老年髋部骨折手术时机与术后并发症的关系的研究
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摘要
本文以探索老年髋部骨折患者接受手术治疗的时机与术后并发症是否存在关联为目的,同时确定与术后并发症存在关联的其他因素。我们选择2006年1月-2008年10月在吉林大学第一医院骨科行髋部骨折手术治疗的老年患者62名。准确记录其手术时机,骨折类型,手术方式,术前内科合并症,ASA评分及术中输血量。通过电话随访记录患者术后并发症。根据临床特点对上述记录结果进行分组,运用SAS软件对数据进行比较和统计分析。通过1年的临床研究,我们得到最终得到结论,认为手术时机、性别、年龄、骨折类型、手术方式及ASA评分的各组内术后并发症发生率无显著性差异。术中输血量、术前内科合并症组内的术后并发症率存在显著性差异。手术时机、性别、年龄、骨折类型、手术方式、ASA评分及术中输血量与术后并发症的发生率无因果关联。术前内科合并症与术后并发症的发生率存在因果关联。在髋部骨折手术治疗术后1年的老年患者中,手术时机与术后并发症的发生无因果关联。性别、年龄、骨折类型、手术方式、ASA评分及术中输血量与术后并发症的发生无关联性。术前内科合并症是影响术后并发症发生率的独立因素,与其存在因果联系。与术前无内科合并症的患者相比,术前存在内科合并症患者的术后并发症发生率是其1.651倍。建议老年髋部骨折患者应尽早行手术治疗,以避免因长期卧床使内科合并症加重。本文为老年髋部骨折的临床治疗提供了一定的理论依据。
Objective: To discuss the relationship between the timing of the surgery after hip fracture and postoperative complications in senile patients, and find out other factors which are related with these complications. Materials and methods: Sixty-two patients, including 28 males aged from 65 to 72 year-old with mean age of 76.3 year-old and 34 females aged from 65 to 95 year-old with mean age of 78.1 year-old, undergone orthopedics surgery were studied in the retrospective cohort study. Timing of the surgery, the type of fracture, kind of surgery, preoperative comorbidities, ASA score and volume of blood transfusion were extracted from these patients who are followed up by telephone calls for the postoperative complications. The data were divided into subgroups according to the clinical characteristics. All data have been analysed by SAS software. Results: There is not significant difference in the mortality of the postoperative complication in the subgroups of timing of surgery, gender, age, kind of surgery and ASA score. There is significant difference in the mortality of the postoperative complication in the subgroups of preoperative comorbidities and the volume of blood transfusion. There is a significant causality between preoperative comorbidities and postoperative complications. Conclusion: There is no relationship between the timing of surgery and postoperative complications within one year in senile patients who had surgery for hip fracture. No correlations were found between the postoperative complications and gender, age, type of fracture, kind of surgery, ASA sore and the volume of blood volume. Preoperative comorbidities is an independent predictor of the postoperative complications. The mortality of the postoperative complications is 1.651 times higer in patients who have preoperative complications than those without preoperative complications. The operations for the treatment of fractures of the hip in senile patients should be performed as soon as possible to avoid the deterioration of the preoperative comorbidities caused by long-term bed.
Objective: To discuss the relationship between the timing of the surgery after hip fracture and postoperative complications in senile patients, and find out other factors which are related with these complications. Materials and methods: Sixty-two patients, including 28 males aged from 65 to 72 year-old with mean age of 76.3 year-old and 34 females aged from 65 to 95 year-old with mean age of 78.1 year-old, undergone orthopedics surgery were studied in the retrospective cohort study. Timing of the surgery, the type of fracture, kind of surgery, preoperative comorbidities, ASA score and volume of blood transfusion were extracted from these patients who are followed up by telephone calls for the postoperative complications. The data were divided into subgroups according to the clinical characteristics. All data have been analysed by SAS software. Results: There is not significant difference in the mortality of the postoperative complication in the subgroups of timing of surgery, gender, age, kind of surgery and ASA score. There is significant difference in the mortality of the postoperative complication in the subgroups of preoperative comorbidities and the volume of blood transfusion. There is a significant causality between preoperative comorbidities and postoperative complications. Conclusion: There is no relationship between the timing of surgery and postoperative complications within one year in senile patients who had surgery for hip fracture. No correlations were found between the postoperative complications and gender, age, type of fracture, kind of surgery, ASA sore and the volume of blood volume. Preoperative comorbidities is an independent predictor of the postoperative complications. The mortality of the postoperative complications is 1.651 times higer in patients who have preoperative complications than those without preoperative complications. The operations for the treatment of fractures of the hip in senile patients should be performed as soon as possible to avoid the deterioration of the preoperative comorbidities caused by long-term bed.
