非手术治疗老年髋部骨折影响预后的因素

Factors influencing the prognosis of elderly patients with hip fracture after nonoperative management

背景:髋部骨折是老年人常见的骨折类型,多数有条件的患者均采用手术治疗。但仍有相当部分的病例因各种原因采取非手术治疗。目的:分析影响非手术治疗老年人髋部骨折预后的相关因素。方法:回顾性分析2001年1月至2007年12月收治的61例60岁以上选择非手术治疗的髋部骨折病例的临床资料。采用SPSS13.0统计软件对临床数据进行单因素及多因素生存分析,以期发现影响非手术治疗老年髋部骨折患者生存的因素。结果与结论:随访至2008年7月,19例患者存活,Harris评分平均为43.58分。其中<70岁11例,Harris评分(55.81±29.59)分;>70岁8例,Harris评分(26.75±23.58)分,两者间比较差异有显著性意义(P<0.05)。生存分析显示1,2,5年总存活率分别为0.803±0.051,0.607±0.063,0.301±0.072。单因素分析显示年龄、治疗期间能否早期摆脱卧位状态以及血清白蛋白水平对预后的影响差异具有显著性意义(P<0.05)。COX多因素回归模型分析提示年龄、治疗期间能否早期摆脱卧位状态具有独立预后意义(P<0.05)。可见对于非手术方法治疗的70岁以上高龄髋部骨折患者,年龄、治疗期间能否早期摆脱卧位状态是影响生存率的主要因素。

BACKGROUND： Hip fracture is common fracture type in the elderly patients, and most of the patients were treated with operation. But there are still a lot of patients treated with non-operation therapy for a variety of reasons. OBJECTIVE： To explore the factors that influence the prognosis of elderly patients with hip fracture treated non-surgically METHODS： Sixty-one elderly patients aged more than 60 years with hip fracture were collected from January 2001 to December 2007 and treated non-surgically, and the clinical data of the patients were retrospectively analyzed. Data of comorbidities, Harris hip score and other important data were collected. The SPSS 13.0 software was used to analyze the prognostic factors through univariate and multivariate method in order to find the factors that could affect the survival of the elderly patients with hip fracture treated non-surgically.RESULTS AND CONCLUSION： After followed-up to July 2008, 19 patients survived. The result of Harris hip score in 19 survival case was 43.58 in average. Among the 19 survival cases, 11 patients 〈 70 years old and the Harris hip score was （55.81＋29.59）; 8 patients 〉 70 years old and the Harris hip score was （26.75±23.58）. There was a significant difference of Harris hip score between them （P 〈 0.05）. The 1, 2 and 5 years survival rates of the 61 cases were 0.803±0.051, 0.607＋0.063 and 0.301±0.072, respectively. Based on univadate log-rank analysis, age, posture （bedridden or non-bedridden） and the serum albumin concentration had great significance on the prognosis （P 〈 0.05）. COX multivariate regression analysis showed that age and posture （bedridden or non-bedridden） had independent prognostic significance （P 〈 0.05）. It showed that for the elderly patients over 70 years old with hip fracture treated non-surgically, age and posture （bedridden or non-bedridden） were the main factors to affect the survival rate.