老年髋部骨折手术风险评估表的临床应用

A preoperative risk scoring system for elderly patients with hip fracture

目的观察老年髋部骨折手术风险评估表对老年髋部骨折患者手术风险预测的效能。方法对2014年2月1日至2016年2月1日北京大学人民医院创伤骨科收治的286例老年髋部骨折患者资料进行前瞻性研究。将老年髋部骨折手术风险评估表按照评分分为0~10分组、11~20分组、21~30分组、31~40分组和>41分组5组。通过观察老年髋部骨折患者术前评分与术后出现内科并发症或死亡的关系,以验证老年髋部骨折手术风险评估表对老年髋部骨折患者手术风险预测的效能。结果根据老年髋部骨折手术风险评估表286例患者术前评分(24.9±11.0)分(0~69分)。其中股骨颈骨折(24.0±11.0)分,股骨转子间骨折(26.3±10.8)分。0~10分组25例,1例(4.00%)发生并发症;11~20分组72例,3例(4.17%)发生并发症;21~30分组116例,17例(14.66%)发生并发症;31~40分组51例,12例(23.53%)发生并发症;>41分组22例,11例(50.00%)发生并发症。结论老年髋部骨折患者术后内科并发症发生率随术前手术风险评估表评分增高而增高,老年髋部骨折手术风险评估表对手术风险预测效果较好。

Objective To verify the effectiveness of a self-designed preoperative risk scoring system for elderly patients with hip fracture. Methods A total of 286 elderly patients with hip fracture were included for this prospective study who had been admitted from February 1, 2014 to February 1, 2016 to Department of Trauma and Orthopedics, Peking University People’s Hospital. They were divided into 5 groups according to their scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture: 0 to 10 points, 11 to 20 points, 21 to 30 points, 31 to 40 points and above 41 points. Postoperative complications and deaths were recorded. The correlations between their preoperative scores and postoperative medical complications or death were analyzed to verify the effectiveness of the preoperative risk scoring system for elderly patients with hip fracture. Results The 286 patients scored 24.9±11.0 (from 0 to 69) preoperatively. The femoral neck fractures scored 24.0±11.0 and femoral intertrochanteric fractures 26.3±10.8. The incidence of medical complications was 4.00%(1/25) in the 0 to 10 points group, 4.17%(3/72) in the 11 to 20 points group, 14.66%(17/116) in the 21 to 30 points group, 23.53%(12/51) in the 31 to 40 points group and 50.00%(11/22) in the above 41 pints group. Conclusion As the incidence of postoperative medical complications in elderly patients with hip fracture is positively correlated with the scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture, the preoperative risk scoring system can provide an effective prediction of surgical risks.