引文
[1] Marks R, Allegrante JP, Mackenzie CR, et al. Hip fracture among the elderly: cause, consequences and control[J]. Ageing Res Rev, 2003,2: 57-93.
[2] E.I.O. Vidal, C.M. Coeli, R.S. Pinheiro. Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: a probabilistic record linkage study in Brazil [J]. Osteoporos Int, 2006,17: 1569-1576.
[3] A. Karagiannis, E. Papakitsou, K. Dretakis. Mortality Rates of Patients with a Hip Fracture in a Southwestern District of Greece: Ten-Year Follow-Up with Reference to the Type of Fracture [J]. Calcif Tissue Int, 2006,78:72-77.
[4] Cummings SR, Melton LJ. Epidemiology and outcomes of Osteoporotic fratures [J]. Lancet, 2002,359:1761-67.
[5]吴志成,李晓东,马志新.老年髋部骨折流行病学及相关问题的研究现状[J].内蒙古医学院学报, 27(6):64-67.
[6]肖德明,王崇武.老年人髋部骨折的流行病学研究现状[J].中国老年学杂志, 1994,14(2):113-115.
[7]陈孝平.外科学[M]. 2005年, 1版.北京:人民卫生出版社.
[8]陈孝平.外科学[M]. 2002年, 1版.北京:人民卫生出版社.
[9]史豳豳,蒋卫平.老年髋部骨折的相关问题[J].医学综述, 2008,14:2663-2665.
[10]王亦璁.骨与关节损伤[M]. 3版.北京:人民卫生出版社, 2001: 854-855.
[11]吴建国,尹律平,汤俊连.老年髋部骨折的治疗选择及围手术期处理[J].中国骨与关节损伤杂志, 2005,20(1):47-48.
[12]刘军,谷贵山.老年髋部骨折后死亡原因的研究进展[J].中国矫形外科杂志, 2007,15(8):1400-02.
[13]曾玮,刘智,李刚.影响高龄髋部骨折患者手术安全性的相关因素分析[J].浙江实用医学, 2007,12:414-416.
[14]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):1021-25.
[15]丁宇,阮狄克,肖明.老年髋部骨折术后早期临床疗效观察与影响因素分析[J].临床骨科杂志, 2008,11(5):406-409.
[16]方大标,王秋根,张平.影响髋部骨折疗效的相关因素分析[J].中国矫形外科杂志, 2005,13:1858-1860.
[17] Zuckerman J D, Skovron M I, Koval K J, et al. Postoperative com plications and mortality associted with operative delay in older patients who have a fracture of the hip [J]. JBJS Am, 1995,7:1551.
[18] Hayes DW, Brower RL, John KJ. Articular cartilage. Anatomy, injury, and repair [J]. Clin Podiatr Med Surg, 2001,18(1):35.
[19] JoheA, Casaletto, RaymondGatt. Post-operativemortality related to waiting time forhip fracture surgery [J]. Injury, 2004,35:114-120.
[20] Doruk H, Mas MR, Yildiz C, et al. The effect of the timing of hip fracture surgery on the activity ofdaily living and mortality in elderly [J]. Arch Gerontol Geriatrics, 2004,39:179-185.
[21]郭庆翔,温世锋.老年人髋部骨折围手术期肺部疾病的防治[J].赣南医学院学报, 2005,25(3):361-362.
[22]楼慧玲,梁剑,郭奇峰.老年人髋部骨折围手术期肺部并发症的防治[J].实用医学杂志, 2004,20(8):904-905.
[23] Holt EM, Evuns RA, Metcalfe JW. 100femoral neck fracture; the effect of preinjury mobility and Surgical experiece on outcome [J]. Injury, 1994, 25(2):91.
[24] Villar R, Allen S. Hip fracture in healthy patients [J]. J Med(s), 1996,293: 1203.
[25] Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE. Influence of health status and the timing of surgery on mortality in hip fracture patients [J]. Am Orthop. 1997,26:621-7.
[26] Hoenig H, Rubenstein LV, Sloane R, Horner R, Kahn K. What is the role of timing in the surgical and rehabilitative care of communitydwelling older persons with acute hip fracture? [J]. Arch Int Med. 1997,157: 513-20.
