90岁及以上长寿老年人髋部骨折手术疗效分析

Outcome analysis of hip fracture surgery in patients aged 90and over

目的 探讨90岁及以上长寿老年髋部骨折患者手术疗效. 方法 收集2012年1月至2016年12月我院收治的90岁及以上长寿老年髋部骨折患者的年龄、性别、并存疾病、骨折类型、手术时机、手术方式、并发症、病死率、功能恢复等资料,比较术后1年死亡与存活患者资料差异,分析患者术后1年死亡的独立危险因素. 结果 符合入选标准的90岁及以上长寿老年人101例,平均年龄(92.3 ± 2.7)岁,其中男性43例、女性58例,股骨转子间骨折66例、股骨颈骨折35例,术前能够独立行走患者45例、需要辅助装置行走患者56例.术后30 d死亡9例(8.9% ) 、术后6个月死亡17例(16.8% )、术后1年死亡27例(26.7% ) ,肺部感染、营养不良是死亡的主要原因.伤前不能独立行走是术后1年死亡的独立危险因素(OR=7.298 ,P=0.020) . 结论 手术是90岁及以上长寿髋部骨折患者的合理治疗方案,伤前活动能力差是术后死亡的独立危险因素,死亡的主要原因是肺部感染和营养不良,衰弱在其中发挥重要作用.

Objective To investigate the outcomes of hip fracture surgery in patients aged 90 and over. Methods Clinical data of patients aged 90 years and over admitted to our hospital from January 2012 to December 2016 were collected. The data included age ,gender ,comorbidities ,type of fracture , timing of surgery , operation method , complications , mortality , and functional outcomes.Differences in these items were compared between patients who died one year after surgery and those who survived.Independent risk factors for one-year mortality were analyzed. Results A total of 101 patients who met the inclusion criteria were enrolled in the study. There were 43 males and 58 females ,with a mean age of (92.3 ± 2.7)years ;66 cases had intertrochanteric fractures and 35 cases had femoral neck fractures ;in 45 cases patients could walk independently and in 56 cases walking aids were needed before operation. The mortalities at 30 days ,6 months ,and 1 year post-operation were 8.9% (9 cases ) ,16.8% (17 cases ) ,and 26.7% (27 cases ) ,respectively. Pulmonary infection and malnutrition were the main causes of death. Ambulation with walking aids was an independent risk factor for 1-year mortality (OR=7.298 ,P=0.020). Conclusions Surgery for the treatment of hip fractures in patients aged 90 and over is appropriate. Poor preinjury mobility is an independent risk factor for mortality after operation. The main causes of death are pulmonary infection and malnutrition ,and frailty plays an important role in this process.