90岁以上股骨粗隆间骨折术后2年生存调查

Two-year survival survey after surgical treatment for intertrochanteric fracture of femur in elderly over 90 years

[目的]探讨高龄股骨粗隆间骨折术后的生存情况及死亡的危险因素。[方法]回顾性分析2016年1月—2023年3月在本院住院并行手术治疗的172例老年患者的临床资料,所有患者采用股骨近端抗旋转髓内针固定或人工股骨头置换术治疗。采用Kaplan-Meier生存分析和Cox比例风险回归模型分析,单因素比较死亡与生存两组的差异。[结果]随访时间为1~87个月,术后6、12、24个月分别死亡27例(15.7%)、53例(30.8%)、102例(59.3%)。按术后6个月是否生存,单因素比较显示,死亡组的BMI显著小于生存组[(19.7±3.6)kg/m2vs(21.2±3.7)kg/m2,P=0.049],死亡组的ASA分级显著重于生存组[Ⅱ/Ⅲ/Ⅳ/Ⅴ,(2/10/15/0)vs(23/82/39/1),P=0.031],死亡组术前Hb水平显著低于生存组[(92.4±16.6)g/L vs(100.1±18.2)g/L,P=0.043]。多元Cox回归分析显示:ASA级分期重(HR=5.295,P<0.001)、骨折类型复杂(HR=2.264,P=0.013)是高龄股骨粗隆间骨折后死亡的独立危险因素,而女性(HR=0.290,P=0.003)、术前Hb高(HR=0.983,P=0.037)是保护性因素。[结论]对于高龄股骨粗隆间骨折的患者,其术后死亡率尤其是24个月死亡率较高,同时BMI小、ASA分期重、骨折分型复杂是高龄股骨粗隆间骨折术后死亡的危险因素。

[Objective]To investigate the survival and risk factors of death after surgical treatment for intertrochanteric fracture of fe⁃mur in the elderly over 90 years.[Methods]A retrospective study was done on 172 patients elder over 90 years who received surgical treat⁃ment for femoral intertrochanteric fractures in our hospital from January 2016 to March 2023.All patients were treated with proximal femo⁃ral nail anti-rotation or hip hemiarthroplasty.In addition to the Kaplan-Meier survival analysis and Cox proportional risk regression used,univariate comparison were conducted to analyze the difference between the death and survival.[Results]The follow-up period was lasted for 1~87 months,and the mortality was of 27 cases(15.7%),53 cases(30.8%)and 102 cases(59.3%)at 6 months,12 months and 24 months,respectively.In terms of univariate comparison of whether survival at 6 months after surgery,the death group proved significantly greater BMI[(19.7±3.6)kg/m2 vs(21.2±3.7)kg/m2,P=0.049],significantly severe American Society of Anesthesiologists(ASA)classifica⁃tion[II/III/IV/V,(2/10/15/0)vs(23/82/39/1),P=0.031]and significantly lower preoperative Hb level[(92.4±16.6)g/L vs(100.1±18.2)g/L,P=0.043]than the survival group.As consequences of multivariate Cox regression,the severe ASA grade(HR=5.295,P<0.001)and com⁃plex fracture type(HR=2.264,P=0.013)were the independent risk factors for death after surgical treatment for femoral intertrochanteric fractures in elderly,whereas the female(HR=0.290,P=0.003)and high preoperative Hb(HR=0.983,P=0.037)were the protective factors.[Conclusion]The postoperative mortality is higher in the elderly over 90 years with femoral intertrochanteric fractures,especially within 24 months.Meanwhile,light BMI,severe ASA stage and complex fracture classification are risk factors for postoperative death of elderly post⁃operatively for femoral intertrochanteric fractures.