老年髋部骨折患者围手术期死亡高危因素分析
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摘要
目的分析老年髋部骨折患者围手术期死亡的高危因素。方法笔者2008年1月~2013年12月对收治的976例60岁以上行手术治疗的老年髋部骨折患者的临床资料进行回顾性研究,其中股骨转子间骨折498例,平均年龄72.3岁;股骨颈骨折478例,平均年龄75.6岁;观察围手术期死亡的高危因素。结果围手术期死亡32例(3.2%),其中死于心肺疾病者占78.1%。年龄<80岁围手术期死亡10例,≥80岁死亡22例,两者比较差异有统计学意义。股骨颈骨折内固定术治疗患者术后死亡4例,关节置换术治疗患者死亡14例,两者比较差异有统计学意义。结论高龄、心肺疾病和采用关节置换术治疗的老年髋部骨折患者死亡风险更大,多科室的相互协作有助于降低围手术期死亡的风险。
Objective To analyze the risk factors for perioperative death of elderly hip fracture patients.Methods The clinical data of 976 cases of elderly hip fracture over 60 years from Jan. 2008 to Dec. 2013 with surgical treatment were retrospectively analyzed. Among them femoral intertrochanteric fracture was found in 498 patients with an average of 72. 3 years and femoral neck fracture was found in 478 cases with an average of 75. 6 years. Risk factors of the perioperative death were observed. Results Perioperative death occurred in 32 cases( 3. 2%). More than 78. 1% died of cardiopulmonary disease. Among these cases,10 were younger than 80 years and 22 were older than 80 years with statistical significance. Death occurred in 4 cases with fixation treatment and 14 cases with joint replacement in patients with femoral neck fracture and the difference was statistically significant. Conclusion Paitients with advanced age,cardiopulmonary disease and joint replacement therapy with hip fracture have a high risk of death. Cooperation between multiple departments can help reduce the risk of perioperative death.
Objective To analyze the risk factors for perioperative death of elderly hip fracture patients.Methods The clinical data of 976 cases of elderly hip fracture over 60 years from Jan. 2008 to Dec. 2013 with surgical treatment were retrospectively analyzed. Among them femoral intertrochanteric fracture was found in 498 patients with an average of 72. 3 years and femoral neck fracture was found in 478 cases with an average of 75. 6 years. Risk factors of the perioperative death were observed. Results Perioperative death occurred in 32 cases( 3. 2%). More than 78. 1% died of cardiopulmonary disease. Among these cases,10 were younger than 80 years and 22 were older than 80 years with statistical significance. Death occurred in 4 cases with fixation treatment and 14 cases with joint replacement in patients with femoral neck fracture and the difference was statistically significant. Conclusion Paitients with advanced age,cardiopulmonary disease and joint replacement therapy with hip fracture have a high risk of death. Cooperation between multiple departments can help reduce the risk of perioperative death.
引文
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[10]蒋电明,杨友刚.老年髋部骨折手术风险性评估及治疗方式的选择[J].重庆医学,2008,37(10):1021-1022.
[11]Mereddy P,Kamath S,Rama krishnan M,et al.The AO/ASIF Proximal femoral nail antirotation(PFNA):a new dsign for the treatment of unstable proximal femoral fractures[J].Injury,2009,40(4):428-432.
[2]Maxwell MJ,Moran CG,Moppett IK.Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery[J].Br J Anaesth,2008,101(4):511-517.
[3]Penrod JD,Litke A,Hawkes WG,et al.The association of race,gender,and comorbidity with mortality and funtion after hip fracture[J].J Gerontol A Biol Sci Med Sci,2008,63(8):867-872.
[4]杨文彬,廖海浪,何福鲜,等.老年股骨粗隆间骨折早期死亡原因分析[J].中国骨与关节损伤杂志,2011,26(4):348-349.
[5]Lefaivre KA,Macadam SA,Davidson DJ,et al.Length ofstay,mortality,morbidity and delay to surgery in hip fractures[J].J Bone Joint Surg(Br),2009,91(7):922-927.
[6]Moran CG,Wenn RT,Sikand M,et al.Early mortality after hip fracture:is delay before surgery important[J].J Bone Joint Surg(Am),2005,87(3):483-489.
[7]Egol KA,Strauss EJ.Perioperative considerations in geriatric patients with hip fracture:what is the evidence[J].J Orthop Trauma,2009,23(6):386-394.
[8]Roche JJ,Wenn RT,Sahota O,et al.Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people:prospective observational Cohort study[J].BMJ,2005,331(7529):1374.
[9]黄晓,莫冰峰,尹东,等.老年髋部骨折后死亡的相关影响因素分析[J].中国矫形外科杂志,2013,21(8):757-761.
[10]蒋电明,杨友刚.老年髋部骨折手术风险性评估及治疗方式的选择[J].重庆医学,2008,37(10):1021-1022.
[11]Mereddy P,Kamath S,Rama krishnan M,et al.The AO/ASIF Proximal femoral nail antirotation(PFNA):a new dsign for the treatment of unstable proximal femoral fractures[J].Injury,2009,40(4):428-432.