老年髋部骨折与心血管疾病的相关性研究进展
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摘要
<正>随着老年人的数量不断增加,我国已步入老龄化社会。老年人不仅骨质强度低,而且机体的平衡性及肌肉的协调能力较差,使得老年人更容易跌倒从而并发骨质疏松性骨折,给个人和社会带来了沉重的负担。其中髋部骨折的发生率最高,60岁以上的人群中,年龄每增加5岁,其髋部骨折的发生率增加1倍[1],髋部骨折患者约占老年骨折住院患者的30%,并且发病率逐年增加。有研究显示不良心血管事件是髋部骨折患者病死风险增加的主要原因之一,髋部骨折患者的心血管风险较没有髋部骨折的患者增加2倍[2-3]。而髋部骨折术后心血管疾病的发生率高达1.07%[4]。但是老年髋部骨折后心脏疾病的风险并没有
Cardiovascular complication has high morbidity and in-hospital mortality for hip fracture patients.Studies have shown that adverse cardiovascular event is one of the leading causes of increased risk of death in patients with hip fractures. So identification of patients at risk for postoperative cardiac event is crucial. Non-invasive assessment of perioperative cardiovascular event is currently costly and time consuming, while traditional preoperative assessment does not accurately predict cardiovascular complications. Perioperative brain natriuretic peptide( N terminal pro B type natriuretic peptide, NT-proBNP), troponin T( TnT), blood glucose, blood routine, etc. can predict cardiovascular risk and mortality. Therefore, accurate and rapid assessment of preoperative cardiovascular risk should be based on the optimization of surgical treatment. Early, minimally invasive procedure, strong internal fixation,reduced bed rest time, perioperative multi-disciplinary collaboration can reduce postoperative complications and mortality.
Cardiovascular complication has high morbidity and in-hospital mortality for hip fracture patients.Studies have shown that adverse cardiovascular event is one of the leading causes of increased risk of death in patients with hip fractures. So identification of patients at risk for postoperative cardiac event is crucial. Non-invasive assessment of perioperative cardiovascular event is currently costly and time consuming, while traditional preoperative assessment does not accurately predict cardiovascular complications. Perioperative brain natriuretic peptide( N terminal pro B type natriuretic peptide, NT-proBNP), troponin T( TnT), blood glucose, blood routine, etc. can predict cardiovascular risk and mortality. Therefore, accurate and rapid assessment of preoperative cardiovascular risk should be based on the optimization of surgical treatment. Early, minimally invasive procedure, strong internal fixation,reduced bed rest time, perioperative multi-disciplinary collaboration can reduce postoperative complications and mortality.
引文
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[3]Stevens JA,Rudd RA.The impact of decreasing U.S.hip fracture rates on future hip fracture estimates[J].Osteoporosis International,2013,24(10):2725-2728.
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[5]吴新宝,杨明辉.谈谈老年髋部骨折患者手术治疗的几个问题[J].中国骨与关节杂志,2017,6(3):161-162.
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[7]Neuburger J,Currie C,Wakeman R,et al.49the impact of the national hip fracture database on mortality after hip fracture in england[J].Age Ageing,2016,45(Suppl 1):12-15.
[8]Pincus D,Ravi B,Wodchis WP.Wait time for hip fracture surgery and mortality-reply[J].JAMA,2018,319(21):2234-2235.
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[15]Wong CX,Gan SW,Lee SW,et al.Atrial fibrillation and risk of hip fracture:a population-based analysis of 113,600individuals[J].J Intern Cardio,2017,10:243.
[16]Bhattacharyya T,Bhattacharyya T,Iorio R,et al.Rate of and risk factors for acute inpatient mortality after orthopaedic surgery[J].J Bone Joint Surg,2002,84(84-A):562-572.
[17]Wong C.Atrial fibrillation,hip fracture and oral anticoagulant therapy[J].Intern J Cardiology,2017,249:259.
[18]Cees Vermeer.Vitamin K:the effect on health beyond coagulation-an overview[J].J Bone Joint,2012,56:10.
[19]张建政,王晓伟,刘智,等.关注老年髋部骨折病死率过高的问题[J].中国骨与关节杂志,2018,7(7):481-483.
[20]Sennerby U,H?kan Melhus,Gedeborg R,et al.Cardiovascular diseases and risk of hip fracture[J].JAMA,2009,302(15):1666-1673.
[21]Hao Z,Tiansheng S,Zhi L,et al.Hip fracture aggravates systemic inflammation and lung injury in aged chronic cigarette smoke exposed rats[J].J Orthop Res,2014,32(1):24-30.
[22]Sun T,Wang X,Liu Z,et al.Plasma concentrations of pro-and anti-inflammatory cytokines and outcome prediction in elderly hip fracture patients[J].Injury,2011,42(7):707-713.
[23]Gan L,Chen X,Sun T,et al.Significance of serum mtDNAconcentration in lung injury induced by hip fracture[J].Shock,2015,44(1):52-57.
[24]Zhang JZ,Liu Z,Liu J,et al.Mitochondrial DNA induces inflammation and increases TLR9/NF-kB expression in lung tissue[J].Int J Mol Med,2014,33(4):817-824.
