Ho Ching-An, Li Chung-Yi, Hsieh Kou-Shiong, Chen Hua-Fen
Department of Orthopedic Surgery, Catholic Mercy Hospital, Hsinchu County, Taiwan.
J Orthop Sci. 2010 Jan;15(1):30-7. doi: 10.1007/s00776-009-1425-9. Epub 2010 Feb 12.
Factors associated with 1-year survival of hip fracture in Chinese ethnicities has not been clearly elucidated. The purpose of this study was to determine the 1-year survival associated with operated hip fracture and its prognostic factors in a district teaching hospital from January 1, 1998 to 2006.
Hip fracture admissions (ICD-9: 820) identified from an inpatient electronic database over a 9-year period were linked to Taiwan's national death registry. Actuarial analysis was used to determine the 1-year survival rates after hip fracture, which were further compared according to different concurrent illnesses. We used the Cox proportional hazard regression model to explore the significant determinants of 1-year survival of the study patients.
The overall 1-year survival rate of all patients was 86%. This was lower if the operation was accompanied by certain co-morbidities, including heart failure [hazard ratio (HR) 6.12; 95% confidence interval (CI) 1.54-24.36], chronic obstructive pulmonary disease (HR 2.40; 95% CI 1.14-5.05), and pneumonia (HR 4.26; 95% CI 1.95-9.31). In addition, elderly patients (>84 years of age) (HR 7.34; 95% CI 2.49-21.58), arthroplasty (HR 3.69; 95% CI 1.10-12.43), operative delay >48 h (HR 2.86; 95% CI 1.08-7.54), low preoperative hemoglobin level (<11 g/dl) (HR 2.58; 95% CI 1.33-5.01), and high creatinine level (>or=2 mg/dl) (HR 2.52; 95% CI 1.07-5.95) were all significantly associated with increased mortality.
The 1-year survival for patients in this study hospital, 86%, was comparable to or higher than that of previous studies. Improved survival rates among hip fracture patients may be achieved by early recognition and prompt treatment of associated medical illnesses.
中国人群髋部骨折1年生存率的相关因素尚未明确阐明。本研究的目的是确定1998年1月1日至2006年期间某地区教学医院手术治疗的髋部骨折患者的1年生存率及其预后因素。
从住院电子数据库中识别出9年间的髋部骨折入院病例（国际疾病分类第九版：820），并与台湾国家死亡登记处进行关联。采用精算分析确定髋部骨折后的1年生存率，并根据不同的并发疾病进行进一步比较。我们使用Cox比例风险回归模型来探索研究患者1年生存的显著决定因素。
所有患者的总体1年生存率为86%。如果手术伴有某些合并症，生存率会更低，这些合并症包括心力衰竭[风险比（HR）6.12；95%置信区间（CI）1.54 - 24.36]、慢性阻塞性肺疾病（HR 2.40；95% CI 1.14 - 5.05）和肺炎（HR 4.26；95% CI 1.95 - 9.31）。此外，老年患者（>84岁）（HR 7.34；95% CI 2.49 - 21.58）、关节置换术（HR 3.69；95% CI 1.10 - 12.43）、手术延迟>48小时（HR 2.86；95% CI 1.08 - 7.54）、术前血红蛋白水平低（<11 g/dl）（HR 2.58；95% CI 1.33 - 5.01）以及肌酐水平高（≥2 mg/dl）（HR 2.52；95% CI 1.07 - 5.95）均与死亡率增加显著相关。
本研究医院患者的1年生存率为86%，与先前研究相当或更高。通过早期识别和及时治疗相关内科疾病，可提高髋部骨折患者的生存率。
