影响高龄股骨转子间骨折人工股骨头置换术后功能恢复的危险因素

Risk factors of prognosis in elderly patients with femoral intertrochanteric fracture treated by femoral head replacement

目的探讨影响高龄股骨转子间骨折人工股骨头置换术后功能恢复的相关危险因素。方法复习160例经人工股骨头置换术治疗的年龄≥70岁患者病历并随访术后功能恢复情况。单因素分析可能影响预后的11项指标：性别、年龄、骨折类型、伤前生活自理情况、是否吸烟、合并症、下肢血管病变、术前Hb水平、术中输血、假体材料、术后执行功能康复方案。并对有统计学意义的指标行多因素Logistic回归分析,筛选出影响预后的主要危险因素。结果 160例患者均获随访,时间10～36个月。单因素分析显示骨折类型、吸烟、患者生活自理情况、合并症、下肢血管病变和术后执行功能康复方案共计6项指标与术后功能恢复相关（P〈0.05）。多因素分析示合并症、伤前生活自理情况和术后执行功能康复方案为影响高龄股骨转子间骨折患者的主要危险因素（P〈0.05）。结论合并症、伤前生活自理情况和术后执行功能康复方案为影响高龄股骨转子间骨折人工股骨头置换术后功能恢复的主要危险因素。

Objective To investigate the related risk factors of prognosis in elderly patients with femoral intertrochanteric fracture treated by femoral head replacement. Methods 160 cases of patients whose age was seventy or older underwent arthroplasty for femoral intertrochanteric fracture were collected. The factors including gender,age,type of fracture,living capability before injury,smoking,comorbidities,the level of lower extremity arterial disease,Hb level before operation,transfusion during operation,prosthesis and postoperative rehabilitation were analyzed by univariate analysis. Then the factors which were significant in statistics were analyzed by multivariate logistic regression analysis. Results 160 cases were followed up for 10 ～ 36 months. Univariate analysis showed that type of fracture,living capability before injury,smoking,comorbidities,living capability before injury and postoperative rehabilitation were statistical significant（ P〈0. 05）. Multivariate analysis showed that comorbidities,living capability before injury and postoperative rehabilitation were independent risk factors of prognosis（ P〈0. 05）. Conclusions Comorbidities,living capability before injury and postoperative rehabilitation are independent risk factors for prognosis of elderly patients with femoral intertrochanteric fracture treated artificial femoral head replacement.