多学科协作诊疗模式下老年股骨转子间骨折患者髓内钉固定术后1年死亡的危险因素分析  

Risk factors for one-year mortality in elderly patients with femoral intertrochanteric fracture following multidisciplinary treatment by intramedullary nailing

作　　者：白利永 谢添 鲁攀攀 李荥娟[2,3,4] 陈翔溆 张元维 石柳[1,2,3] 邹继红 任利群[2,4] 邱晓东[2,5] 孙杰[2,5] 崔颖 陈辉[1,2] 王浩[1,2,3] 赵雅宽 田楚伟 芮云峰 Bai Liyong;Xie Tian;Lu Panpan;Li Yingjuan;Chen Xiangxu;Zhang Yuanwei;Shi Liu;Zou Jihong;Ren Liqun;Qiu Xiaodong;Sun Jie;Cui Ying;Chen Hui;Wang Hao;Zhao Yakuan;Tian Chuwei;Rui Yunfeng(Department of Orthopaedics,Trauma Center,Zhongda Hospital Affiliated to Southeast University,Orthopaedic Trauma Institute of Southeast University,Nanjing 210009,China;Multidisciplinary Team(MDT)for Geriatric Hip Fracture Management,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;School of Medicine,Southeast University,Nanjing 210009,China;Department of Geriatrics,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;Department of Anesthesiology,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;Operation Room,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院骨科、创伤救治中心,东南大学创伤骨科研究所,南京210009 [2]东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT),南京210009 [3]东南大学医学院,南京210009 [4]东南大学附属中大医院老年科,南京210009 [5]东南大学附属中大医院麻醉科,南京210009 [6]东南大学附属中大医院手术室,南京210009

出　　处：《中华创伤骨科杂志》2022年第9期779-785,共7页Chinese Journal of Orthopaedic Trauma

基　　金：江苏省老年健康科研项目(LD2021010,LKZ2022010);瑞华慈善基金会资助项目(YL20220525)。

摘　　要：目的:探讨多学科协作诊疗(MDT)模式下老年股骨转子间骨折患者髓内钉固定术后1年的病死率及死亡危险因素。方法:回顾性分析2018年1月至2020年8月期间东南大学附属中大医院骨科采用MDT模式下股骨近端髓内钉固定治疗的158例老年股骨转子间骨折患者资料。男41例,女117例;平均年龄为82.5岁(65~95岁);骨折改良Evans分型:Ⅰ型15例,Ⅱ型16例,Ⅲ型35例,Ⅳ型81例,Ⅴ型11例。统计患者术后1年病死率,对患者性别、年龄、体重指数、骨折改良Evans分型、受伤至手术时间、美国麻醉医师协会(ASA)分级、Charlson合并症指数(CCI)和合并内科疾病,以及术前血红蛋白(Hb)、血清白蛋白(ALB)和总淋巴细胞计数(TLC)等进行单因素分析筛选危险因素,再将P<0.05的因素纳入多因素logistic回归模型分析,确定患者术后1年死亡的危险因素。结果:术后1年内共有13例患者死亡,病死率为8.2%(13/158)。单因素分析结果显示:存活患者与死亡患者的年龄、体重指数、骨折改良Evans分型、CCI、术前Hb比较差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示:年龄>85岁(OR=0.122,95%CI:0.018~0.834,P=0.032)、体重指数>23.9 kg/m^(2)(OR=0.083,95%CI:0.013~0.510,P=0.007)、CCI≥3分(OR=0.051,95%CI:0.090~0.275,P=0.001)和术前Hb<90 g/L(OR=4.733,95%CI:1.036~21.624,P=0.045)是MDT模式下老年股骨转子间骨折患者髓内钉固定术后1年死亡的危险因素。结论:年龄>85岁、体重指数>23.9 kg/m^(2)、CCI≥3分和术前Hb<90 g/L的老年股骨转子间骨折患者MDT模式下髓内钉固定术后1年内容易发生死亡,应高度关注。Objective To analyze the risk factors for postoperative one-year mortality in elderly patients with femoral intertrochanteric fracture following multidisciplinary treatment(MDT)by intramedullary nailing.Methods The clinical data were retrospectively analyzed of the 158 elderly patients with femoral intertrochanteric fracture who had undergone MDT by proximal femoral intramedullary nailing between January 2018 and August 2020 at Department of Orthopedics,Trauma Center,Zhongda Hospital Affiliated to Southeast University.There were 41 males and 117 females with an average age of 82.5 years(from 65 to 95 years).By the modified Evans classification,there were 15 cases of typeⅠ,16 cases of typeⅡ,35 cases of typeⅢ,81 cases of typeⅣ,and 11 cases of typeⅤ.The one-year mortality was documented in the patients after surgery.To screen for risk factors,univariate analysis was conducted of gender,age,body mass index(BMI),modified Evans classification of fractures,time from injury to operation,American Society of Anesthesiologists(ASA)classification,Charlson comorbidity index(CCI)and comorbidities,as well as preoperative hemoglobin(Hb),serum albumin(ALB)and total lymphocyte count(TLC).The factors with P<0.05 were included in the multivariate logistic regression model analysis to determine the risk factors.Results A total of 13 patients died within one year after surgery,yielding a mortality of 8.2%(13/158).Univariate analysis showed significant differences in age,body mass index,modified Evans classification of fractures,CCI and Hb between the surviving and dead patients(P<0.05).Multivariate logistic regression analysis showed that age>85 years(OR=0.122,95%CI:0.018 to 0.834,P=0.032),BMI>23.9 kg/m^(2)(OR=0.083,95%CI:0.013 to 0.510,P=0.007),CCI≥3 points(OR=0.051,95%CI:0.090 to 0.275,P=0.001)and preoperative Hb<90 g/L(OR=4.733,95%CI:1.036 to 21.624,P=0.045)were the independent risk factors for postoperative one-year mortality in the elderly patients with intertrochanteric fracture following MDT by proximal femoral intr

关 键 词：髋骨折 骨折固定术 髓内 死亡 危险因素 多学科协作诊疗 老年人 

分 类 号：R687.3[医药卫生—骨科学]