摘要
背景:国内外针对老年髋部骨折术后死亡原因及其相关因素的研究很多,但针对卧床保守治疗的研究不多。目的:探讨高龄脆性髋部骨折保守治疗患者住院期间死亡原因及相关危险因素。方法:回顾性分析2013年6月至2019年5月行保守治疗的≥75岁脆性髋部骨折患者的临床资料,男27例,女48例;年龄为75~100岁,平均(83.7±5.5)岁;股骨颈骨折37例,股骨转子间骨折38例。根据患者住院期间的生存情况分为生存组54例、死亡组21例,分析两组的死亡相关因素,包括年龄、性别、体重指数、骨折部位、住院时间、内科合并症、伤前活动能力以及血液学指标(包括白细胞计数、中性粒细胞计数、淋巴细胞计数、血红蛋白水平、血清白蛋白水平)。结果:住院期间,75例患者中21例死亡,死亡率为28.0%,其中16例死于呼吸系统疾病,4例死于心血管疾病,1例死于脑梗死。单因素分析结果显示,与死亡相关的危险因素是年龄≥85岁和伤前活动能力。多因素Logistic回归分析显示,患者年龄≥85岁(P=0.047),伤前活动能力(P<0.01)是高龄脆性髋部骨折保守治疗住院期间死亡的独立危险因素。结论:高龄脆性髋部骨折患者年龄≥85岁、患者伤前活动能力差是死亡的独立危险因素。此类患者行保守治疗住院期间死亡率高,主要死因是呼吸系统疾病。住院后应积极防治呼吸系统疾病,必要时无需严格卧床以减少卧床并发症的发生,延长患者生存时间,降低患者死亡率。
Background:There are many researches on the causes of death and related factors of elderly hip fracture at home and abroad,but few studies focus on conservative treatment in bed.Objective:To investigate the cause of death of the elderly patients with fragility fracture of hip receiving the conservative treatment during hospitalization and the associated risk factors.Methods:Data of 75 patients including 27 males and 48 females over 75 years old with the mean of(83.7±5.5)years who had fragility fracture of hip and received conservative treatment from June 2013 to May 2019 were retrospectively analyzed,including 37 patients with femoral neck fracture and 38 patients with intertrochanteric fracture.The patients were divided into 2 groups as the survival group(n=54)and the death group(n=21).The death related factors including age,gender,BMI,fracture site,hospitalization time,pre-injury activity,medical complication,and hematological data(total white blood cell count,total neutrophil count,total lymphocyte count,hemoglobin and serum albumin)were analyzed between the groups.Results:21 patients of all were dead during hospitalization and the mortality rate was 28.0%.16 patients died of respiratory disease,4 patients died of cardiovascular disease,and 1 patient died of cerebral infarction.The mortality was associated with age≥85 years old and pre-injury activity.A binary logistic regression analysis revealed that age≥85 years old,pre-injury activity were the independent risk factors for the mortality.Conclusions:Age≥85 years old(P=0.047)and pre-injury activity(P<0.047)were the independent risk factors for the mortality of the elderly with fragility fracture of hip during hospitalization.The mortality rate of these patients taken conservative treatment during hospitalization was high.The main cause of death was respiratory disease.After hospitalization,the elderly patients with fragility fracture of hip should be actively prevented and treated for their respiratory diseases.As necessary,the patients don't need to stay in bed strictly in order to reduce the occurrence of bed complications,to prolong the survival time and to reduce the mortality rate.
作者
韩云毅
孙永青
康建国
赵大中
蒋育欣
任磊
邓超
HAN Yunyi;SUN Yongqing;KANG Jianguo;ZHAO Dazhong;JIANG Yuxin;REN Lei;DENG Chao(Department of Orthopaedics,Beijing Electric Power Hospital,Beijing 100073,China)
出处
《中华骨与关节外科杂志》
2020年第9期747-751,共5页
Chinese Journal of Bone and Joint Surgery
关键词
老年
髋部
骨质疏松性骨折
保守治疗
死亡因素
Advanced Age
Hip
Osteoporotic Fracture
Conservative Treatment
Mortality
