超高龄髋部骨折患者的临床特点和手术安全性分析

Clinical characteristics and surgical safety of super elderly patients with hip fracture

背景:超高龄(≥90岁)髋部骨折患者给骨科医师带来越来越大的挑战。目的:分析超高龄髋部骨折患者的合并症特点,探讨此类患者的围手术期安全性。方法:回顾性分析2006年1月至2020年12月我中心收治的髋部骨折病例,经筛选,纳入本研究1537例。以年龄分组:A组(≥90岁,139例)和B组(65~89岁,1398例)。比较两组的性别、骨折诊断、合并症情况,然后进行匹配处理,比较匹配后两组(AP组和BP组)术前住院日、总住院日、围手术期死亡率和并发症发生率。结果:A组发生股骨转子间骨折的患者比例高于B组(χ2=16.471,P<0.01),合并糖尿病或其他代谢性疾病的患者比例低于B组(χ2=9.752,P=0.0028),而合并贫血的患者比例则高于B组(χ2=97.472,P=0.006)。AP组和BP组的围手术期死亡率以及大部分并发症的发生率比较,差异无统计学意义;但肺部感染并发率差别具有统计学意义(χ2=4.187,P=0.041)。结论:超高龄髋部骨折中有较多的转子间骨折;合并贫血的患者比例高,合并糖尿病等代谢疾病的患者比例低;围手术期较易并发肺部感染;死亡率和绝大多数并发症发生率并未升高。

Background:The hip fracture in super elderly patients(≥90 years old)brings more and more challenges to orthopaedic doctors.Objective:To analyze the characteristics of comorbidities in super elderly patients with hip fracture,and explore whether they are more prone to perioperative complications and death.Methods:Hip fracture cases in our center from January 2006 to December 2020 were analyzed retrospectively,and after screening 1537 cases were included in this study and grouped by age:group A(≥90 years old,n=139)and group B(65-89 years old,n=1398).The gender,fracture diagnosis and comorbidities of the two groups were compared;then a propensity score matching was performed.After matching,preoperative hospital stay,total hospital stay,perioperative mortality and complication rate were compared.Results:The proportion of femoral intertrochanteric fractures in group A was higher than that in group B(χ2=16.471,P<0.01).The proportion of patients with diabetes or other metabolic diseases in group A was lower than that in group B(χ2=9.752,P=0.0028),however,the proportion of patients with anemia were relatively high in group A(χ2=97.472,P=0.006).After matching,there was no difference in perioperative mortality or most complication rates between groups,but the difference in the incidence of pneumonia was statistically significant(χ2=4.187,P=0.041).Conclusions:There are more intertrochanteric fractures among super-aged hip fractures.In super elderly patients with hip fracture,there is a high proportion of patients with anemia and a low proportion of patients with metabolic diseases such as diabetes;perioperative mortality and most complication rates have not increased,and the only increased complication is pulmonary infection.