老年髋部骨折术后生存情况及死亡危险因素分析△

Survival analysis and death risk factors after surgical treatment of hip fractures in elderly

摘要:

[目的] 探讨老年髋部骨折术后生存情况及死亡危险因素。[方法] 本院 2013 年 1 月—2023 年 1 月收治的 1 693 例老年髋部骨折患者纳入本研究，观察术后死亡的发生情况。采用单因素比较和多因素 Cox 回归分析筛选死亡的危险因素。[结果]本研究 1 693 例患者，共计 1 618 例获得完整随访，失访 75 例，失访率 4.4%；死亡 566 例，死亡率 34.5%。死亡组患者的年龄 [(82.3±7.4) 岁 vs (77.6±7.2) 岁, P＜0.001]、肾功能不全比例 [例, 是/否, (22/544) vs (23/1102), P＜0.001]、输血比例 [例, 是/否, (259/ 307) vs (408/719), P＜0.001] 和住院天数 [(14.1±18.2) d vs (12.1±5.4) d, P=0.010] 显著大于生存组，而股骨颈骨折占比 [例, 股骨颈/粗隆间, (220/346) vs (560/567), P＜0.001]、手术方式为内固定 （internal fixation, IF） 占比 [例, HA/THA/IF, (259/45/262) vs (479/345/303), P＜0.001] 均显著高于生存组。Cox 回归分析表明： IF（HR=2.643, P＜0.05）、肾功能不全（HR=1.564, P＜0.05）、年龄（HR=1.062, P＜0.05）是死亡发生的独立危险因素。与股骨粗隆间骨折相比，股骨颈骨折是死亡的保护性因素（P＜0.05）。[结论]年龄、肾功能不全、骨折部位、手术方式、是否输血、住院天数为死亡的危险因素，与股骨粗隆间骨折相比，股骨颈骨折是死亡的保护性因素；IF、肾功能不全、年龄是死亡的独立危险因素。

Abstract:

[Objective] To investigate the survival state and death risk factors after surgical treatemtn of hip fractures in the elderly. [Methods] A total of 1 693 elderly patients who admitted to our hospital for hip fractures from January 2013 to January 2023 were included in this study, and the incidence of postoperative death was observed. The risk factors of death were screened by univariate comparison and multivariate Cox regression analysis. [Results] Of the 1 693 patients in this study, a total of 1 618 patients received complete follow-up, and 75 cases were lost to follow-up (4.4%). There were 566 deaths with a mortality rate of 34.5%. Regarding univariant comparison, the death group were significantly greater than the survival group, in terms of age [(82.3±7.4) years vs (77.6±7.2) years, P＜0.001], renal insufficiency ratio [yes/no (22/544) vs (23/1102), P＜0.001], blood transfusion ratio [yes/no, (259/307) vs (408/719), P＜0.001] and hospitalization days [(14.1± 18.2) days vs (12.1±5.4) days, P=0.010], the proportion of femoral neck fracture [femoral neck fracture /intertrochanteric fracture, (220/346) vs (560/567), P＜0.001] and the surgical method as internal fixation (IF) [HA/THA/IF, (259/45/262) vs (479/345/303), P＜0.001]. As results of Cox regression analysis, the IF (HR=2.643, P＜0.05), renal insufficiency (HR=1.564, P＜0.05) and age (HR=1.062, P＜0.05) were independent risk factors for death. Femoral neck fracture was a protective factor for death compared with intertrochanteric fracture (P＜0.05). [Conclusion] Advanced age, renal insufficiency, fracture site as intertrochanteric portion, operation method as internal fixation, blood transfusion and longer hospital stay were the risk factors for death. Compared with intertrochanteric fracture, femoral neck fracture was the protective factor for death. The IF, renal insufficiency and advanced age were independent risk factors for death.