骨科-老年科共管模式下手术治疗稳定型与不稳定型老年股骨转子间骨折的临床效果比较

Comparison of mid-to-long-term clinical outcomes for stable and unstable femoral intertrochanteric fractures in the elderly managed under orthopedics and geriatric comanagement

目的:比较骨科-老年科共管模式下手术治疗稳定型与不稳定型老年股骨转子间骨折的临床效果。方法:回顾性分析2015年5月至2017年4月首都医科大学附属北京积水潭医院收治的采用骨科-老年科共管模式下手术治疗的452例老年股骨转子间骨折患者的临床资料,根据术前骨折分型将患者分为稳定型骨折组(180例)和不稳定型骨折组(272例)。记录并比较两组患者的死亡率及日常活动能力资料。结果:所有患者均获得36~71个月随访,平均(47.8±15.4)个月。术后3年及末次随访时,两组患者死亡率比较,差异均无统计学意义(P均>0.05)。末次随访时,两组患者日常活动能力比较,差异无统计学意义(P>0.05)。结论:骨科-老年科共管模式下手术治疗老年股骨转子间骨折,患者死亡率较高、活动能力明显下降,稳定型与不稳定型股骨转子间骨折患者死亡率和日常活动能力相似。

Objective:To compare the mid-to-long term clinical outcomes of stable and unstable femoral intertrochanteric fractures in the elderly managed under orthopedics and geriatric comanagement.Methods:A retrospective analysis was conducted on the clinical data of 455 elderly patients with femoral intertrochanteric fractures treated under orthopedics and geriatric comanagement who were admitted to Department of Traumatic Orthopedics,Beijing Jishuitan Hospital,Capital Medical University from May 2015 to April 2017.Patients were divided into a stable fracture group(181 cases)and an unstable fracture group(274 cases)based on preoperative fracture classification.The mortality rate and activity ability of the two groups were recorded and compared,Kaplan-Meier survival curves were drawn,and the mortality rate at the last follow-up was analyzed.Results:All patients were followed up for 36 to 71 months,with an average of(47.8±15.4)months.There was no statistically significant difference in mortality rates between the two groups(all P>0.05)at 3 years post-operation or at the last follow-up.Comparison of the daily activity ability between the two groups at the last follow-up also showed no statistically significant difference(P>0.05).Conclusions:The comanagement of orthopedics and geriatric for the treatment of femoral intertrochanteric fractures in elderly patients resulted in higher mid-to-long-term mortality rates and significantly reduced mobility.The long-term mortality rate and daily activity ability were similar between the two groups of patients.