老年髋部骨折术后对侧再骨折的独立风险因素分析

Independent risk factors of contralateral refracture after hip fracture surgery in elderly patients

目的探讨髋部骨折术后3年内对侧髋部再骨折发生的独立风险因素。方法采用回顾性研究,选择2014年1月至2017年12月笔者所在单位收治的髋部骨折患者作为研究对象,根据术后3年内是否发生对侧髋部骨折,分为初次骨折组和再次骨折组。分别对两组患者的年龄、性别、初次骨折类型、对侧髋部骨密度、并存病、内固定方式、麻醉方式进行单因素和多因素Logistic分析,分析髋部骨折后再骨折的独立风险因素。结果2014年1月至2017年12月共纳入567例老年髋部骨折患者,术后3年内有74例(13.1%)患者发生对侧髋部再骨折,术后1年是再骨折发生高峰期。单因素分析年龄(P=0.002),男性(P=0.014),高血压病(P=0.022)、痴呆(P=0.007)、并存病数量≥4项(P=0.000)和脆性骨折病史(P=0.000)差异有统计学意义,同时对侧髋部再骨折组患者的骨密度值(P=0.012),初次髋部骨折行骨折内固定术(P=0.033)和股骨转子间骨折(P=0.022)与初次骨折组比较,差异有统计学意义。多因素Logistic回归分析显示:高龄(OR=1.050,95%CI=1.011~1.090,P=0.012)、高血压病(OR=1.836,95%CI=1.029~3.277,P=0.040)、痴呆(OR=2.244,95%CI=1.048~4.804,P=0.037)、骨密度(OR=1.175,95%CI=1.049~1.454,P=0.039)、伤前脆性骨折史(OR=6.614,95%CI=3.254~13.447,P=0.000)是术后3年内发生对侧髋部骨折的独立风险因素。结论老年髋部骨折术后对侧髋部再骨折发生率高,术后1年是再骨折发生高峰期;高龄、高血压病、痴呆、骨密度、伤前脆性骨折史是术后发生对侧骨折的独立风险因素。

Objective To explore the related risk factors of contralateral hip re-fracture within 3 years after hip fracture surgery.Methods A retrospective study of patients with hip fracture was conducted from January 2014 to December 2017.According to contralateral hip fracture within 3 years after operation,all patients were divided into primary fracture group and secondary fracture group.The age,gender,type of primary fracture,internal fixation method,contralateral hip bone mineral density and comorbidity of the two groups were compared and analyzed by univariate and multivariate logistic regression.Results A total of 567 elderly hip fracture patients were included.74 patients (13.1%) were associated with contralateral hip fracture within 3 years after operation,and the peak occurred within 1 year after operation.Univariate analysis showed significant differences in age (P=0.002),gender (male,P=0.014),intertrochanteric fracture (P=0.022),hypertension (P=0.022),dementia (P=0.007),coexisting diseases ≥ 4 (P=0.000),history of fragility fracture (P=0.000),bone mineral density (P=0.012) and arthroplasty (P=0.033) compared to primary fracture group.Multivariate logistic regression analysis showed that age (OR=1.050,95% CI=1.011-1.090,P=0.012),hypertension (OR=1.836,95% CI=1.029-3.277,P=0.040),dementia (OR=2.244,95% CI=1.048-4.804,P=0.037),bone mineral density (OR=1.175,95% CI=1.049-1.454,P=0.039),history of fragility fracture (OR=6.614,95% CI=3.254-13.447,P=0.000) were independent risk factors for contralateral re-fracture within 3 years after surgery.Conclusions The incidence of contralateral re-fracture in elderly patients with hip fracture is high,and the peak occurs 1 year after surgery.Elder age,hypertension,dementia,lower bone mineral density and history of fragility fracture are risk factors for contralateral fracture after operation.