大坪骨科老年手术风险评分系统评分对老年髋部骨折患者术后实施分层救治的临床意义

Clinical significance of Daping orthopedics operative risk scoring system for senile patient in stratified treatment of elderly patients with hip fracture after operation

目的探讨大坪骨科老年手术风险评分系统(DORSSSP)对老年髋部骨折患者实施分层救治的临床意义。方法采用回顾性病例对照研究分析2014年1月—2018年1月苏州大学附属第二医院收治的440例老年髋部骨折患者临床资料,其中男130例,女310例;年龄60~98岁[(79.3±6.3)岁]。依据患者病情,采用DORSSSP进行术前风险预测评估,根据评分将患者分为低风险组(A组,208例)、中风险组(B组,157例)、高风险术后未转入外科ICU(SICU)组(C组,23例)、高风险术后转入SICU组(D组,52例)。对各组并发症、病死率预测值与实际值进行比较。结果(1)A、B、C、D组DORSSSP预测并发症例数分别为52例、60例、14例、31例,各组实际并发症例数分别为45例、55例、13例、16例,A、B、C组预测值与实际值比较差异无统计学意义(P>0.05),D组预测值与实际值比较差异有统计学意义(P<0.01);D组术后并发症发生率低于C组(P<0.05)。(2)A、B、C、D组DORSSSP预测死亡发生例数分别为0例、3例、2例、4例,各组实际死亡例数分别为0例、1例、2例、1例,A、B、C组预测值与实际值比较差异无统计学意义(P>0.05),D组预测值与实际值比较差异有统计学意义(P<0.05);D组术后病死率低于C组,但差异无统计学意义(P>0.05)。结论DORSSSP评分能较好预测老年髋部骨折患者术后并发症发生率和病死率,根据DORSSSP评分实施分层救治,将重症患者术后转入SICU治疗,能显著降低重症患者术后并发症发生率。

Objective To investigate the guiding significance of Daping orthopedics operative risk scoring system for senile patient(DORSSSP)for stratified treatment of elderly patients with severe hip fractures.Methods A retrospectively case-control study was performed for data of 440 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from January 2014 to January 2018,including 130 male and 310 female patients aged 60-98 years[(79.3±6.3)years].According to the DORSSSP scoring system,the patients were divided into low risk group(Group A,n=208),medium risk group(Group B,n=157)and high risk group without SICU transfer after operation(Group C,n=23)and high risk group with SICU transfer after operation(Group D,n=52).The risk prediction results of each group were recorded and compared with the actual complications and mortality.Results(1)According to the prediction of DORSSSP,the number of postoperative complications in Groups A,B,C and D were 52,60,14 and 31,respectively,while the number of actual complications after operation was 45,55,13 and 16.There was significant difference between the predicted value and the actual value of postoperative complications in Group D(P<0.01),which was not found in other three groups(P>0.05).The incidence of postoperative complications in Group D was lower than that in Group C(P<0.05).(2)According to the prediction of DORSSSP,the number of postoperative death in Groups A,B,C and D were 0,three,two and four,respectively,while the number of actual death after operation was 0,one,two and one,respectively.The predicted value and the actual value of death were significantly different in Group D(P<0.05),but were not in other three groups(P>0.05).The incidence of postoperative death in Group D was lower than that in Group C(P>0.05).Conclusions There is a good correlation between DORSSSP score and postoperative complications and mortality.Based on DORSSSP score for stratified treatment,the interventional treatment of elderly patients with severe hip fracture after operation into SICU can better reduce the incidence of complications.