[27] (2002) Prevention and management of hip fractures in older people. A national clinical guideline. Scottish Intercollegiate Guidelines Network, Edinburgh (SIGN publication no. 56; available at http://www.sign.ac.uk/guidelines/fulltext/56/index. Html; accessed 20 February 2004).
[28] Mullen JO, Mullen NL. HiP Franture Mortality: A Prospective, Multifactorial Study to Predict and Minimize Death Risk [J]. Clin-Orthop, 1992,280:214-222.
[29]何伟东,黄新宇,柯楚雄,等.老年髋部骨折围手术期并存症与并发症[J].实用医学杂志, 2001,17(7):626-627.
[30] 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.
[31]何伟民,张晓龙,顾峥嵘.影响老年髋部骨折手术治疗效果的因素分析[J].上海医学, 2004,27(5)331-333.
[32] Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture [J]. Am J Med. 2002,112:702-9.
[33] Boretto, Ferro. First-year mortality and long-term results of hemiarthroplasty for hip fractures in the elderly [J]. J Orthopaed Traumatol, 2002,3:35-40.
[34] Michael Gdalevich, Dani Cohen. Morbidity and mortality after hip fracture: the impact of operative delay [J]. Arch Orthop Trauma Surg, 2004,124:334-340.
[1] Marks R, Allegrante JP, Mackenzie CR, et al. Hip fracture among the elderly: cause, consequences and control[J]. Ageing Res Rev, 2003,2: 57-93.
[2]吴建国,尹律平,汤俊连.老年髋部骨折的治疗选择及围手术期处理[J].中国骨与关节损伤杂志, 2005,20(1):47-48.
[3]曾玮,刘智,李刚.影响高龄髋部骨折患者手术安全性的相关因素分析[J].浙江实用医学, 2007,12:414-416.
[4]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):1021-25.
[5]丁宇,阮狄克,肖明.老年髋部骨折术后早期临床疗效观察与影响因素分析[J].临床骨科杂志, 2008,11(5):406-409.
[6]方大标,王秋根,张平.影响髋部骨折疗效的相关因素分析[J].中国矫形外科杂志, 2005,13:1858-1860.
[7] Michael Gdalevich, Dani Cohen. Morbidity and mortality after hip fracture: the impact of operative delay [J]. Arch Orthop Trauma Surg, 2004,124: 334-340.
[8] Zuckerman J D, Skovron M I, Koval K J, et al. Postoperative com plications and mortality associted with operative delay in older patients who have a fracture of the hip [J]. JBJS Am, 1995,7:1551.
[9] Holt EM, Evuns RA, Metcalfe JW. 100femoral neck fracture; the effect ofpreinjury mobility and Surgical experiece on outcome [J]. Injury, 1994,25(2):91.
[10] Villar R, Allen S. Hip fracture in healthy patients [J]. J Med(s), 1996,293: 1203.
[11] Mullen JO, Mullen NL. HiP Franture Mortality: A Prospective, Multifactorial Study to Predict and Minimize Death Risk [J]. Clin-Orthop, 1992,280:214-222.
[12]何伟东,黄新宇,柯楚雄,等.老年髋部骨折围手术期并存症与并发症[J].实用医学杂志, 2001,17(7):626-627.
[13] 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.
[14] Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture [J]. Am J Med. 2002,112:702-9.
[15] Barnes R, Brown JT, Garden R. Subcapital fractures of the femur. A prospective review. Journel of Bone and Joint Surgey, 1976,58-B(1):2-24.
[16] Dolk T. Influence of the treatment factors on the outcome after hip fractures. Upsala J. Med. Sci, 1989,94:209-221.
[17] Holmberg S, Kalen R, Thorngren. Treatment and outcome of femoral neck fractures. An analysis of 2418 patients admitted from their own homes. Clin. Orthop., 1987,218:42-51.
[18]楼慧玲,梁剑,郭奇峰.老年人髋部骨折围手术期肺部并发症的防治[J].实用医学杂志, 2004,20(8):904-905.
[19]红军.试用临床流行病学[M]. 1版.吉林:吉林大学出版社.
[20] Feldman D, Zuckerman J.D, Frankel V.H. Geriatric hip fractures: preoperative decision making. J. Musculoskel Med, 1990,7:69-80.
