老年股骨粗隆股骨头置换术后死亡的危险因素分析

Risk factors of death after femoral head replacement for femoral intertrochanteric fracture in elderly

摘要:

［目的］ 探讨老龄股骨粗隆间骨折患者行股骨头置换术后生存情况及其死亡的危险因素。［方法］ 回顾性分析 2015 年 1 月—2019 年 10 月在本院行股骨头置换术的 131 例老年患者的临床资料。随访获得患者的生存结局，采用单项因素比较和 Cox 比例风险回归模型筛查危险因素。［结果］ 术后 1 年死亡 8 例 （6.11%），1 年生存率为 93.89%；2 年内共死亡 22 例 （16.79%），2 年生存率为 83.21%。与未死亡组相比，死亡组患者年龄显著大，BMI 值显著小，术前血红蛋白 （Hb） 显著低， 术前合并 2 种以上合并症的比率显著高，手术时间和术后恢复下地活动时间显著长，术后 3 个月 Harris 评分显著低，差异有统计学意义（P<0.05）。Cox 比例风险回归结果显示高龄是死亡危险因素（HR=1.117，P=0.001）。［结论］老年股骨粗隆间骨折股骨头置换术后死亡风险较高，尤其是高龄者和合并症数量多者，应引起重视。

Abstract:

[Objective] To explore the survival and risk factors of death after femoral head replacement for femoral intertrochanteric fracture in elderly. [Methods] A retrospective study was done on 131 elderly patients who underwent femoral head replacement for femoral intertrochanteric fractures in our hospital from January 2015 to October 2019. As survival outcomes were obtained by follow-up, univariate comparison and Cox proportional hazard regression were performed to search the risk factors for death. [Results] Of them, 8 patients died one year after operation accounting for 6.11% with the 1-year survival rate of 93.89%, while a total of 22 cases died in 2 years, accounting for 16.79%, with 2-year survival rate of 83.21%. Compared with the non-death group, the death group was significant older, had significant- ly lower BMI, preoperative hemoglobin (Hb) , higher ratio of 2 or more preoperative comorbidities, longer operation time and time to resume walking postoperatively and lower Harris score 3 months postoperatively, which all proved statistically significant (P<0.05) . As results of Cox proportional hazard regression, the advanced age was a risk factor for death (HR=1.117, P=0.001) . [Conclusion] The risk of death is higher after femoral head replacement for femoral intertrochanteric fractures in the elderly, especially for those with advanced age and multi- ple comorbidities preoperatively, which should be paid attention to.