骨折住院患者出院转归的影响因素分析  

Analysis of factors affecting the discharge outcomes of inpatients with fractures

作　　者：陈垂继 王安辉 王海鹏 王育才 Chen Chuiji;Wang Anhui;Wang Haipeng;Wang Yucai(Department of Orthopedics,Tangdu Hospital Affiliated to AiRForce Medical University,Xi’an 710038,China;Department of Epidemiology,AiRForce Medical University,Xi’an 710032,China)

机构地区：[1]空军军医大学唐都医院骨科,西安710038 [2]空军军医大学流行病学教研室,西安710032

出　　处：《创伤外科杂志》2024年第12期911-917,共7页Journal of Traumatic Surgery

基　　金：陕西省创新能力支撑计划资助项目(2021TD-45)。

摘　　要：目的探讨骨折住院患者出院时临床转归的相关影响因素。方法回顾性分析2012年1月—2021年12月于唐都医院骨科住院的14954例骨折患者临床资料,根据出院时的临床转归分为临床治愈组(n=9811)和非临床治愈组(n=5143)。比较两组患者的年龄、性别、职业、居住地、婚姻状况、骨折季节、骨折地点、骨折类型、入院方式、入院病情、治疗方式、住院天数、骨折合并损伤、基础疾病等因素情况,并通过多因素Logistics回归分析骨折住院患者出院转归的独立影响因素。结果两组患者性别、骨折类型和骨折季节比较差异无统计学意义(P>0.05),患者的年龄、婚姻状况、职业、居住地、骨折地点、骨折原因、入院方式、入院病情、骨折部位、骨折类型、手术治疗、住院天数、合并损伤和基础疾病与骨折患者出院转归(治愈)均显著相关(P<0.05)。多因素Logistic回归分析的结果提示,骨折住院患者出院转归(临床治愈)的有利因素有一般病情(OR=1.260,95%CI:1.137~1.396)、骨折部位为手或腕(OR=1.234,95%CI:1.005~1.516)以及髋或大腿(OR=1.212,95%CI:1.056~1.390)、闭合性骨折(OR=1.559,95%CI:1.392~1.746)、手术治疗(OR=24.099,95%CI:21.071~27.561);不利因素有骨折的原因不明确(OR=0.646,95%CI:0.503~0.828)、骨折部位在脊柱(OR=0.708,95%CI:0.545~0.920)及骨盆(OR=0.752,95%CI:0.597~0.947)、住院天数长(OR=0.995,95%CI:0.993~0.998)、合并损伤(OR=0.740,95%CI:0.675~0.812)和基础疾病(OR=0.757,95%CI:0.676~0.848)。结论骨折患者入院时病情为急危重、部位为脊柱和(或)骨盆骨折、合并其他损伤或伴有基础疾病者,应有针对性的治疗与护理,增加患者出院时达到临床治愈概率。另外,手术治疗者出院时达到临床治愈率明显高于非手术治疗者,但手术容易导致骨不愈合的并发症,所以骨折治疗时应严格把握手术指征。Objective To explore the influencing factors of clinical outcomes of inpatients with fractures when they were discharged from hospitals.Methods Clinical data of fracture patients hospitalized in the Department of Orthopaedic Trauma,Tangdu Hospital were analyzed retrospectively from Jan.2012 to Dec.2021.Patients were divided into cured group(n=9811)and non-cured group(n=5143),according to the clinical outcome(medical record)at the time of discharge.The age,sex,occupation,place of residence,marital status,fracture season,fracture place,fracture cause,mode of admission,general condition on admission,fracture location and type,mode of treatment,days of hospitalization,combined injuries and underlying diseases were compared between the two groups.Multivariate logistics regression was furtheradopted to analyze the independent influencing factors.Results It was found that the factors of age,marital status,occupation,place of residence,fracture place and cause,mode of admission,general condition on admission,fracture location,surgical treatment,days of hospitalization,combined injuries and basic diseases were significantly correlated with the discharge outcomes of inpatients with fractures(all P<0.05),except forsex,fracture type and fracture season(all P>0.05).Multivariate logistic regression analysis suggested the following favorable factors fora cured fracture at hospital discharge:stable general condition on admission(Or=1.260,95%CI:1.137-1396),hand orwrist fractures(Or=1.234,95%CI:1.005-1.516),hip orthigh fractures(Or=1.212,95%CI:1.056-1.390),closed fractures(Or=1.559,95%CI:1.392-1.746)and surgical treatment(Or=24.099,95%CI:21.071-27.561);and unfavorable factors of uncertain fracture causes(Or=0.646,95%CI:0.503-0.828),spine fractures(Or=0.708,95%CI:0.545-0.920),pelvis fractures(Or=0.752,95%CI:0.597-0.947),long hospital stay(Or=0.995,95%CI:0.993-0.998),and combined with otherinjuries(Or=0.740,95%CI:0.675-0.812)orunderlying diseases(Or=0.757,95%CI:0.676-0.848).Conclusion Forfracture patients in critical condition on ad

关 键 词：骨折 出院转归 临床治愈 影响因素 

分 类 号：R683[医药卫生—骨科学]