改良DORSSSP评分系统对老年髋部骨折内固定术后并发症的预测作用

Predictive effect of modified DORSSSP scoring system on complications after hip fracture internal fixation in elderly patients

目的探讨改良大坪骨科老年患者手术风险评分系统(DORSSSP)对老年髋部骨折内固定术后并发症的预测作用。方法回顾性分析2016年1月-2018年9月陆军军医大学大坪医院关节四肢外科收治的行内固定术治疗的老年髋部骨折患者168例,男性87例,女性81例;年龄60~89岁,平均73.8岁。分别采用DORSSSP评分与改良DORSSSP评分对其进行评估,根据术后6个月内并发症发生情况将纳入研究患者分为发生组(54例)与未发生组(114例),对比此两组的DORSSSP评分及改良DORSSSP评分,绘制基于预测术后并发症发生结果的工作曲线(ROC),比较此两种评分系统的灵敏度、特异度及曲线下面积(AUC)。结果DORSSSP总评分平均为(27.35±4.68)分,改良DORSSSP总评分平均为(24.46±3.91)分;术后随访6个月,168例患者有54例出现并发症,并发症发生率为32.14%(54/168);发生组的DORSSSP评分与改良DORSSSP评分均显著高于未发生组(P<0.05);DORSSSP评分系统与改良DORSSSP评分系统预测老年髋部骨折内固定术后并发症发生结果中,AUC分别为0.879、0.905,灵敏度分别为81.48%、90.74%,特异度分别为80.70%、86.84%,改良DORSSSP评分的灵敏度及特异度均高于DORSSSP评分(P<0.05)。结论老年髋部骨折内固定术后并发症发生率较高,且发生并发症患者的DORSSSP评分、改良DORSSSP评分均高于未发生者,此两种评分系统均对患者术后并发症的发生具有一定的预测价值,但改良DORSSSP评分系统的预测价值更高。

Objective To explore the predictive effect of modified Daping Orthopaedic Operative Risk Scoring System for Senile Patient(DORSSSP)on complications after internal fixation of hip fracture in elderly patients.Methods Totally 168 elderly patients with hip fracture treated by internal fixation in our hospital from Jan.2016 to Sep.2018 were selected,who were evaluated by DORSSSP and modified DORSSSP respectively.There were 87 males and 81 females,with an average age of 73.8 years(range,60-89 years).These patients were divided into the occurrence group and the non-occurrence group according to the occurrence of complications within 6 months after operation,then the DORSSSP score and the modified DORSSSP score of the two groups were compared,the receiver operating characteristic curve(ROC)based on the predicting outcome of postoperative complications were drawn,and the sensitivity,specificity and area under curve(AUC)of the two scoring systems were also compared.Results The total score of DORSSSP was(27.35±4.68)on average,and the total score of modified DORSSSP was(24.46±3.91)on average.At 6 months after operation,there were 54 cases with complications in 168 patients,and the incidence rate of complications was 32.14%(54/168).The scores of DORSSSP and modified DORSSSP in the occurrence group were significantly higher than those in the non-occurrence group(P<0.05).The AUC was 0.879 and 0.905,respectively,in predicting complications after internal fixation of hip fracture in the elderly by DORSSSP and modified DORSSSP and the sensitivity was 81.48%and 90.74%,respectively,the specificity was 80.70%and 86.84%,respectively,and the sensitivity and specificity of modified DORSSSP score were higher than those of DORSSSP score(P<0.05).Conclusion The incidence of complications after internal fixation of hip fracture in the elderly is high,the DORSSSP score and modified DORSSSP score of the patients with complications are higher than those of the patients without complications,and these two scoring systems have certain predictive value for the occurrence of complications after operation.However,the modified DORSSSP scoring system has a higher predictive value and can be used to guide clinical work to minimize the occurrence of postoperative complications.