骨质疏松性髋部骨折是否合并支气管扩张比较 （开放获取）

Comparison of clinical outcomes of osteoporotic hip fractures with or without bronchiectasis (OA)

摘要:

[目的]研究骨质疏松性髋部骨折合并支气管扩张（bronchiectasis, BE）患者的特点，以便更好地进行围手术期的评估和管理。[方法]回顾性分析本院 2020 年 1 月—2022 年 10 月骨质疏松性髋部骨折住院并手术患者的临床资料，筛选出支气管扩张患者 48 例 （BE 组），无支气管扩张患者 （non-BE 组） 48 例。采用单项因素比较，两两相关分析和二分逻辑回归分析 BE 的影响因素。[结果] 与 non-BE 患者相比，BE 患者的骨密度 （bone mineral density, BMD） T 值 [(-2.5±0.4) vs (-2.2±0.6), P= 0.003] 和维生素 D 水平 [(14.9±2.3) ng/ml vs (18.5±2.4) ng/ml, P＜0.001] 显著降低， 而术后急性肺部感染发生率显著升高 [例 (%), 20 (41.7) vs 5 (10.4), P＜0.001]，但两组术后 1 年死亡率的差异无统计学意义（P＞0.05）。BE 组患者的分层比较：发生急性肺部感染组患者的维生素 D 水平较低、术后 1 年死亡比例高、支气管扩张严重程度指数 （bronchiectasis severity index, BSI） 分级重 （P＜0.05）；术后 1 年死亡组的维生素 D 水平低、卧床时间长、BSI 分级重、术后急性肺部感染发生率高（P＜0.05）。两两相关分析表明，BSI 分级与 BMD 及维生素 D 水平呈显著负相关 （P＜0.05），与卧床时间呈显著正相关 （P＜0.05）。术后 1 年内是否死亡的逻辑回归表明，急性肺部感染 （OR=9.16, P=0.023） 和术中出血量 （OR=1.11, P=0.037） 是术后 1 年死亡的独立危险因素。 维生素 D 水平高不是术后 1 年死亡的独立危险因素 （OR=0.720, P=0.181）。[结论] 骨质疏松性髋部骨折并支气管扩张患者 BMD 和维生素 D 水平明显降低，术后更易发生急性肺部感染，BMD 和维生素 D 水平降低与支气管扩张严重程度相关。术后急性肺部感染、术中出血量是术后 1 年死亡的独立危险因素。

Abstract:

[Objective] To study the characteristics of osteoporotic hip fractures complicated with bronchiectasis (BE) for better periop-erative evaluation and management. [Methods] From January 2020 to October 2022, 48 patients with bronchiectasis (the BE group) and 48 patients without BE (the non-BE group) were selected from those who underwent surgical treatment for osteoporotic hip fractures in our hospital. The impacts of BE were analyzed by univariate comparison, pairwise correlation analysis and binary logistic regression analysis. [Results] The BE patients had significantly lower bone mineral density (BMD) T value [(-2.5±0.4) vs (-2.2±0.6), P=0.003] and vitamin D levels [(14.9±2.3) ng/ml vs (18.5±2.4) ng/ml, P＜0.001] than the non-BE group, whereas the former had significantly higher incidence of postoperative acute pulmonary infection than the latter [cases (%), 20 (41.7) vs 5 (10.4), P＜0.001], despite of no significant difference in mortality in a year postoperatively between them (P＞0.05). In term of stratified comparison in the BE patients: the patients with acute pulmonary infection had lower vitamin D levels, higher mortality in a year after surgery, and more severe bronchiectasis severity index (BSI) than those without acute pulmonary infection (P＜0.05). In addition, the death group had lower vitamin D level, longer bed rest time, more severe BSI grade and higher incidence of postoperative acute pulmonary infection than the alive group (P＜0.05). As for pairwise correlation, the BSI grade was negatively correlated with BMD and vitamin D levels, while positively correlated with bed rest duration (P＜0.05). As results of logistic regression, the acute pulmonary infection (OR=9.16, P＜0.05) and intraoperative blood loss (OR=1.11, P＜0.05) were independent risk factors for death in one year after surgery, while high vitamin D levels may be a protective factor for death (OR=0.720, P＞0.05). [Conclusion] The patients with osteoporotic hip fracture complicated with BE usually have reduced bone mineral density and vitamin D levels, and are prone to acute pulmonary infection after surgery. The decrease of BMD and vitamin D levels are related to the BE severity. Postoperative acute pulmonary infection and intraoperative blood loss were independent risk factors for death in 1 year after surgery.