老年髋部骨折后死亡的相关影响因素分析

Factors associated with the mortality in elderly patients with hip fracture

[目的]探讨影响老年髋部骨折后死亡的相关危险因素,为临床上提高老年髋部骨折患者生存率及生存质量提供依据。[方法]通过对2004年1月～2008年1月住院治疗的老年髋部骨折患者进行回顾性分析,评价分析老年髋部骨折后早期及中期死亡的危险因素。[结果]患者的年龄、伤前合并症数量、治疗方式、伤后并发症均对老年髋部骨折患者1年及5年的病死率有显著影响(P<0.05),而患者的性别只对患者5年病死率有显著影响;其中高龄和保守治疗是患者1年病死率的独立危险因素,高龄和合并症≥3种是患者5年病死率的独立危险因素;而手术方式、手术时机、麻醉方式对病死率无明显影响。[结论]对老年髋部骨折患者的治疗,应给予立体化的治疗。重视高龄患者的病情评估,提高男性患者治疗的依从性,积极治疗患者的合并症及给予恰当的心理疏导,尽可能创造手术条件;同时选择恰当的手术时机、合适的麻醉方式及手术方式,注意伤后并发症的防治及治疗,可以减少老年髋部骨折患者早、中期的病死率,提高患者的生存质量。

[ Objective] To analyze the factors influencing the mortality in elderly patients with hip fracture to establish the theoretic and provide a guide for a further improvement of curative effect. [ Method] Totally 183 cases of elderly patients （aged 60 and above）with hip fractures treated in our hospital from January 2004 to January 2008 were followed up. The clinical data were collected for statistical analysis in order to analyze the factors affecting the mortality of these groups. [ Result] The factors significantly influencing the outcome of the one - year mortality （ With P 〈 0. 05 ） included the age, the complications before inju- ry, the ability to walk before injury, therapies, the complications after injury, osteoporosis treatment. The factors significantly in- fluencing the five -year mortality included the age, sex, the complications before injury, the ability to walk before injury, thera- pies, the complications after injury. The multivariate Logistic regression analysis showed that the independent risk factors affect- ing the one - year mortality of the eldery hip fracture were age and therapies, and that the independent risk factors affecting the five -year mortality were age and the complications before injury. [ Conclusion] Multiple factors lead to high mortality in the elderly patients with hip fractures, the importance of those factors affecting the mortality should be more emphasized. We have to pay attention to the advanced age patients with disease assessment, improve the treatment of men with compliance, being positive for the complications before injury, as far as being possible to create the conditions of the surgery, choose the right operation time, the right anesthesia method and the operation method, improve the condition of the complication after injury and body sta- tus before operation,give standard treatment for osteoporosis,in order to reduce the mortality and improve the quality of life of the elderly patients with hip fracture.