老年股骨粗隆间骨折术后1年内死亡分析△

Factors related to death within one year after internal fixation for femoral intertrochanteric fracture in the elderly

摘要:

［目的］探讨苏南地区两家医院老年股骨粗隆间骨折患者术后 1 年内死亡的危险因素。［方法］回顾性分析苏南地区 2 家医院骨科 2014 年 8 月—2021 年 1 月 864 例老年股骨粗隆间骨折患者的临床资料，依据患者是否在术后 1 年内死亡，将患者分为两组。采用单项因素比较与二元多因素逻辑回归分析死亡的相关因素，并行 ROC 分析主要因素预测死亡的意义。［结果］864 例患者中术后 1 年内死亡 144 例，死亡率为 16.66%。肺部感染为致死的最主要原因。单项因素比较，死亡组年龄显著大于未死亡组 （P<0.05），受伤到手术时间显著长于未死亡组 （P<0.05），住院时间显著长于未死亡组 （P<0.05），术前 ASA 评级显著重于未死亡组 （P<0.05），术前白蛋白水平显著低于未死亡组 （P<0.05）。逻辑回归分析表明，高龄 （OR=2.895，P= 0.002）、低白蛋白水平 （OR=0.418，P=0.004）、肺部疾病 （OR=2.221，P=0.023）、长住院时间 （OR=2.989，P<0.001）、高 ASA 评级（OR=2.504，P=0.019）是发生死亡的独立危险因素。ROC 曲线分析表明曲线下面积（area under curve, AUC）依次为住院时间（0.885）、年龄（0.841）、低白蛋白状态（0.654）。［结论］高龄、低白蛋白血症、肺部基础疾病、长住院时间、高 ASA 评分是老年股骨粗隆间骨折术后 1 年内死亡的危险因素。

Abstract:

[Objective] To search the factors related to death within one year after internal fixation with proximal femoral nail anti-rota- tion (PFNA) for femoral intertrochanteric fractures in the elderly in two hospitals of southern Jiangsu. [Methods] A retrospective study was conducted on 864 patients who received PFNA for femoral intertrochanteric fracture from August 2014 to January 2021 in the two hospitals. Based on whether or not died within one year after operation, the patients were divided into two groups. Univariate comparison and binary multivariate logistic regression were done to explore the factors related to death. In addition, receiver operator characteristic (ROC) curve analysis was used to evaluate the value of the main factor for predicting the death. [Results] Among the 864 patients, 144 died within one year after operation, accounted for 16.7%, with the main death cause of pulmonary infection. In term of univariate comparison, the death group was significantly older (P＜0.05) , had significantly longer interval between injury and operation (P＜0.05) , significantly longer hospi- tal stay (P＜0.05) , significantly worsened ASA grade (P＜0.05) and significantly lower albumin level than the non-death group (P＜0.05) . As result of logistic regression, the advanced age (OR=2.895, P=0.002) , low albumin (OR=0.418, P=0.004) , pulmonary disease (OR= 2.221, P=0.023) , long hospital stay (OR=2.989, P＜0.001) and worsened ASA grade (OR=2.504, P=0.019) were the independent risk fac- tors for death within one year after operation for femoral intertrochanteric fracture in the elderly. Regarding to ROC analysis, the aera under curve (AUC) was ranked up-down in sequence of hospital stay (0.885) , age (0.841) and low albumin (0.654) . [Conclusion] The advanced age, hypoalbuminemia, underlying pulmonary diseases, prolonged hospital stay, and worsened ASA grade are main factors related to death within one year after surgery for intertrochanteric fractures in the elderly over 65 years old in this study.