15 d内不良事件进行比较分析。校正术前及术中基线资料P<0.05的混杂因素,将P<0.05的术后不良事件纳入多因素Logistic回归分析,进一步研究代谢综合征对术后15 d内不良事件的独立影响。结果:两组患者间的年龄,BMI,心功能不全病史,慢性阻塞性肺病(chronic obstruvtive pulmonary disease,COPD)病史,肾功能不全病史,手术时机,ASA分级、手术时间以及术后15 d内并发手术部位感染、急性心功能衰竭、DVT、尿路感染及输血情况差异有统计学意义(P<0.05)。校正术前及术中基线资料混杂因素,多因素Logistic回归分析结果显示代谢综合征会增高老年股骨转子间骨折内固定术后15 d内的手术部位感染率[OR=3.785,95%CI(1.086-13.188),P=0.037],DVT发生率[OR=2.265,95%CI(1.096-4.682),P=0.027]),尿路感染率[OR=2.703,95%CI(1.049-6.963),P=0.039]及输血率[OR=1.811,95%CI(1.142-2.870),P=0.012]。结论:伴有代谢综合征的老年股骨转子间骨折患者术后存在更高的手术部位感染率、下肢深静�Objective:To explore the effect of metabolic syndrome on 15 days postoperative adverse events of femoral intertrochanteric fractures with internal fixation.Methods:From January 2011 to June 2019,986 elderly patients with intertrochanteric fracture were treated with internal fixation,including 312 males and 674 females,with an average age of(77.71±7.58)years old.And there were 97 patients with metabolic syndrome and 889 patients without metabolic syndrome.Through the electronic medical record system,the patient's age,gender,fracture type,cause of trauma,body mass index,smoking history,preoperative comorbidities,preoperative blood transfusion,operation timing,ASA classification,anesthesia method,internal fixation type,operation duration,and 15 days postoperative adverse events,which include surgical site infection,acute heart failure,acute respiratory failure,pulmonary infection,acute renal failure,DVT,embolism in important organs,urinary tract infection,death,and blood transfusion after surgery were collected.The differences of preoperative and intraoperative baseline datas and 15 days postoperative adverse events between the two groups were compared and analyzed by t text or univariateχ2 test.Adjusted for the preoperative and intraoperative mixed factors with P<0.05,and 15 days postoperative adverse events with P<0.05 were then analyzed by multivariate unconditional Logistic regression analysis to further study the independent effects of metabolic syndrome on 15 days postoperative adverse events.Results:There were statistical differences in age,body mass index,history of cardiac insufficiency,history of COPD,history of renal insufficiency,operation timing,ASA classification,operation duration,surgical site infection,acute heart failure,DVT,urinary tract infection and blood transfusion between two groups(P<0.05).Adjusted for the preoperative and intraoperative mixed factors,multivariate unconditional logistic regression analysis showed that metabolic syndrome could increase the infection rate of the surgical sit

关 键 词：代谢综合征 股骨转子间骨折 骨折固定术 内 不良事件 

分 类 号：R687.3[医药卫生—骨科学]