Karagiannis A, Papakitsou E, Dretakis K, Galanos A, Megas P, Lambiris E, Lyritis G P
Orthopedic Department, University Hospital, University of Patras, Patras, Greece.
Calcif Tissue Int. 2006 Feb;78(2):72-7. doi: 10.1007/s00223-005-0169-6. Epub 2006 Feb 6.
Increased mortality after a hip fracture has been associated with age, sex, and comorbidity. In order to estimate the long-term mortality with reference to hip fracture type, we followed 499 patients older than 60 years who had been treated surgically for a unilateral hip fracture for 10 years. At admission, patients with femoral neck fractures (n = 172) were 2 years younger than intertrochanteric patients (77.6 +/- 7.7 [SD] vs. 79.9 +/- 7.4 [SD], P = 0.001) and had a greater prevalence of heart failure (57% vs. 40.3%, P = 0.03). Similar mortality rates were observed at 1 year in both types of fracture (17.9% vs. 11.3%, log rank test P = 0.112). Mortality rates were significantly higher for intertrochanteric fractures at 5 years (48.8% vs. 34.7%, P = 0.01) and 10 years (76% vs. 58%, P = 0.001). Patients 60-69 years old with intertrochanteric fractures had significantly higher 10-year mortality than patients of similar age with femoral neck fractures (P = 0.008), while there was no difference between the groups aged 70-79 (P > 0.3) and 80-89 (P = 0.07). Women were less likely to die in 5 years (relative risk [RR] = 0.57, 95% confidence interval [CI] 0.41-0.79, P = 0.0007) and 10 years (RR = 0.65, 95% CI 0.49-0.85, P = 0.002). Age, sex, the type of fracture, and the presence of heart failure were independent predictors of 10-year mortality (Cox regression model P < 0.0001). The intertrochanteric type was independently associated with 1.37 (95% CI 1.03-1.83) times higher probability of death at 10 years (P = 0.002). In conclusion, the type of fracture is an independent predictor of long-term mortality in patients with hip fractures, and the intertrochanteric type yields worse prognosis.
髋部骨折后死亡率增加与年龄、性别及合并症有关。为了参照髋部骨折类型评估长期死亡率，我们对499例60岁以上接受单侧髋部骨折手术治疗的患者进行了10年随访。入院时，股骨颈骨折患者（n = 172）比转子间骨折患者年轻2岁（77.6±7.7[标准差]对79.9±7.4[标准差]，P = 0.001），且心力衰竭患病率更高（57%对40.3%，P = 0.03）。两种骨折类型在1年时的死亡率相似（17.9%对11.3%，对数秩检验P = 0.112）。转子间骨折在5年（48.8%对34.7%，P = 0.01）和10年（76%对58%，P = 0.001）时的死亡率显著更高。60 - 69岁的转子间骨折患者10年死亡率显著高于同龄股骨颈骨折患者（P = 0.0 — 08），而70 - 79岁组（P > 0.3）和80 - 89岁组（P = 0.07）之间无差异。女性在5年（相对危险度[RR]=0.57，95%置信区间[CI]0.41 - 0.79，P = 0.0007）和10年（RR = 0.65，95%CI 0.49 - 0.85，P = 0.002）时死亡的可能性较小。年龄、性别、骨折类型及心力衰竭的存在是10年死亡率的独立预测因素（Cox回归模型P < 0.0001）。转子间骨折类型与10年时死亡概率高出1.37倍（95%CI 1.03 - 1.83）独立相关（P = 0.002）。总之，骨折类型是髋部骨折患者长期死亡率的独立预测因素，转子间骨折类型预后更差。
