老年髋部骨折术后对侧髋部再骨折的影响因素分析

Influencing factors of refractures of the contralateral hip in elderly patients with hip fracture

目的 探讨老年髋部骨折术后对侧髋部再骨折的影响因素,以期为预防二次髋部骨折和骨质疏松性骨折提供临床依据. 方法 回顾性分析2008年4月至2013年12月收治的419例老年初次髋部骨折患者资料,男178例,女241例;年龄为61 ～ 95岁,平均72.5岁;骨折类型：股骨颈骨折154例,股骨转子间骨折265例;受伤至手术时间为2～8d（平均4.4d）.根据患者术后有无对侧髋部再骨折分为骨折组和无骨折组,比较两组患者的年龄、性别、合并内科疾病情况、初发骨折类型、骨质疏松情况、受伤至手术时间及末次随访时髋关节Harris评分,对P＜0.05的因素进行多因素logistic回归分析. 结果 419例患者中35例发生对侧髋部再骨折,发生率为8.4％.骨折组（n=35）与无骨折组（n=384）患者的年龄、初发骨折类型、骨质疏松情况及合并内科疾病情况比较差异均有统计学意义（P＜0.05）.末次随访时骨折组患者髋关节Harris评分平均为（85.7±7.0）分,无骨折组患者平均为（84.1±7.6）分,两组比较差异无统计学意义（P＞0.05）.多因素logistic回归分析结果显示：合并内科疾病（OR =5.155）、骨质疏松（OR=6.793）、高龄（OR =4.502）是老年髋部骨折术后对侧髋部再骨折的主要危险因素（P＜0.05）. 结论 老年髋部骨折术后对侧髋部再骨折的主要危险因素是合并内科疾病、骨质疏松和高龄.术后2年内要积极治疗合并内科疾病,加强抗骨质疏松治疗,以预防髋部二次骨折的发生.

Objective To study risk factors of refractures of the contralateral hip in elderly patients with hip fracture.Methods A retrospective study was conducted of the 419 elderly patients with hip fracture who had been treated at our department from April 2008 through December 2013.They were 178 males and 241 females,61 to 95 years of age （average,72.5 years）.There were 154 cases of femoral neck fracture and 265 cases of intertrochanteric fracture.The time from injury to operation ranged from 2 to 8 days （average,4.4 days）.They were divided into a refracture group and no-fracture group according to presence or absence of refracture of the contralateral hip after surgery.The 2 groups were compared in terms of gender,age,combined disease,fracture type,osteoporosis,time from injury to operation,and Harris score at the last follow-up.Factors with P 〈 0.05 were analyzed by multivariate logistic regression.Results The incidence of refracture of the contralateral hip among the 419 patients was 8.4% （35/419）.There were significant differences between the refracture group （n =35） and the no-fracture group（n =384） groups in age,primary fracture type,osteoporosis and combined disease （P 〈 0.05）.The Harris score at the last follow-up was 85.7 ± 7.0 for the refracture group and 84.1 ± 7.6 for the no-fracture group,showing no significant difference （P 〉 0.05）.The multivariate logistic regression analysis showed that combined disease （OR =5.155）,osteoporosis （OR =6.793） and age （OR =4.502） were the major risk factors for refracture of the contralateral hip （P 〈 0.05）.Conclusions Combined disease,osteoporosis and great age may be the major risks for refracture of the contralateral hip in elderly patients following the surgery for primary hip fracture.To prevent contralateral hip fracture,effective treatment of combined disease and osteoporosis is of great importance during the first 2 years after primary fracture surgery.