Petersen M B, Jørgensen H L, Hansen K, Duus B R
Department of Orthopaedics, Bispebjerg University Hospital, Copenhagen, Denmark.
Injury. 2006 Aug;37(8):705-11. doi: 10.1016/j.injury.2006.02.046. Epub 2006 Jun 12.
Displaced femoral neck fractures are known to be associated with high rates of mortality. The purpose of the present study is to investigate pre- and postoperative factors which influence this mortality in a series of 1186 consecutive Danish patients presenting to one hospital's orthopaedic department with Garden type 3-4 fractures. Subsequent mortality data was obtained from the state population register (224 were still alive). The stepwise Cox proportional hazards model was used for multivariate analysis in order to obtain the predictors of postoperative mortality. The median survival of male subjects fell from 5.2 years in an age-matched control population to 1.6 years in the patients. In women survival time fell from 6.6 to 2.8 years. Almost all excess mortality occurred during the first 3 months following hemiarthroplasty. In order of significance, key factors negatively influencing mortality at 3 months were: cardiac complications, dementia, male sex, age, waiting time before operation, stroke and dislocation of the prosthesis and perioperative fracture. Of these, waiting time for surgery and dislocation of the prosthesis could be modified. A number of other studies have confirmed the importance of optimising these factors.
已知移位型股骨颈骨折与高死亡率相关。本研究的目的是调查在一家医院骨科就诊的1186例连续丹麦患者中，影响Garden 3-4型骨折死亡率的术前和术后因素。随后的死亡率数据来自国家人口登记处（224人仍存活）。采用逐步Cox比例风险模型进行多变量分析，以获得术后死亡率的预测因素。男性受试者的中位生存期从年龄匹配对照组的5.2年降至患者组的1.6年。女性的生存时间从6.6年降至2.8年。几乎所有的额外死亡都发生在半髋关节置换术后的前3个月。按重要性排序，在3个月时对死亡率有负面影响的关键因素为：心脏并发症、痴呆、男性、年龄、手术前等待时间、中风、假体脱位和围手术期骨折。其中，手术等待时间和假体脱位是可以改变的。其他一些研究证实了优化这些因素的重要性。
