股骨粗隆间骨折患者术后预后不良的临床风险及改良型POSSUM对患者预后的评估效能分析  

Analysis of clinical risks of poor postoperative prognosis of patients with intertrochanteric femur fractures and the efficacy of the modified POSSUM in evaluation prognosis

作　　者：杜娟 陈静 代阳 吴烨 DU Juan;CHEN Jing;DAI Yang(Department of Orthopedics and Traumatology,Chongqing Jiulongpo District Hospital of Traditional Chinese Medicine,Chongqing 400080,China)

机构地区：[1]重庆市九龙坡区中医院骨伤科,重庆400080

出　　处：《临床和实验医学杂志》2025年第2期176-180,共5页Journal of Clinical and Experimental Medicine

基　　金：重庆市科卫联合医学科研项目(编号:2022MSXM096)。

摘　　要：目的分析股骨粗隆间骨折患者术后预后不良的临床风险及改良型生理学和手术侵袭度评分(POSSUM)对患者预后的评估效能。方法回顾性纳入2022年2月至2023年2月在重庆市九龙坡区中医院接受治疗的股骨粗隆间骨折患者120例为研究对象。对患者进行1年随访,根据患者的预后情况进行分组:将26例发生并发症的患者及8例死亡患者纳入预后不良组(n=34),其他86例未发生并发症及死亡情况的患者纳入预后良好组(n=86)。对两组临床资料进行分析,包括患者的年龄、性别、体重指数、骨折原因、贫血、手术时机、麻醉方式、术前美国麻醉医师协会(ASA)分级>Ⅱ级占比、骨折分型Ⅲ~Ⅳ型占比、心电图异常占比,采用单因素及多因素Logistic回归分析探究影响患者预后的相关因素。并采用改良型POSSUM评估患者预后情况,将各项临床指标及改良型POSSUM纳入逻辑回归分析中,构建预测模型,并采用受试者操作特征(ROC)曲线验证此模型对患者预后情况的预测价值。结果预后良好组和预后不良组患者在年龄、性别、体重指数、骨折原因、贫血、手术时机、麻醉方式等方面比较,差异均无统计学意义(P>0.05);预后不良组患者术前ASA分级>Ⅱ级占比、骨折分型Ⅲ~Ⅳ型占比、心电图异常占比分别为70.59%、73.53%、67.65%,均高于预后良好组(40.70%、41.86%、47.67%),差异均有统计学意义(P<0.05)。预后不良组患者的改良型POSSUM为(27.98±2.46)分,高于预后良好组[(23.87±3.16)分],差异有统计学意义(P<0.05)。120例患者经改良型POSSUM预测并发症、死亡情况与实际发生情况比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析可知术前ASA分级>Ⅱ级、骨折分型(Ⅲ、Ⅳ型)、改良型POSSUM升高均为患者预后不良的危险因素,据此建立相关预测模型,此模型预测患者预后的曲线下面积值为0.878,95%CI:0.814~0.943,敏感度为0.794,特异�Objective To analyze the clinical risks of poor postoperative prognosis of patients with intertrochanteric femur fractures and the efficacy of the physiology and operative severity score for the enumeration of mortality and morbidity(POSSUM)in predicting prognosis.Methods A total of 120120 patients with intertrochanteric fractures who were treated in Chongqing Jiulongpo District Hospital of Traditional Chinese Medicine from February 2022 to February 2023 were retrospectively included in the study.The patients were followed up for 1 year and grouped according to the prognosis of the patients:26 patients with complications and 8 patients with death were included in the poor prognosis group(n=34),and the other 86 patients without complications and death were included in the good prognosis group(n=86).The clinical data of both groups were analyzed,including patient age,gender,body mass index,cause of fracture,anemia,timing of surgery,anesthesia method,the proportion of patients with a preoperative American Society of Anesthesiologists(ASA)classification above gradeⅡ,the proportion of patients with typeⅢ-Ⅳfractures,and the proportion of abnormal electrocardiogram findings.The related factors affecting the prognosis of patients were explored by univariate and multivariate Logistic regression analysis.And the modified POSSUM was employed to evaluate the patients'outcomes,exploring its assessment effectiveness.Relevant clinical indicators and modified POSSUM were included in a Logistic regression analysis to establish a predictive model and the receiver operating characteristic(ROC)curve was used to verify the model's predictive value for patient prognosis.Results There was no statistically significant difference in age,sex,body mass index,fracture cause,anemia,operation time and anesthesia method between the good prognosis group and the poor prognosis group(P>0.05).The proportion of preoperative ASA grade>Ⅱ,the proportion of fracture typeⅢ-Ⅳand the proportion of abnormal electrocardiogram in the poor prognos

关 键 词：股骨骨折 预后 临床风险 改良型POSSUM评分系统 

分 类 号：R47[医药卫生—护理学]