髋部骨折术后对侧髋部再骨折的相关因素分析

Analysis on risk factors of contra-lateral hip re-fracture after operation of hip fracture

目的探讨髋部骨折患者术后出现对侧髋部再次骨折的相关危险因素。方法对261例接受手术治疗的髋部骨折患者行回顾性研究及临床随访,根据术后是否出现对侧髋部骨折分组,对两组间的相关因素(性别、年龄、BMI、患侧、首次骨折部位、手术方式、围术期实际失血量、术后短期瞻望、术后卧床时间、内科合并症、Charlson合并症指数、术后抗骨质疏松治疗、术后6个月随访时Harris髋关节功能评分及FIM功能独立性评定)进行单因素分析及多因素Logistic回归分析。结果平均随访时间28.3个月,15例出现对侧髋部骨折;两组间单因素分析及多因素回归分析均显示年龄、术后短期谵妄、合并高血压病、合并脑血管病、术后抗骨质疏松治疗、术后Harris评分、术后FIM评分是术后对侧髋部再骨折的相关危险因素(P<0.05)。结论髋部骨折术后出现对侧髋部再骨折的危险因素包括年龄、术后谵妄、内科合并症等被动因素,以及术后抗骨质疏松治疗、术后关节功能康复情况等主动因素。术后患者需积极接受内科疾病的治疗,并增强抗骨质疏松的治疗和髋关节功能康复锻炼的主观能动性,以预防再骨折的发生。

Objective To investigate and analyze risk factors of contra-lateral hip re-fracture after operation of hip fracture. Methods We retrospectively studied and followed 261 cases operated for hip fracture, and all patients were divided into the re-fracture group or the no-re-fracture group, and compare related factors including sex, age, BMI, affected side, initial fracture type, operation, perioperative blood loss, postoperative delirium, postoperative bedridden time, medical complications, Charlson comorbidity index, antiostoporosis therapy, hip function score with Harris and functional independence measurementby single factor analysis and multivariate Logistic regression analysis. Results The mean follow-up time was 28.3 months, and the contra-lateral hip fracture was found in 15 cases. Single factor analysis and multivariate Logistic regression analysis both showed that the risk factors were age, postoperative delirium, hypertension, cerebrovascular disease, antiostoporosis therapy, hip function score with Harris and functional independence measurement （P〈0.05）. Conclusion Risk factors of contra-lateral hip re-fracture after operation of hip fracture include age, postoperative delirium, medical complications, and subjective factors of antiostoporosis therapy, Harris score, and FIM score. Patients should receive medical treatment, and be treated for ostoporosis and rehabilitation training of hip function should be initiated to prevent re-fracture.