研究老年髋部骨折患者手术治疗后对侧髋部再骨折发生的影响探讨

Study on the Influence of the Occurrence of Contralateral Hip Re-fracture after Surgical Treatment in Elderly Hip Fracture Patients

目的分析老年髋部骨折患者手术后对侧髋部再骨折产生的影响因素。方法选择2020年6月—2021年8月昆明同仁医院收治的100例老年髋部骨折患者为研究对象,统计患者1年内对侧髋部再骨折发生率,采用单因素、多元Logistic回归方法对于对侧髋部再骨折影响因素进行分析。结果经过单因素分析发现,不同年龄(60~70岁2例,≥70岁28例)、骨质疏松程度(轻度5例,重度25例)、合并基础疾病(是20例,否10例)、手术时机(<10 d 22例,≥10 d 8例)、术后卧床时间(<30 d 4例,≥30 d 26例)、术后功能锻炼(是6例,否24例)、锻炼依从性(良好12例,差18例)的患者术后对侧髋部再骨折发生率比较,差异有统计学意义(χ^(2)=50.794、9.722、10.705、5.820、11.868、10.019、7.143,P<0.05),而不同性别、初发骨折类型、手术方式的患者侧髋部再骨折的发生率比较,差异无统计学意义(P>0.05),经Logistic回归分析,老年髋部骨折患者的骨质疏松程度、手术时机、年龄、合并基础疾病、术后卧床时间、术后功能锻炼、锻炼依从性均是老年髋部骨折患者术后侧髋部再骨折的危险因素(P<0.05)。结论老年髋部骨折骨质疏松程度、患者年龄、手术时机、合并基础疾病、术后卧床时间、术后功能锻炼、锻炼依从性均会对于手术后对侧髋部再骨折产生一定影响,因此,应针对患者的个体情况为其制定康复训练计划,积极预防对侧髋部再骨折。

Objective To analyze the factors influencing the generation of contralateral hip re-fracture in elderly hip fracture patients after surgery.Methods 100 elderly patients with hip fracture admitted to Kunming Tongren Hospital from June 2020 to August 2021 were selected as the research objects.The incidence of contralateral hip re-fracture within 1 year was counted.Univariate and multivariate logistic regression methods were used to analyze the influencing factors of contralateral hip re-fracture.Results After univariate analysis,comparison of the incidence of postoperative contralateral hip refracture in patients with different ages(2 cases at 60-70 years old,28 cases at≥70 years old),degree of osteoporosis(mild 5 cases,severe 25 cases),combined underlying diseases(yes 20 cases,no 10 cases),operation timing(<10 d 22 cases,≥10 d 8 cases),postoperative bed time(<30 d 4 cases,≥30 d 26 cases),postoperative functional exercise(yes 6 cases,no 24 cases)and exercise compliance(good 12 cases,poor 18 cases),and the difference was statistically significant(χ^(2)=50.794,9.722,10.705,5.820,11.868,10.019,7.143,P<0.05).There was no statistically significant difference in the incidence of side hip re-fracture between patients of different sex,initial fracture type and surgical method(P>0.05).By logistic regression analysis,the degree of osteoporosis,timing of surgery,age,combined underlying diseases,postoperative bed rest time,postoperative functional exercise,and exercise compliance were all risk factors for postoperative lateral hip re-fracture in elderly patients with hip fracture(P<0.05).Conclusion The degree of osteoporosis,age,timing of surgery,combined underlying diseases,postoperative bed rest,postoperative functional exercise,and exercise compliance of elderly patients with hip fractures all have an impact on postoperative contralateral hip re-fracture.Therefore,a rehabilitation training plan should be formulated for the individual patient to actively prevent the contralateral hip re-fracture.