[25]Zhang JZ,Wang J,Qu WC,et al.Plasma mitochondrial DNAlevels were independently associated with lung injury in elderly hip fracture patients[J].Injury,2017,48(2):454-459.
[26]Farhat GN,Cauley JA.The link between osteoporosis and cardiovascular disease[J].Clin Cases Miner Bone Metab,2008,5(1):19-34.
[27]Aronow WS.Heart disease and aging[J].Med Clinics North Amer,2006,90(5):849-862.
[28]Sennerby U,Farahmand B,Ahlbom A,et al.Cardiovascular diseases and future risk of hip fracture in women[J].Osteoporos Int,2007,18(10):1355-1362.
[29]Diepen SV,Majumdar SR,Bakal JA,et al.Heart failure is a risk factor for orthopedic fracture[J].Circulation,2008,118(19):1946-1952.
[30]Carbone L,BuzkováP,Fink HA,et al.Hip fractures and heart failure:findings from the cardiovascular health study[J].J Europ Heart,2010,31(1):77.
[31]Kadono Y,Yasunaga H,Horiguchi H,et al.Statistics for orthopedic surgery 2006-2007:data from the Japanese diagnosis procedure combination database[J].J Orthop Sci,2010,15(2):162-170.
[32]Nordling P,Kiviniemi T,Strandberg M,et al.Predicting the outcome of hip fracture patients by using N-terminal fragment of pro-B-type natriuretic peptide[J].BMJ Open,2016,6(2):e009416.
[33]Oscarsson Tibblin A,Fredrikson M,Sorliden M,et al.N-terminal fragment of pro-B-type natriuretic peptide is a predictor of cardiac events in high-risk patients undergoing acute hip fracture surgery[J].J British Anaes,2009,103(2):206-212.
[34]高长虹,李震花,张涛.老年髋部骨折手术前后血清B型尿钠肽和心肌肌钙蛋白的变化[J].中国矫形外科杂志,2017,25(22):2042-2045.
[35]Ushirozako H,Ohishi T,Fujita T,et al.Does N-terminal probrain type natriuretic peptide predict cardiac complications after hip fracture surgery[J]?Clinic Orthop Related Res,2017,475(6):1730-1736.
[36]Hietala P,Strandberg M,Strandberg N,et al.Perioperative myocardial infarctions are common and often unrecognized in patients undergoing hip fracture surgery[J].J Trauma Acute Care Surg,2013,74(4):1087-1091.
[37]Chen Y,Yang X,Meng K,et al.Stress-induced hyperglycemia after hip fracture and the increased risk of acute myocardial infarction in nondiabetic patients[J].Diabetes Care,2013,36(10):3328-3332.
[38]刘晓峰.血常规指标在脆性髋部骨折近期病死风险中的预测价值[D].福建医科大学,2016:1-35.
[39]Riemen A H K,Hutchison J D.The multidisciplinary management of hip fractures in older patients[J].Orthop Trauma,2016:S1877132716300252.
[2]Ariza-Vega P,Kristensen MT,Martín-Martín L,et al.Predictors of long-term mortality in older peoplewith hip fracture[J].Arch Phys Med Rehabil,2015,96(7):1215-1221.
[3]Stevens JA,Rudd RA.The impact of decreasing U.S.hip fracture rates on future hip fracture estimates[J].Osteoporosis International,2013,24(10):2725-2728.
[4]Kadono Y,Yasunaga H,Horiguchi H,et al.Statistics for orthopedic surgery 2006-2007:data from the Japanese Diagnosis Procedure Combination database[J].J Orthop Science,2010,15(2):162-170.
[5]吴新宝,杨明辉.谈谈老年髋部骨折患者手术治疗的几个问题[J].中国骨与关节杂志,2017,6(3):161-162.
[6]Kanis JA,A.Odén,Mccloskey EV,et al.A systematic review of hip fracture incidence and probability of fracture worldwide[J].Osteoporosis International,2012,23(9):2239-2256.
[7]Neuburger J,Currie C,Wakeman R,et al.49the impact of the national hip fracture database on mortality after hip fracture in england[J].Age Ageing,2016,45(Suppl 1):12-15.
[8]Pincus D,Ravi B,Wodchis WP.Wait time for hip fracture surgery and mortality-reply[J].JAMA,2018,319(21):2234-2235.
[9]Katsoulis M,Benetou V,Karapetyan T,et al.Excess mortality after hip fracture in elderly persons from Europe and the USA:the Chances project[J].J Internal Medicine,2017,281(3):300-310.
[10]Smilowitz NR,Berger JS.Perioperative management to reduce cardiovascular events[J].Circulation,2016,133(11):1125-1130.
[11]Fleisher LA,Fleischmann KE,Auerbach AD,et al.2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery:a report of the american college of cardiology/american heart association task force on practice guidelines[J].Circulation,2014,130(24):e278-333.
[12]Heyes GJ,Tucker A,Marley D,et al.Predictors for readmission up to 1 year following hip fracture[J].Archives Trauma Res,2015,4(2).
