POSSUM和P-POSSUM评分系统对高龄转子间骨折行髋关节置换术的风险预测

Risk prediction of POSSUM and P-POSSUM scoring system for hip replacement in elderly intertrochanteric fractures

目的探讨POSSUM和P-POSSUM评分系统对老龄转子间骨折行髋关节置换术术后风险预测的实用性。方法对148髋行髋关节置换的高龄转子间骨折患者进行POSSUM和P-POSSUM评分,预测术后并发症和死亡例数,并与观测值比较。结果 POSSUM评分系统预测术后并发症23例,观测并发症34例,差异无统计学意义(P> 0. 05);预测死亡84例,观测死亡8例,差异有统计学意义(P <0. 01); P-POSSUM评分系统预测死亡11例,观测死亡8例,差异无统计学意义(P> 0. 05)。结论 POSSUM对死亡率的预测值偏高,对并发症的预测有很好的临床价值; P-POSSUM对术后死亡风险有很好的预测能力。但POSSUM和P-POSSUM部分评价内容,如年龄评分、骨科高危因素及定义术后并发症方面有待国内形成大数据后改良。

Objective To investigate the practicability of the POSSUM and P-POSSUM scoring system for postoperative risk assessment of hip replacement in elderly patients with intertrochanteric fractures.Methods We retrospectively applied the POSSUM and P-POSSUM scores on 148 patients with intertrochanteric fractures treated with hip arthroplasty.The postoperative complications and number of deaths were predicted and compared with the observed values.Results The POSSUM predicted that there would be 23 cases with complications while we observed 34 cases with complications.However,the difference was not statistically significant(P>0.05).The POSSUM predicted that there would be 84 postoperative deaths but only 8 deaths happened.There difference was statistically significant(P<0.05).Moreover,the P-POSSUM predicted that there would be 11 postoperative deaths that was not significantly different from actual deaths(P>0.05).Conclusion The POSSUM over predicts the mortality,but it has a good clinical value for the prediction of complications.The P-POSSUM can predict postoperative mortality more precisely.However,some evaluation contents of POSSUM and P-POSSUM such as age scores,orthopedic risk factors and definition of postoperative complications need to be improved when big data are generated in China.