股骨颈骨折患者院内死亡的预测模型  

Prediction model for mortality of patients with femoral neck fracture in hospital

作　　者：庹琳 张大志 黄德勇 包小源 Tuo Lin;Zhang Dazhi;Huang Deyong;Bao Xiaoyuan(Department of Hospital Management,Peking University Health Science Center,Beijing 100191,China;Department of Anesthesiology,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedics,Beijing Jishuitan Hospital,Beijing 100035,China;Clinical Research Institute,Peking University Health Science Center,Beijing 100191,China)

机构地区：[1]北京大学医学部医院管理处,北京100191 [2]首都医科大学附属北京积水潭医院麻醉科,北京100035 [3]首都医科大学附属北京积水潭医院矫形骨科,北京100035 [4]北京大学医学部临床医学高等研究院,医学信息学中心,北京100191

出　　处：《中华骨科杂志》2025年第5期280-287,共8页Chinese Journal of Orthopaedics

摘　　要：目的分析股骨颈骨折院内死亡的危险因素并建立院内死亡的预测模型。方法回顾性分析2014年至2023年北京大学六所直属附属医院和两所共建附属医院的4028102例住院患者的病例资料,其中4744例为股骨颈骨折住院患者,男1486例、女3258例,年龄(74±13.3)岁(范围19~103岁)。提取患者的性别、年龄、住院时间、住院费用、术前合并症、治疗方式、麻醉方式、是否发生院内死亡等一般资料。根据是否出现院内死亡分为死亡组与存活组。比较两组患者一般资料及临床指标的差异,将差异有统计学意义的指标纳入二分类变量logistic回归分析,筛选股骨颈骨折患者院内死亡的危险因素。绘制预测股骨颈骨折院内死亡的受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积(area undercurve,AUC)。结果死亡组30例,存活组4714例,死亡率0.63%。死亡患者中接受髋关节置换者20例,非手术治疗者10例。死亡组年龄(t=7.524,P<0.001)、住院时间(t=3.802,P<0.001)、住院费用(t=3.961,P<0.001)、非手术治疗率(P<0.001)、麻醉方式(P=0.002)、痴呆(P=0.045)、恶性肿瘤(P<0.001)、肾功能不全(χ^(2)=27.901,P<0.001)、高血压(χ^(2)=4.155,P=0.042)、脑梗死(χ^(2)=8.271,P=0.004)、泌尿感染(P=0.043)、电解质紊乱(χ^(2)=16.660,P<0.001)、胆囊切除术后(P=0.070)、肝功能异常(P=0.015)、精神分裂症(P=0.062)、心肌梗死(χ^(2)=19.057,P<0.001)、糖尿病伴终末器官损害(P=0.036)、充血性心力衰竭(χ^(2)=93.122,P<0.001)、慢性阻塞性肺疾病(χ^(2)=27.714,P<0.001)的比例大于存活组,差异有统计学意义(P<0.10)。二分类logistic回归分析显示年龄(OR=1.08,P=0.008)、非手术治疗(OR=2.87,P=0.017)、合并恶性肿瘤(OR=9.35,P<0.001)、肾功能不全(OR=4.07,P=0.004)、高血压(OR=4.45,P=0.007)、脑梗死(OR=2.42,P=0.040)、电解质紊乱(OR=4.29,P=0.009)、精神分裂症(OR=41.23,P=0.002)、慢性阻塞性肺疾病(OR=3.84,P=0.0ObjectiveTo analyze the risk factors of in-hospital mortality in patients with femoral neck fracture and establish a prediction model for in-hospital mortality.MethodsFrom 2014 to 2023,a total of 4,028,102 hospitalized patients from six directly affiliated hospitals and two co-constructed affiliated hospitals of Peking University were retrospectively analyzed.Among them,4,744 patients were hospitalized with femoral neck fractures,including 1,486 males and 3,258 females,aged 74±13.3 years(range,19-103 years).Gender,age,length of hospital stay,hospitalization costs,preoperative comorbidities,treatment methods,anesthesia methods,and in-hospital mortality were extracted from the medical records.According to the presence or absence of in-hospital death,the patients were divided into death group and survival group.The differences in general data and clinical indicators between the two groups were compared,and the indicators with statistically significant differences were included in binary logistic regression analysis to screen the risk factors for in-hospital death in patients with femoral neck fracture.The receiver operating characteristic(ROC)curve for predicting in-hospital mortality of femoral neck fracture was drawn,and the area under the curve(AUC)was calculated.ResultsThere were 30 cases in the death group and 4,714 cases in the survival group,with a mortality rate of 0.63%.Among the dead patients,20 had undergone hip replacement,and 10 had received non-surgical treatment.In the death group,age(t=7.524,P<0.001),length of hospital stay(t=3.802,P<0.001),hospitalisation cost(t=3.961,P<0.001),rate of non-surgical treatment(P<0.001),anaesthesia modality(P=0.002),dementia(P=0.045),malignant tumour(P<0.001),renal insufficiency(χ^(2)=27.901,P<0.001),hypertension(χ^(2)=4.155,P=0.042),cerebral infarction(χ^(2)=8.271,P=0.004),urinary infections(P=0.043),electrolyte disorders(χ^(2)=16.660,P<0.001),post-cholecystectomy(P=0.070),abnormal liver function(P=0.015),schizophrenia(P=0.062),myocardial infarction(χ^(2)=19.057,

关 键 词：髋骨折 矫形外科手术 死亡 危险因素 

分 类 号：R683.3[医药卫生—骨科学] R683.42[医药卫生—外科学]