[21] McGeoy P.F, Evans J. Fracture of the hip. Immediate versus delayed treatment. Canadian Med. Assn. J., 1960,83:260-263.
[22] Neer C.S. The surgical treatment of the fractured hip. Surg. Clin. North America, 1951,31:499-512.
[23] Zuckerman, J.D, Schon L.C. Hip fractures. In Comprehensive Care of Orthopaedic Injuries in the Elderly, pp.23-111. Edtied by J. D. Zuckerman. Baltimore, Urban and Schwarzenberg, 1990.
[2] E.I.O. Vidal, C.M. Coeli, R.S. Pinheiro. Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: a probabilistic record linkage study in Brazil [J]. Osteoporos Int, 2006,17: 1569-1576.
[3] A. Karagiannis, E. Papakitsou, K. Dretakis. Mortality Rates of Patients with a Hip Fracture in a Southwestern District of Greece: Ten-Year Follow-Up with Reference to the Type of Fracture [J]. Calcif Tissue Int, 2006,78:72-77.
[4] Cummings SR, Melton LJ. Epidemiology and outcomes of Osteoporotic fratures [J]. Lancet, 2002,359:1761-67.
[5]吴志成,李晓东,马志新.老年髋部骨折流行病学及相关问题的研究现状[J].内蒙古医学院学报, 27(6):64-67.
[6]肖德明,王崇武.老年人髋部骨折的流行病学研究现状[J].中国老年学杂志, 1994,14(2):113-115.
[7]陈孝平.外科学[M]. 2005年, 1版.北京:人民卫生出版社.
[8]陈孝平.外科学[M]. 2002年, 1版.北京:人民卫生出版社.
[9]史豳豳,蒋卫平.老年髋部骨折的相关问题[J].医学综述, 2008,14:2663-2665.
[10]王亦璁.骨与关节损伤[M]. 3版.北京:人民卫生出版社, 2001: 854-855.
[11]吴建国,尹律平,汤俊连.老年髋部骨折的治疗选择及围手术期处理[J].中国骨与关节损伤杂志, 2005,20(1):47-48.
[12]刘军,谷贵山.老年髋部骨折后死亡原因的研究进展[J].中国矫形外科杂志, 2007,15(8):1400-02.
[13]曾玮,刘智,李刚.影响高龄髋部骨折患者手术安全性的相关因素分析[J].浙江实用医学, 2007,12:414-416.
[14]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):1021-25.
[15]丁宇,阮狄克,肖明.老年髋部骨折术后早期临床疗效观察与影响因素分析[J].临床骨科杂志, 2008,11(5):406-409.
[16]方大标,王秋根,张平.影响髋部骨折疗效的相关因素分析[J].中国矫形外科杂志, 2005,13:1858-1860.
[17] Zuckerman J D, Skovron M I, Koval K J, et al. Postoperative com plications and mortality associted with operative delay in older patients who have a fracture of the hip [J]. JBJS Am, 1995,7:1551.
[18] Hayes DW, Brower RL, John KJ. Articular cartilage. Anatomy, injury, and repair [J]. Clin Podiatr Med Surg, 2001,18(1):35.
[19] JoheA, Casaletto, RaymondGatt. Post-operativemortality related to waiting time forhip fracture surgery [J]. Injury, 2004,35:114-120.
[20] Doruk H, Mas MR, Yildiz C, et al. The effect of the timing of hip fracture surgery on the activity ofdaily living and mortality in elderly [J]. Arch Gerontol Geriatrics, 2004,39:179-185.
[21]郭庆翔,温世锋.老年人髋部骨折围手术期肺部疾病的防治[J].赣南医学院学报, 2005,25(3):361-362.
[22]楼慧玲,梁剑,郭奇峰.老年人髋部骨折围手术期肺部并发症的防治[J].实用医学杂志, 2004,20(8):904-905.
[23] Holt EM, Evuns RA, Metcalfe JW. 100femoral neck fracture; the effect of preinjury mobility and Surgical experiece on outcome [J]. Injury, 1994, 25(2):91.
[24] Villar R, Allen S. Hip fracture in healthy patients [J]. J Med(s), 1996,293: 1203.
[25] Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE. Influence of health status and the timing of surgery on mortality in hip fracture patients [J]. Am Orthop. 1997,26:621-7.
