老年股骨转子间骨折入院72h延迟手术的因素

Factors of delaying hip arthroplasty 72 hours after admission for femoral intertrochanteric fractures in elderly

摘要:

[目的] 探讨老年股骨转子间骨折入院 72 h 延迟手术的因素。[方法] 回顾性分析 2018 年 10 月—2022 年 2 月采用髋关节置换联合内固定重建股骨大转子治疗的 144 例老年股骨转子间骨折患者，依据患者是否在入院 72 h 完成手术分为延迟组和未延迟组，采用单项因素比较以及二分多因素逻辑回归分析，探索延迟手术的因素。[结果]144 例中，33 例为入院 72 h 内完成手术（未延迟组），占 22.9%；另外 111 例为入院 72 h 后完成手术（延迟组），占 77.1%。单项因素分析显示：延迟组年龄显著小于未延迟组 [(82.3±4.8) 岁 vs (84.4±5.6) 岁, P=0.043]，延迟组泌尿系感染比例 [26(23.4%) vs 0(0%), P=0.002]、心律失常比例 [24(21.6%) vs 1(3.0%), P=0.013]、肺部感染比例 [35(31.5%) vs 2(6.0%), P=0.003] 均显著大于未延迟组。延迟组丙氨酸转氨酶水平显著高于未延迟组 [(15.1±8.9) IU/L vs (11.8±5.5) IU/L, P=0.044]。两组性别构成、饮酒史、吸烟史、合并高血压比率、合并糖尿病比率、ASA 分级的差异均无统计学意义 （P＞0.05），两组间各项血液检验指标，包括 Hb、HCT、TB、ALB、Crea、GLU、 K、Na、CI、Ca 的差异均无统计学意义 （P＞0.05），两组间肺部 CT、心脏彩超和颅脑 CT 结果的差异均无统计学意义 （P＞ 0.05）。多因素逻辑回归分析显示：心律失常 （OR=9.383, 95% CI 1.174~75.018, P=0.035）、肺部感染 （OR=7.342, 95% CI 1.539~ 35.035, P=0.012） 是老年股骨转子间骨折入院 72 h 延迟手术的独立危险因素。[结论] 本研究中老年股骨转子间骨折入院 72 h 延迟手术的危险因素是心律失常和肺部感染。

Abstract:

[Objective] To explore the factors of delaying hip arthroplasty 72 hours after admission for femoral intertrochanteric frac- tures in elderly. [Methods] A retrospective study was conducted on a total of 144 elderly patients who underwent hip arthroplasty combined with internal fixation to reconstruct the greater trochanter for femoral intertrochanteric fracture from October 2018 to February 2022. Ac- cording to whether the patient had operation completed 72 hours after admission, they were divided into delayed group and undelayed group. Univariate comparison and binary multifactor logistic regression analysis were used to search the factors related to delay surgery. [Results] Of 144 patients, 33 had surgical treatment performed within 72 hours after admission (the undelayed group), accounting for 22.9%; while the other 111 got surgical operation beyond 72 hours after admission (the delayed group), accounting for 77.1%. In term of uni- variate comparison, the delayed group was significantly younger than the undelayed group [(82.3±4.8) years vs (84.4±5.6) years, P=0.043], the delayed group had significantly higher proportion than the undelayed group in terms of urinary tract infections [26(23.4%) vs 0(0%), P= 0.002], arrhythmia [24(21.6%) vs 1(3.0%), P=0.013], and lung infection [35(31.5%) vs 2(6.0%), P=0.003]. In addition, the delayed group had significantly higher level of alanine aminotransferase than the undelayed group [(15.1±8.9) IU/L vs (11.8±5.5) IU/L, P=0.044]. Howev- er, there were no significant differences in gender composition, drinking history, smoking history, rate of hypertension, rate of diabetes and ASA classification between the two groups (P＞0.05), no significant differences in blood test indexes, including Hb, HCT, TB, ALB, Crea, GLU, K, Na, CI and Ca between the two groups (P＞0.05), and no significant differences in the results of lung CT, heart ultrasound and cra- niocerebral CT between 2 groups (P＞0.05). As results of multivariate logistic regression analysis, arrhythmia (OR=9.383, 95%CI 1.174~ 75.018, P=0.035), pulmonary infection (OR=7.342, 95%CI 1.539~35.035, P=0.012) were independent risk factors for delaying surgical op- eration 72 hours after admission for femoral intertrochanteric fractures. [Conclusion] In this study, arrhythmia and pulmonary infection are the risk factors for delayed operation intervention 72 hours after admission for femoral intertrochanteric fracture in the elderly.