老年髋部骨折术后1年死亡风险及危险因素分析

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摘要目的了解老年髋部骨折术后1年内死亡率及相关危险因素。方法回顾性分析2012年1月至2016年12月我院收治的1 004例髋部骨折患者的资料，其中男329例，女675例；年龄60~104岁，平均年龄(80.01±8.14)岁。根据手术后1年内是否存活，分为死亡组和存活组。死亡组158例，男69例，女89例；年龄61~98岁，平均年龄(82.56±7.42)岁。存活组846例，男260例，女586例；年龄60~104岁，平均年龄(79.53±8.18)岁。比较死亡组与存活组患者年龄、性别、合并症、手术时机、固定方式的差异，先进行单因素分析，初步筛选出有意义的因素，再将有统计学差异的危险因素带入多因素Logistic回归分析中，筛选出术后1年内患者死亡的独立危险因素。结果单因素分析发现：高龄、男性、股骨转子间骨折、冠心病、心律失常、痴呆、肺部感染、慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)、心功能不全、合并症数量≥4种、延期手术、神经阻滞麻醉、血红蛋白及白蛋白水平低是术后1年死亡的危险因素。多因素Logistic回归分析发现：高龄(OR＝1.002，P＝0.055)、男性(OR＝1.980，P＝0.000)、冠心病(OR＝1.657，P＝0.020)、痴呆(OR＝1.883，P＝0.042)、心功能不全(OR＝1.999，P＝0.030)、白蛋白水平低(OR＝0.915，P＝0.000)是术后1年内死亡的独立危险因素。结论老年髋部骨折术后1年死亡率高达15.7%，高龄、男性、冠心病、痴呆、心功能不全、白蛋白水平低是术后1年死亡的独立危险因素。

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关键词 ：老年髋部骨折, 死亡, 危险因素

Abstract：Objective To study the mortality and risk factors for elderly hip fracture patients within 1 year after operation.Methods The data of 1004 patients with hip fracture admitted to our hospital from January 2012 to December 2016 were analyzed retrospectively.The mean age was (80.01±8.14)，ranged from 60~104 years，including 329 males and 675 females.According to whether they survived within one year after operation，they were divided into non-survival group (158 cases) and survival group (846 cases).In the death group，there were 158 cases，69 males and 89 females，ranged 61~98 years with an average age of (82.56±7.42) years.In the survival group，846 cases were male 260 cases，female 586 cases，mean age (79.53±8.18) years，ranged from 60 to 104 years.The difference of age，sex，coexisting disease，operation time and fixation mode between the two groups were compared.The significant factors were carried into the multiple logistic regression analysis，and the independent risk factors of 1-year mortality within 1 year after operation were screened out.Results In univariate analysis，elder，male，intertrochanteric fracture of femur，coronary heart disease，arrhythmia，dementia，pulmonary infection，COPD，cardiac insufficiency，number of coexisting diseases ≥ 4，delayed operation，nerve block anesthesia，low hemoglobin and albumin levels were found to be the risk factors of oneyear mortality.Multivariate logistic regression analysis showed that：elder (OR＝1.002，P＝0.055)，male (OR＝1.980，P＝0.000)，coronary heart disease (OR＝1.657，P＝0.020)，dementia (OR＝1.883，P＝0.042)，cardiac insufficiency (OR＝1.999，P＝0.030)，low albumin (OR＝0.915，P＝0.000) were independent risk factors for mortality within one year after operation.Conclusion The 1-year mortality rate of hip fracture was 15.7%.Elder，male，coronary heart disease，dementia，cardiac insufficiency and low albumin are the independent risk factors for 1-year mortality.

Key words： anterior pelvic ring fractures external fixation internal anterior fixation

基金资助:首都卫生发展科研专项(2016-1-5092)

通讯作者: 王晓伟

作者简介: 赵建文(1981－ )，男，主治医师，解放军总医院第七医学中心骨科，100700。

引用本文:

赵建文，王晓伟 *，孙天胜，刘智，张建政. 老年髋部骨折术后1年死亡风险及危险因素分析[J]. 实用骨科杂志, 2020, 26(5): 399-403.
Zhao Jianwen，Wang Xiaowei *，Sun Tianshen，et al. Mortality and Risk Factors for Death in Elderly Hip Fracture Patients with in 1 Year after Surgery. sygkzz, 2020, 26(5): 399-403.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I5/399

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