[13]Xu B,Han L,Liu H,et al.Cardiovascular disease and hip fracture among older inpatients in Beijing,China[J].Biomed Res Int,2013,2013(19):493696.
[14]Hietala P,Strandberg M,Strandberg N,et al.Perioperative myocardial infarctions are common and often unrecognized in patients undergoing hip fracture surgery[J].J Trauma Acute Care Surg,2013,74(4):1087-1091.
[15]Wong CX,Gan SW,Lee SW,et al.Atrial fibrillation and risk of hip fracture:a population-based analysis of 113,600individuals[J].J Intern Cardio,2017,10:243.
[16]Bhattacharyya T,Bhattacharyya T,Iorio R,et al.Rate of and risk factors for acute inpatient mortality after orthopaedic surgery[J].J Bone Joint Surg,2002,84(84-A):562-572.
[17]Wong C.Atrial fibrillation,hip fracture and oral anticoagulant therapy[J].Intern J Cardiology,2017,249:259.
[18]Cees Vermeer.Vitamin K:the effect on health beyond coagulation-an overview[J].J Bone Joint,2012,56:10.
[19]张建政,王晓伟,刘智,等.关注老年髋部骨折病死率过高的问题[J].中国骨与关节杂志,2018,7(7):481-483.
[20]Sennerby U,H?kan Melhus,Gedeborg R,et al.Cardiovascular diseases and risk of hip fracture[J].JAMA,2009,302(15):1666-1673.
[21]Hao Z,Tiansheng S,Zhi L,et al.Hip fracture aggravates systemic inflammation and lung injury in aged chronic cigarette smoke exposed rats[J].J Orthop Res,2014,32(1):24-30.
[22]Sun T,Wang X,Liu Z,et al.Plasma concentrations of pro-and anti-inflammatory cytokines and outcome prediction in elderly hip fracture patients[J].Injury,2011,42(7):707-713.
[23]Gan L,Chen X,Sun T,et al.Significance of serum mtDNAconcentration in lung injury induced by hip fracture[J].Shock,2015,44(1):52-57.
[24]Zhang JZ,Liu Z,Liu J,et al.Mitochondrial DNA induces inflammation and increases TLR9/NF-kB expression in lung tissue[J].Int J Mol Med,2014,33(4):817-824.
[25]Zhang JZ,Wang J,Qu WC,et al.Plasma mitochondrial DNAlevels were independently associated with lung injury in elderly hip fracture patients[J].Injury,2017,48(2):454-459.
[26]Farhat GN,Cauley JA.The link between osteoporosis and cardiovascular disease[J].Clin Cases Miner Bone Metab,2008,5(1):19-34.
[27]Aronow WS.Heart disease and aging[J].Med Clinics North Amer,2006,90(5):849-862.
[28]Sennerby U,Farahmand B,Ahlbom A,et al.Cardiovascular diseases and future risk of hip fracture in women[J].Osteoporos Int,2007,18(10):1355-1362.
[29]Diepen SV,Majumdar SR,Bakal JA,et al.Heart failure is a risk factor for orthopedic fracture[J].Circulation,2008,118(19):1946-1952.
[30]Carbone L,BuzkováP,Fink HA,et al.Hip fractures and heart failure:findings from the cardiovascular health study[J].J Europ Heart,2010,31(1):77.
[31]Kadono Y,Yasunaga H,Horiguchi H,et al.Statistics for orthopedic surgery 2006-2007:data from the Japanese diagnosis procedure combination database[J].J Orthop Sci,2010,15(2):162-170.
[32]Nordling P,Kiviniemi T,Strandberg M,et al.Predicting the outcome of hip fracture patients by using N-terminal fragment of pro-B-type natriuretic peptide[J].BMJ Open,2016,6(2):e009416.
[33]Oscarsson Tibblin A,Fredrikson M,Sorliden M,et al.N-terminal fragment of pro-B-type natriuretic peptide is a predictor of cardiac events in high-risk patients undergoing acute hip fracture surgery[J].J British Anaes,2009,103(2):206-212.
[34]高长虹,李震花,张涛.老年髋部骨折手术前后血清B型尿钠肽和心肌肌钙蛋白的变化[J].中国矫形外科杂志,2017,25(22):2042-2045.
[35]Ushirozako H,Ohishi T,Fujita T,et al.Does N-terminal probrain type natriuretic peptide predict cardiac complications after hip fracture surgery[J]?Clinic Orthop Related Res,2017,475(6):1730-1736.
[36]Hietala P,Strandberg M,Strandberg N,et al.Perioperative myocardial infarctions are common and often unrecognized in patients undergoing hip fracture surgery[J].J Trauma Acute Care Surg,2013,74(4):1087-1091.
[37]Chen Y,Yang X,Meng K,et al.Stress-induced hyperglycemia after hip fracture and the increased risk of acute myocardial infarction in nondiabetic patients[J].Diabetes Care,2013,36(10):3328-3332.
[38]刘晓峰.血常规指标在脆性髋部骨折近期病死风险中的预测价值[D].福建医科大学,2016:1-35.
[39]Riemen A H K,Hutchison J D.The multidisciplinary management of hip fractures in older patients[J].Orthop Trauma,2016:S1877132716300252.