半髋关节置换和股骨近端防旋髓内钉内固定治疗高龄患者髋部骨折的风险评估

Risk assessment of hemiarthroplasty and internal fixation of proximal femoral nail antirotation for treating hip fractures in older adults

背景:髋部骨折修复方式包括人工关节置换和股骨近端防旋髓内钉置入。Portsmouth 死亡率和并发症发病率的生理学和手术严重程度评分系统(P-POSSU)是否能应用于骨科患者的术前风险评估其价值尚值得研究。目的:应用P-POSSUM 评分系统比较不同植入物治疗老年髋部骨折的术前预测与实际病死率,探索P-POSSUM 评分系统的临床应用价值。方法:通过病案室查找到郑州市骨科医院2016 年1 月至2017 年1 月收治70 岁以上老年髋部骨折且经过手术治疗的患者病历共166 例,根据内植物分为2 组,其中半髋关节置换组85 例股骨颈骨折患者全部行半髋关节置换(双极人工股骨头置换),股骨近端防旋髓内钉组81 例股骨转子间骨折病例全部行闭合复位股骨近端防旋髓内钉内固定治疗。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。先计算出166 例髋部骨折患者的总病死率,再分别计算出2 组患者的实际病死率,然后通过用P-POSSUM 评分系统算出总体患者及2 组患者的预测病死率,对计算所得实际数据与预测数据进行对比分析。结果与结论:①70 岁以上老年髋部骨折患者总体样本共166 例(含12 例死亡患者)的实际病死率为7.2%,P-POSSUM 预测的病死率为5.4%;②半髋关节置换组85 例患者(死亡4 例)实际病死率为4.7%,通过P-POSSUM 计算预测病死率为3.5%;③股骨近端防旋髓内钉组81 例(死亡8 例)患者实际病死率为9.9%,通过P-POSSUM 计算预测病死率为6.2%;④以上实际病死率与P-POSSUM 系统预测病死率进行统计学分析,差异均无显著性意义(P > 0.05);⑤证实P-POSSUM 系统可以客观有效的预测高龄老年髋部骨折行半髋关节置换及股骨近端防旋髓内钉内固定患者的手术风险。

BACKGROUND: Methods of hip fracture repair include arthroplasty and proximal femoral nail antirotation placement. Whether Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity is feasible for risk assessment before bone surgeries needs to be investigated. OBJECTIVE: To compare the preoperative prediction and actual mortality in senile hip fracture treated with different implants based on Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity, so as to explore the clinical application value of the scoring system. METHODS: One hundred and sixty-six cases of hip fractures with the age of above 70 years admitted in the Zhengzhou Orthopaedics Hospital from January 2016 to January 2017 were collected, and assigned into hemiarthroplasty group (bipolar artificial femoral head replacement, n=85, femoral neck fracture), and proximal femoral nail antirotation group (n=81, intertrochanteric fracture). All patients signed the informed consents, and the study was approved by the ethics committee of the hospital. The total mortality rate of 166 patients was calculated, and then the actual mortality rate in the two groups was calculated. The predictive mortality rate of all patients and two groups was calculated by Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity system. The actual and predictive data were compared and analyzed. RESULTS AND CONCLUSION:(1) The actual mortality rate of 166 patients (including 12 cases of death) was 7.2%, and the predictive mortality rate was 5.4%.(2) The actual mortality rate in the hemiarthroplasty group (totally 85 cases, 4 cases of death) was 4.7%, and the predictive mortality rate was 3.5%.(3) The actual mortality rate in the proximal femoral nail antirotation group (totally 81 cases, 8 cases of death) was 9.9%, and the predictive mortality rate was 6.2%.(4) There was no significant difference in the actual mortality rate and predictive mortality rate (P > 0.05).(5) In summary, Portsmouth-Physiological and Operative Severity Score system for the Enumeration of Mortality and Morbidity system can objectively and effectively predict the risk of the older adults with hip fractures undergoing hemiarthroplasty and internal fixation of proximal femoral nail antirotation.