POSSUM和P-POSSUM评分系统对高龄转子间骨折行髋关节置换术的风险预测
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摘要
目的探讨POSSUM和P-POSSUM评分系统对老龄转子间骨折行髋关节置换术术后风险预测的实用性。方法对148髋行髋关节置换的高龄转子间骨折患者进行POSSUM和P-POSSUM评分,预测术后并发症和死亡例数,并与观测值比较。结果 POSSUM评分系统预测术后并发症23例,观测并发症34例,差异无统计学意义(P> 0. 05);预测死亡84例,观测死亡8例,差异有统计学意义(P <0. 01); P-POSSUM评分系统预测死亡11例,观测死亡8例,差异无统计学意义(P> 0. 05)。结论 POSSUM对死亡率的预测值偏高,对并发症的预测有很好的临床价值; P-POSSUM对术后死亡风险有很好的预测能力。但POSSUM和P-POSSUM部分评价内容,如年龄评分、骨科高危因素及定义术后并发症方面有待国内形成大数据后改良。
Objective To investigate the practicability of the POSSUM and P-POSSUM scoring system for postoperative risk assessment of hip replacement in elderly patients with intertrochanteric fractures. Methods We retrospectively applied the POSSUM and P-POSSUM scores on 148 patients with intertrochanteric fractures treated with hip arthroplasty.The postoperative complications and number of deaths were predicted and compared with the observed values.Results The POSSUM predicted that there would be 23 cases with complications while we observed 34 cases with complications.However,the difference was not statistically significant( P > 0. 05).The POSSUM predicted that there would be 84 postoperative deaths but only 8 deaths happened.There difference was statistically significant( P < 0. 05). Moreover,the P-POSSUM predicted that there would be 11 postoperative deaths that was not significantly different from actual deaths( P > 0. 05).Conclusion The POSSUM over predicts the mortality,but it has a good clinical value for the prediction of complications.The P-POSSUM can predict postoperative mortality more precisely.However,some evaluation contents of POSSUM and P-POSSUM such as age scores,orthopedic risk factors and definition of postoperative complications need to be improved when big data are generated in China.
Objective To investigate the practicability of the POSSUM and P-POSSUM scoring system for postoperative risk assessment of hip replacement in elderly patients with intertrochanteric fractures. Methods We retrospectively applied the POSSUM and P-POSSUM scores on 148 patients with intertrochanteric fractures treated with hip arthroplasty.The postoperative complications and number of deaths were predicted and compared with the observed values.Results The POSSUM predicted that there would be 23 cases with complications while we observed 34 cases with complications.However,the difference was not statistically significant( P > 0. 05).The POSSUM predicted that there would be 84 postoperative deaths but only 8 deaths happened.There difference was statistically significant( P < 0. 05). Moreover,the P-POSSUM predicted that there would be 11 postoperative deaths that was not significantly different from actual deaths( P > 0. 05).Conclusion The POSSUM over predicts the mortality,but it has a good clinical value for the prediction of complications.The P-POSSUM can predict postoperative mortality more precisely.However,some evaluation contents of POSSUM and P-POSSUM such as age scores,orthopedic risk factors and definition of postoperative complications need to be improved when big data are generated in China.
引文
[1]Byrne DD,Newcomb CW,Carbonari DM,et al.Risk of hip fracture associated with untreated and treated chronic hepatitis B virus infection[J].Journal of Hepatology,2014,61(2):210-218.
[2]刘海龙.POSSUM与P-POSSUM评分对髋部骨折患者术后并发症发生率及死亡率预测作用的回顾性分析[J].中国骨与关节杂志,2017,6(6):451-454.
[3]Copeland GP,Jones D,Walters M.POSSUM:a scoring system for surgical audit.[J].British Journal of Surgery,2010,78(3):355-360.
[4]吴云峰,李锋,孙志颖,等.改良POSSUM及P—POSSUM评分在老年髋部骨折手术风险评估中的应用价值[J].中国骨与关节损伤杂志,2011,26(6):481-483.
[5]韩天宇,梁娜,刘欣伟,等.POSSUM评分在老年股骨粗隆间骨折患者围手术期中的应用[J].创伤与急危重病医学,2015,3(4):196-197.
[6]Ramanathan TS,Moppett IK,Wenn R,et al.POSSUM scoring for patients with fractured neck of femur.[J]. British Journal of Anaesthesia,2005,94(4):430-433.
[7] Prytherch DR,Whiteley MS,Higgins B,et al. POSSUM and Portsmouth POSSUM for predicting mortality[J].Br J Surg,1998,85(9):1217-1220.
[8]刘志勇,张新潮,蔡国平,等.骨科POSSUM和P-POSSUM评分系统预测老年髋部骨折手术风险的价值[J].中华创伤杂志,2014,30(7):706-710.
[2]刘海龙.POSSUM与P-POSSUM评分对髋部骨折患者术后并发症发生率及死亡率预测作用的回顾性分析[J].中国骨与关节杂志,2017,6(6):451-454.
[3]Copeland GP,Jones D,Walters M.POSSUM:a scoring system for surgical audit.[J].British Journal of Surgery,2010,78(3):355-360.
[4]吴云峰,李锋,孙志颖,等.改良POSSUM及P—POSSUM评分在老年髋部骨折手术风险评估中的应用价值[J].中国骨与关节损伤杂志,2011,26(6):481-483.
[5]韩天宇,梁娜,刘欣伟,等.POSSUM评分在老年股骨粗隆间骨折患者围手术期中的应用[J].创伤与急危重病医学,2015,3(4):196-197.
[6]Ramanathan TS,Moppett IK,Wenn R,et al.POSSUM scoring for patients with fractured neck of femur.[J]. British Journal of Anaesthesia,2005,94(4):430-433.
[7] Prytherch DR,Whiteley MS,Higgins B,et al. POSSUM and Portsmouth POSSUM for predicting mortality[J].Br J Surg,1998,85(9):1217-1220.
[8]刘志勇,张新潮,蔡国平,等.骨科POSSUM和P-POSSUM评分系统预测老年髋部骨折手术风险的价值[J].中华创伤杂志,2014,30(7):706-710.