三种评分系统在老年髋部骨折患者术后病死率预测中的可行性研究

Three preoperative scoring systems to predict 30-day mortality in elderly patients undergoing hip fracture surgery

目的探讨计数病死率和患病率的生理学和手术严重性评分（POSSUM）系统、P-POSSUM系统及生理能力与手术侵袭度（E-PASS）评分系统在老年髋部骨折患者术后病死率预测中的应用价值。方法回顾性分析2010年1月至2014年6月期间行手术治疗的654例老年髋部骨折患者资料，男225例，女429例；年龄60—103岁，平均71．7岁。骨折部位：股骨转子间骨折363例，股骨颈骨折291例。治疗方式：闭合复位髓内钉固定363例，人工双极头置换242例，全髋关节置换49例。应用POSSUM系统、P-POSSUM系统和E-PASS评分系统预测术后病死率，分析手术风险预测值和观察值之间的差异。结果654例患者中，25例（3．8％）患者于术后30d内死亡。应用POSSUM系统预测术后病死率时，实际死亡人数／预测死亡人数为0．30，预测结果与实际结果之间比较差异有统计学意义（X^2=34．840，P=0．009）。应用P-POSSUM系统和E．PASS评分系统预测术后病死率时，实际死亡人数／预测死亡人数分别为0．83、1．04，预测结果与实际结果之间比较差异均无统计学意义（P〉0．05）。结论与POSSUM系统比较，P—POSSUM系统和E．PASS评分系统可以更准确地预测老年髋部骨折患者的术后病死率。

Objective To compare 3 kinds of preoperative scoring systems used to predict 30-day mortality in a hip fracture population, Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity （POSSUM）, Portsmouth modified POSSUM （P-POSSUM） and Estimation of Physiologic Ability and Surgical Stress （E-PASS）. Methods A retrospective study was conducted to analyze the aged 654 patients who had undergone surgery for femoral intertrochanteric fracture or femoral neck fracture from January 2010 through June 2014 at our hospital. They were 225 men and 429 women, 60 to 103 years of age （average, 71.7 years） . There were 363 femoral intertrochanteric fractures and 291 femoral neck fractures. Closed reduction and intramedullary nailing was performed in 363 cases, artificial dipolar replacement in 242 cases, and total hip replacement in 49 cases. POSSUM, P-POSSUM and E-PASS scoring systems were used to predict the 30-day mortality. The discrepancy between the predictive risk and the actual observation was analyzed. Results Of the 654 patients, 25 died within 30 days after operation. According to POSSUM scoring system, the predictability （observed deaths/POSSUM deaths） was 0.30, showing a significant difference between the predictive deaths and the actual deaths（x^2 =34. 840, P=0. 009）. According to P-POSSUM and E-PASS scoring systems, the predictability was respectively 0. 83 and 1.04, demonstrating no significant differences between the predictive deaths and the actual deaths （ P 〉 0. 05）. Conclusion P-POSSUM and E-PASS scoring systems may predict 30-day mortality more accurately than POSSUM scoring system in elderly patients undergoing hip fracture surgery.