长寿老年人转子间骨折住院后的生存分析

Survival analysis of very elderly inpatients with intertrochanteric fracture

目的 探讨长寿老年人转子间骨折后生存情况及相关危险因素。 方法 回顾性分析我院从2006年1月至2013年12月收治的90岁以上长寿老年人转子间骨折患者共54例，失访5例，分析患者骨折住院后的生存情况。 结果 随访至2015年1月，随访时间最长为85个月，最短为0.2个月，平均随访33.3个月，17例患者存活，Harris评分为（61.2±10.6）分；生存分析显示1、3和5年总存活率分别为0.88±0.05，0.35±0.08，0.18±0.08，平均生存时间为（33.3±4.6）个月，中位生存时间为（25.0±5.4）个月。Cox多因素回归模型分析提示美国麻醉医协会（ASA）分级、手术时间和术前内科并发症数量为患者转子间骨折后生存时间的危险因素（均P〈 0.05）。 结论 手术治疗较保守治疗能提高长寿老年人转子间骨折后的生存时间；ASA分级、手术时间和术前内科并发症数量是长寿老年人转子间骨折后生存时间的危险因素。

Objective To study the survival status of very elderly patients with intertrochanteric fracture admitted in hospital and its risk factors. Methods Clinical data of 54 patients with intertrochanteric fracture aged 90 years and over admitted in hospital from Jan. 2006 to Dec. 2013 were retrospectively analyzed. 5 patients were lost to follow-up. The survival status of patients was analyzed. Results Patients were followed up until January 2015. The period of follow-up ranged from 85 months to 0.2 months, with an average follow-up of 33.3 months. 17 cases were survived. Harris scores were（61.2 ± 10.6）. The overall 1-, 3-, 5- year survival rates were（0.88 ± 0.05）, （0.35 ± 0. 08）,（0.18±0. 08）, respectively. The mean and median survival times were（33.3±4.6） months and（25.0±5.4） months. Cox proportional hazard regression model showed that American Society of Anaesthesiologists（ASA） score, operation time and the number of comorbidities were the risk factors for the survival time of very elderly patients with intertrochanteric fracture （all P 〈 0. 05）. Conclusions Compared with conservative treatment, surgical treatment can increase the survival time of the elderly patients with intertrochanteric fracture. ASA score, operation time and the number of comorbidities may be the risk factors for the survival time of very elderly patients with intertrochanteric fracture.