老年髋部骨折患者术前风险评估

Preoperative risk assessment in elderly patients with hip fractures

背景:目前临床上有多种风险预测评估系统及相关危险因素,均可在一定程度上对患者的病情严重性进行客观评估,但尚无专门针对老年髋部骨折患者的手术风险预测系统。目的:比较老年髋部骨折患者手术风险评分系统(ORSSHF)与生理学和手术严重度评分系统(POSSUM),探索能客观而准确反映该类患者手术风险的预测方法。方法:依据统计学及POSSUM评分系统建立ORSSHF评分系统,分别应用ORSSHF和POSSUM评分系统回顾性研究2011年3月至2012年3月接受手术治疗的112例老年髋部骨折患者,男47例,女65例;年龄60～94岁,平均(74.6±6.8)岁。按术前风险评分进行分组,用统计学方法比较两种评分系统对该类患者手术并发症和死亡率的预测价值。结果:应用POSSUM和ORSSHF评分系统进行预测,发生并发症例数分别为50例和44例,死亡例数分别为6例和4例,实际发生并发症36例、死亡3例。前者预测值显著高于实际值(P<0.05);后者预测值和实际值无统计学差异。结论:POSSUM评分系统评估老年髋部骨折患者术前风险存在一定局限性;ORSSHF评分系统能较准确地评估该类患者的术前风险及预测术后并发症和死亡率,一定程度上弥补POSSUM评分系统的不足。

Background： Clinical risk assessment systems and risk factors are able to make an objective assessment for diseases. But there is not a predictive system for surgical risk in elderly patients with hip fracture. Objective： The purpose of the study is to establish an orthopedics operation risk scoring system for elderly patients with hip fractures （ORSSHF）, and to compare ORSSHF with POSSUM （physiological and operative severity score for the enumeration of mortality and morbidity） in predicting surgical risks. Methods： ORSSHF was established on the basis of statistics and POSSUM. The clinical data of 112 elderly patients with hip fracture were retrospectively studied by ORSSHF and POSSUM. All the patients underwent surgical treatment from March 2011 to March 2012. The predictive incidence of complications and mortality based on ORSSHF and POSSUM were compared. Results： According to POSSUM, complications may occur in 50 patients and 6 patients may die. According to ORSSHF, complications may occur in 44 patients and 4 patients may die. However, complications occurred in 36 patients and 3 patients died after surgery. Conclusions： ORSSHF can more accurately predicting surgical risks for elderly hip fractures as compared with POSSUM.