Clinic of Orthopaedics and Traumatology, Bursa High Specialty Research and Training Hospital, Yýldýrým, Bursa, Turkey.
Singapore Med J. 2010 Feb;51(2):137-43.
Hip fractures in the elderly are associated with significant mortality. This study aimed to investigate the risk factors for mortality in elderly patients with hip fractures during a one-year period.
This was a prospective study which included consecutive isolated nonpathologic hip fractures in 74 (52 female, 22 male) patients in a level-1 trauma centre. These patients were 65 years or older and were ambulatory before the fracture. The patients were treated with hemiarthroplasty. The factors investigated were age, gender, nutritional status determined by blood albumin and total lymphocyte count, haemoglobin levels on the day of admission, mobilisation time after surgery, length of hospital stay, comorbidities, American Society of Anaesthesiologists (ASA) rating of operative risk, and the time period between injury and surgery. The patients were followed up for one year after surgery, or until death.
In total, 15 patients died during the one-year period. Patient survival was 94.6 percent at 3 months, 81.1 percent at 6 months and 79.7 percent at 12 months. There were two in-hospital deaths. The factors significantly associated with mortality were patients with more than two comorbidities, an ASA score of III-IV, a blood albumin level of less than 3.5 g/dl and a total lymphocyte count of less than 1500 cells/ml on admission. However, after the multivariate analysis, an ASA score of III-IV, low total lymphocyte count, female gender and low haemoglobin levels on admission remained the independent and significant risk factors associated with a one-year mortality.
This study confirms that a high ASA score, female gender, a lower lymphocyte count and low haemoglobin levels on admission are significant factors in assessing the one-year mortality in elderly patients with hip fractures. Predicting these risk factors improves the case management.
老年人髋部骨折与较高的死亡率相关。本研究旨在探讨一年内老年髋部骨折患者死亡的危险因素。
这是一项前瞻性研究，纳入了一家 1 级创伤中心的 74 例（52 名女性，22 名男性）连续的非病理性单纯髋部骨折患者。这些患者年龄在 65 岁及以上，在骨折前能够行走。患者接受人工髋关节置换术治疗。研究的因素包括年龄、性别、通过血清白蛋白和总淋巴细胞计数确定的营养状况、入院当天的血红蛋白水平、术后的活动时间、住院时间、合并症、美国麻醉医师协会（ASA）手术风险分级，以及受伤与手术之间的时间间隔。患者在手术后 1 年或死亡前进行随访。
在 1 年的随访期内，共有 15 例患者死亡。术后 3 个月的患者生存率为 94.6%，6 个月为 81.1%，12 个月为 79.7%。有 2 例院内死亡。与死亡率显著相关的因素是患者合并症超过 2 种、ASA 评分 III-IV、入院时血清白蛋白水平<3.5 g/dl 和总淋巴细胞计数<1500 个细胞/ml。然而，经过多变量分析，ASA 评分 III-IV、低总淋巴细胞计数、女性和入院时低血红蛋白水平仍然是与 1 年死亡率相关的独立和显著危险因素。
本研究证实，ASA 评分高、女性、淋巴细胞计数低和入院时血红蛋白水平低是评估老年髋部骨折患者 1 年死亡率的重要因素。预测这些危险因素可改善病例管理。
