老年股骨转子间骨折术后1年死亡率及危险因素分析

Risk factors related to mortality at one year after surgery for intertrochanteric fracture in the elderly

目的探讨老年股骨转子间骨折术后1年死亡率的影响因素。方法回顾性研究南京医科大学第一附属医院骨科2015年01月至2017年01月采用股骨近端髓内钉治疗并获得随访的161例股骨转子间骨折患者(年龄≥60岁)资料,分析术后1年死亡率,通过病历总结分析年龄、性别、骨折类型、术前合并疾病及其数量、受伤至手术时间、术前血红蛋白浓度、白细胞数、白蛋白、血钾、尿素氮、丙氨酸氨基转移酶等资料,并进行单因素及多因素回归分析。结果共收集资料完整患者161例,随访时间12～24个月,1年累计死亡20例,死亡率为12.4%。单因素分析显示:骨折分型、术前高血压、慢性阻塞性肺病和糖尿病、术前合并疾病的数量、术前白蛋白以及丙氨酸氨基转移酶在存活组与死亡组间差异有统计学意义(P<0.05)。多因素回归分析显示:术前慢性阻塞性肺病和糖尿病,以及术前白蛋白<35 g/L是影响死亡的独立危险因素(P<0.05)。结论术前健康状况是影响老年股骨转子间骨折疗效的危险因素。改善术前健康情况,提高生活自理能力,防治术后并发症以降低老年股骨转子间骨折患者术后1年的死亡率,提高手术疗效。

Objective To analyse risk factors related to mortality at one year after surgery for intertrochanteric fracture in the elderly. Methods Records of patients undergoing surgery at our hospital between January 2015 andJanuary2017 were retrospectively reviewed. By telephone follow up,the health condition of each patient was surveyed, and one year postoperative mortality was analyzed. The age, gender,fracture type, presence of chronic diseases at admission, time between fracture and surgery, and preoperative laboratory examination results were analyzed. Univariateand multivariate regression analyses were performed on relevant influencing factors. Results Complete data were available for a total of 161 patients who were followed up for 12- 24 months （age≥60 years）. There were 20 deaths （12.4% ） at one year. Univariate analysis revealed that factors such as fracture type, chronic obstructive pulmonary disease,diabetes, number of preoperative diseases, preoperative albumin, and preoperative alanine amino transferase differed significantly between survival and death groups （P〈0.05）. Multivariate regression analysis revealed that chronic obstructive pulmonary disease, diabetes, and preoperative albumin were independent risk factors for death （P〈0.05）. Conclusions Taking full consideration of risk factors in the treatment of intertrochanteric fracture in the elderly, selecting appropriate anesthesia and treatment methods, improving preoperative health conditions may reduce the one- year mortality and facilitate functional recovery after surgery.