老年股骨转子间骨折患者术后死亡危险因素分析

Risk factors analysis for postoperative mortality of elder patients with intertrochanteric fractures

目的分析老年股骨转子间骨折术后死亡率及其危险因素。方法以2014年1月-2015年12月因股骨转子间骨折行股骨近端交锁髓内钉内固定治疗的患者为研究对象,其中135例患者符合选择标准纳入研究。收集患者临床资料,包括性别、年龄、入院至手术时间、合并内科疾病,以及入院时血红蛋白、白蛋白、总淋巴细胞计数(total lymphocyte count,TLC)、营养状况。采用单因素分析及Cox比例风险模型筛查患者术后死亡危险因素。结果内固定术后2年内共27例(20.0%)患者死亡,其中16例(11.9%)于术后1年内死亡。单因素分析显示,年龄、合并冠状动脉粥样硬化性心脏病、合并内科疾病数量、入院时血红蛋白及白蛋白水平是股骨近端交锁髓内钉内固定治疗的老年股骨转子间骨折患者术后死亡影响因素(P<0.05)。多因素分析显示,年龄(≥80岁)、合并2种以上内科疾病和术前白蛋白<35 g/L是患者术后死亡的独立危险因素(P<0.05)。结论老年股骨转子间骨折患者术后死亡率高,因此对于此类患者,尤其是高龄、合并内科疾病较多和低白蛋白患者,应综合评估围术期风险,加强围术期管理,以改善临床预后。

Objective To analyze the risk factors for postoperative mortality of elder patients with intertrochanteric fractures. Methods Patients with intertrochanteric fractures who underwent proximal femoral interlocking intramedullary nail fixation between January 2014 and December 2015 were enrolled in the study. Among them, 135 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender,age, time from admission to surgery, comorbidities, and preoperative hemoglobin, albumin, and total lymphocyte count(TLC), and nutritional status. Univariate analysis and Cox proportional hazards regression model were used to screen the risk factors for postoperative mortality. Results Twenty-seven patients(20.0%) died within 2 years after surgery, and 16(11.9%) died within 1 year after surgery. Univariate analysis showed that age, coronary atherosclerotic heart disease,number of comorbidities, preoperative hemoglobin and albumin levels were the influencing factors of postoperative mortality in elder patients with intertrochanteric fractures treated with proximal femoral interlocking intramedullary nail fixation(P<0.05). Multivariate analysis showed that age(≥80 years), combined more than 2 medical diseases, and preoperative albumin(<35 g/L) were the independent risk factors for postoperative mortality(P<0.05). Conclusion To improve the clinical outcomes, perioperative risk should be comprehensively evaluated and perioperative management strengthened in the elder patients with intertrochanteric fractures, especially those with advanced age, more combined diseases, and low albumin, for the high postoperative mortality.