[26] Hoenig H, Rubenstein LV, Sloane R, Horner R, Kahn K. What is the role of timing in the surgical and rehabilitative care of communitydwelling older persons with acute hip fracture? [J]. Arch Int Med. 1997,157: 513-20.
[27] (2002) Prevention and management of hip fractures in older people. A national clinical guideline. Scottish Intercollegiate Guidelines Network, Edinburgh (SIGN publication no. 56; available at http://www.sign.ac.uk/guidelines/fulltext/56/index. Html; accessed 20 February 2004).
[28] Mullen JO, Mullen NL. HiP Franture Mortality: A Prospective, Multifactorial Study to Predict and Minimize Death Risk [J]. Clin-Orthop, 1992,280:214-222.
[29]何伟东,黄新宇,柯楚雄,等.老年髋部骨折围手术期并存症与并发症[J].实用医学杂志, 2001,17(7):626-627.
[30] 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.
[31]何伟民,张晓龙,顾峥嵘.影响老年髋部骨折手术治疗效果的因素分析[J].上海医学, 2004,27(5)331-333.
[32] Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture [J]. Am J Med. 2002,112:702-9.
[33] Boretto, Ferro. First-year mortality and long-term results of hemiarthroplasty for hip fractures in the elderly [J]. J Orthopaed Traumatol, 2002,3:35-40.
[34] Michael Gdalevich, Dani Cohen. Morbidity and mortality after hip fracture: the impact of operative delay [J]. Arch Orthop Trauma Surg, 2004,124:334-340.
[1] Marks R, Allegrante JP, Mackenzie CR, et al. Hip fracture among the elderly: cause, consequences and control[J]. Ageing Res Rev, 2003,2: 57-93.
[2]吴建国,尹律平,汤俊连.老年髋部骨折的治疗选择及围手术期处理[J].中国骨与关节损伤杂志, 2005,20(1):47-48.
[3]曾玮,刘智,李刚.影响高龄髋部骨折患者手术安全性的相关因素分析[J].浙江实用医学, 2007,12:414-416.
[4]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):1021-25.
[5]丁宇,阮狄克,肖明.老年髋部骨折术后早期临床疗效观察与影响因素分析[J].临床骨科杂志, 2008,11(5):406-409.
[6]方大标,王秋根,张平.影响髋部骨折疗效的相关因素分析[J].中国矫形外科杂志, 2005,13:1858-1860.
[7] Michael Gdalevich, Dani Cohen. Morbidity and mortality after hip fracture: the impact of operative delay [J]. Arch Orthop Trauma Surg, 2004,124: 334-340.
[8] Zuckerman J D, Skovron M I, Koval K J, et al. Postoperative com plications and mortality associted with operative delay in older patients who have a fracture of the hip [J]. JBJS Am, 1995,7:1551.
[9] Holt EM, Evuns RA, Metcalfe JW. 100femoral neck fracture; the effect ofpreinjury mobility and Surgical experiece on outcome [J]. Injury, 1994,25(2):91.
[10] Villar R, Allen S. Hip fracture in healthy patients [J]. J Med(s), 1996,293: 1203.
[11] Mullen JO, Mullen NL. HiP Franture Mortality: A Prospective, Multifactorial Study to Predict and Minimize Death Risk [J]. Clin-Orthop, 1992,280:214-222.
[12]何伟东,黄新宇,柯楚雄,等.老年髋部骨折围手术期并存症与并发症[J].实用医学杂志, 2001,17(7):626-627.
[13] 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.
[14] Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture [J]. Am J Med. 2002,112:702-9.
[15] Barnes R, Brown JT, Garden R. Subcapital fractures of the femur. A prospective review. Journel of Bone and Joint Surgey, 1976,58-B(1):2-24.
[16] Dolk T. Influence of the treatment factors on the outcome after hip fractures. Upsala J. Med. Sci, 1989,94:209-221.
[17] Holmberg S, Kalen R, Thorngren. Treatment and outcome of femoral neck fractures. An analysis of 2418 patients admitted from their own homes. Clin. Orthop., 1987,218:42-51.
[18]楼慧玲,梁剑,郭奇峰.老年人髋部骨折围手术期肺部并发症的防治[J].实用医学杂志, 2004,20(8):904-905.
[19]红军.试用临床流行病学[M]. 1版.吉林:吉林大学出版社.
[20] Feldman D, Zuckerman J.D, Frankel V.H. Geriatric hip fractures: preoperative decision making. J. Musculoskel Med, 1990,7:69-80.
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