老年髋部骨折术后长期病死率及相关危险因素分析

Long-term mortality in the elderly with hip fracture and its related risk factors

目的观察老年髋部骨折术后长期病死率并分析相关的危险因素。方法回顾性分析了2012年1月至2013年12月陆军总医院骨科收治的符合入选标准的髋部骨折患者资料，记录患者年龄、性别、合并基础疾病、美国麻醉医师协会（ASA）分级、骨折类型、手术时机、手术方式等资料，根据患者随访期间是否存活，分为病死组和存活组，将年龄、性别、合并基础疾病、手术时机、手术固定方式作为危险因素，筛选出有统计学意义的因素，再进行多因素logistic回归分析，筛选出患者病死的独立危险因素。结果符合入选标准患者共327例，平均年龄78．7岁；男115例，女212例。截止2017年12月共病死131例，存活196例，总病死率40．1％。单因素分析发现与病死相关的危险因素有：脑卒中（P=0．016）、痴呆（P=0．005）、心衰（P=0．002）、肾功能不全（P=0．027）、麻醉方式（P=0．015）；多因素logistic回归分析显示：年龄（OR=1．092，P=0．000）、脑卒中（DR=1．759，P=0．036）、麻醉方式（OR=6．730，P=0．035）、肾功能不全（OR=5．624，P=0．026）是远期病死的独立危险因素。结论髋部骨折远期病死率高，对于高龄、脑卒中、肾功能不全的患者要特殊关注。对于无明显禁忌症的高危患者，尽可能选择麻醉确实、对机体影响较小的麻醉方式。

Objective To observe the long-term mortality in the elderly patients with hip fracture and evaluate its associated risk factors. Methods Included in this retrospective analysis were the eligible patients who had been treated for hip fracture at Department of Orthopedics, General Army Hospital of PLA from January 2012 to December 2013. Their clinic data were documented, including age, gender, coexisting disease, American Society of Anesthesiologists （ASA） rating, fracture type, operation time and operation pattern. The patients included were divided into 2 groups depending on whether they died or survived during the follow-up period. Mortality-related risk factors included age, gender, comorbidities, timing of operation, and type of fixation. T-test and Chi-squared test were used to analyze any significant differences between mortality and survival. Only the variables with a P 〈 0. 05 at the simple regression test were retested into a logistic multiple regression to screen risk factors for mortality after operation. Results Included in this study were 327 eligible patients with an average age of 78.7 years. They were 115 men （35.2%） and 212 women （64. 8% ）. The total mortality till December 2017 was 40. 1% （there were 131 dead and 196 living cases）. One-way analysis of variance showed that the risk factor related to mortality were stroke （ P = 0. 016）, dementia （ P = 0. 005 ）, heart failure （ P = 0. 002）, dysfunction of kidney （ P = 0. 027） and type of anesthesia （ P = 0. 015 ） ; logistic multiple regression analysis revealed that age （ OR = 1. 092, P = 0. 000）, stroke （ OR = 1. 759, P = 0. 036）, type of anesthesia （ OR = 6. 730, P = 0. 035） and dysfunction of kidney （ OR = 5. 624, P = O. 026） were independent risk factors for long-term mortality. Conclusions Special attention should be paid on hip fracture patients with a high age, stroke and dysfunction of kidney, because their long-term mortality is high. For high risk patients with no obvious contraindications, proper anesthesia methods should be chosen which can lead to definite efficacy and little influence on the body.