髋部骨折术后内科并发症的评估及预测

Evaluation and prediction of medical complications after hip fracture surgery

目的探讨髋部骨折术后内科并发症发生的危险因素。方法回顾分析2009年1月1日至2013年12月31日327例入住骨科并行髋部骨折手术治疗患者的临床资料，以住院期间是否出现内科并发症为标准，将患者分为并发症组（54例）和非并发症组（273例）。平均年龄（75．1±15．6）岁，其中女性213例（65．1％），股骨颈骨折129例（39．4％），粗隆间骨折198例（60．6％）．记录许比较两组患者的一般临床特征、术前内科合并症情况和手术相关指标。通过多因素回归分析总结出髋部骨折术后出现内科并发症的独立危险因素。结果两组患者单因素比较显示，年龄（t=2．85，P=0．007）、骨折前的活动能力（x^2=12．86，P=0．000）、慢性阻塞性肺疾病（COPD）病史（x^2=9．45，P=0．000）、冠心病病史（x^2=10．67，P=0．000）、心力衰竭病史（x^2=15．85，P=0．000）、糖尿病病史（x^2=3．22，P=0．024）、脑血管病病史（x^2=4．21，P=0．008）、麻醉方式（x^2=8．67，P=0．018）、美国麻醉医师协会（ASA）分级≥3级（x^2=2．01，P=0．042）和手术延迟时间（t=4．24，P=0．037）在两组之间的差异具有统计学意义。继而进行多因素回归分析湿示，年龄（B=0．030，OR=1．030）、骨折前卧床（p=2．303，OR=10．716）、COPD病史（p=0．831，OR=1．995）、冠心病病史（p=0．858，OR=2．392）、心力衰竭病史（B=1．971，OR=7．333）和ASA分级≥3级（p=0．809，OR=2．230）为髋部骨折术后内科并发症的独立危险因素、结论高龄、骨折前卧床、COPD病史、冠心病病史、心力衰竭病史和ASA分级≥3级等因素会增加髋部骨折术后内科并发症的风险。

Objective To analyse the risk factors of medical complications after hip fracture surgery. Methods Clinical data of 327 hip fracture patients undergoing surgical treatment in Beijing Haidian Hospital from January 2009 to December 2013 were retrospectively studied. There were 114 males and 213 females with a mean age of （75. 1 ±15.6） years, 129 patients （39.4%） had femoral neck fractures, and 198 patients （60. 6% ） had intertrochanteric fractures. Fifty four patients had medical complications during hospitalization （ complication group） and 273 patients did not have complications （ non- complications group）. The clinical features, presurgieal comorbidities and operative parameters were documented and compared between two groups. The risk factors of medical complications were assessed by regression analysis. Results Univariate analysis showed that age （t = 2.85, P = 0. 007） , lying in bed before fracture（ Xz = 12.86, P = 0. 000）, the history of chronic obstructive puhnonary diseases （COPD） （ X2 = 9.45, P = 0. 000）, coronary heart disease （ X2 = 10.67, P = 0. 000 ）, heart failure （ X2 = 15.85, P = 0. 000） , diabetes （ X2 = 3.22, P = 0. 024 ） , cerebrovascular disease （ X2 = 4. 21, P = 0. 008 ） , anesthesia method （ X2 = 8.67, P = 0.018 ） , American Society of Anesthesiologists （ ASA ） score ≥3 level （ X2 = 2.01 , P = 0. 042 ） and the delay time of operation （ t = 4.24, P = 0. 037 ） were significantly different between two groups. Multivariate regression analysis revealed that age （ β = 0. 030, OR = 1. 030） , lying in bed before fracture （β=2.303, 0R=10.716）, the history of COPD （β =0.831, OR =1.995）, coronary heart disease（ [3 =0. 858, OR =2. 392） , heart failure（ β = 1. 971, OR = 7. 333 ） and ASA score ≥3 level（ β = 0. 809, OR = 2. 583 ） were the independent risk factors of medical complications after hip fracture surgery. Conclusion Age, lying in bed before fracture, the history of COPD, coronary heart disease, heart failure and ASA score ≥3 level would increase the risk of postoperative medical complications for patients with hip fracture.