摘要
背景:随着人口老龄化,合并痴呆的髋部骨折患者逐渐增加,给外科治疗带来挑战。目的:明确痴呆对老年髋部骨折患者术后并发症的影响。方法:分析2000-2019年在解放军总医院就诊的60岁以上首次髋部骨折患者,以入院时合并痴呆患者为研究对象,以年龄±5岁、性别、骨折类型为条件进行1∶10匹配非痴呆患者,比较两组术后并发症发生差异,包括肺炎、呼吸衰竭、胃肠道出血、泌尿系统感染、伤口感染、下肢深静脉血栓、肺栓塞、心绞痛、心律失常、心力衰竭、心肌梗死、脑卒中、死亡。采用多因素条件logistic回归评估痴呆对主要并发症的影响。结果与结论:纳入2887例患者,其中125例(4.3%)为痴呆患者,匹配1243例非痴呆患者。痴呆患者平均年龄为(80.6±7.4)岁,女性占64.8%,转子间骨折占53.6%,股骨颈骨折占46.4%。25例(20.0%)痴呆患者和123例(9.9%)非痴呆患者发生主要并发症(P<0.01)。痴呆患者髋部骨折术后主要并发症发生风险为200.0/1000(95%CI,139.3-278.6),非痴呆患者为99.0/1000(95%CI,83.6-116.9)。多因素条件logistic回归显示,痴呆患者髋部骨折术后主要并发症的发生风险是非痴呆患者的2倍(OR,2.11;95%CI,1.08-4.10)。结果可见,痴呆是老年髋部骨折患者发生术后并发症的独立危险因素。应对痴呆患者进行术前风险评估,开展相应的防治措施以减少术后并发症。
BACKGROUND:The number of hip fracture patients with dementia is increasing with an aging population,posing challenges for surgical treatment.OBJECTIVE:To determine the effect of dementia on postoperative complications in older patients with hip fractures.METHODS:Patients aged over 60 years old with hip fractures from 2000 to 2019 at Chinese PLA General Hospital were included.Dementia patients with a preexisting diagnosis of dementia at admission were identified.Each dementia patient was matched,for age±5 years,gender,and fracture type with 10 non-dementia patients.The differences in postoperative complications were compared between the two groups,including pneumonia,respiratory failure,gastrointestinal bleeding,urinary tract infection,surgical site infection,deep venous thrombosis,pulmonary embolism,angina pectoris,arrhythmia,heart failure,myocardial infarction,stroke,and death.The impact of dementia on major complications was evaluated using multivariate conditional logistic regression.RESULTS AND CONCLUSION:A total of 2887 patients were included,of whom 125(4.3%)were dementia patients and matched with 1243 non-dementia patients.The average age of dementia patients was(80.6±7.4)years;64.8%were female;53.6%were intertrochanteric fractures,and 46.4%were femoral neck fractures.Major complications occurred in 25(20.0%)patients with dementia and 123(9.9%)patients without dementia(P<0.01).The risk of major complications was 200.0 per 1000 persons(95%CI,139.3-278.6)in dementia patients and 99.0 per 1000 persons(95%CI,83.6-116.9)in non-dementia patients.Multivariate conditional logistic regression showed that a 2-fold risk of major postoperative complications after hip fracture surgery was found in dementia patients than in those without dementia(adjusted OR,2.11;95%CI,1.08-4.10).The results show that dementia is an independent risk factor for postoperative complications in elderly patients with hip fractures.Appropriate preoperative risk assessment and corresponding preventive and therapeutic measures should be given to this vulnerable population to mitigate postoperative complications.
作者
江渝
罗燕
林希圣
王昳琳
高泽福
吕厚辰
张里程
唐佩福
刘玉杰
Jiang Yu;Luo Yan;Lin Xisheng;Wang Yilin;Gao Zefu;Lyu Houchen;Zhang Licheng;Tang Peifu;Liu Yujie(Medical School of Chinese PLA,Beijing 100853,China;Department of Orthopedics,Fourth Medical Center of Chinese PLA General Hospital,Beijing 100853,China;National Clinical Research Center for Orthopedics,Sports Medicine&Rehabilitation,Beijing 100853,China;Department of Rehabilitation,Second Medical Center of Chinese PLA General Hospital,Beijing 100853,China)
出处
《中国组织工程研究》
CAS
北大核心
2024年第18期2895-2900,共6页
Chinese Journal of Tissue Engineering Research
基金
国家自然科学基金(81972102),项目负责人:唐佩福
北京市科学技术协会青年人才托举工程(BYESS2022021),项目负责人:吕厚辰
解放军总医院优青培育项目(2020-YQPY-001),项目负责人:吕厚辰。
关键词
老年
髋部骨折
痴呆
手术
并发症
危险因素
匹配
队列研究
older
hip fracture
dementia
surgery
complication
risk factor
matched
cohort study