Ishimaru Daichi, Ogawa Hiroyasu, Maeda Masato, Shimizu Katsuji
Department of Orthopaedic Surgery, Gifu University, Graduate School of Medicine, Yanagido, Japan.
Orthopedics. 2012 Mar 7;35(3):e353-8. doi: 10.3928/01477447-20120222-21.
Proximal femoral fractures in elderly patients are a serious problem in the aging society. Recently, surgical indications have changed due to advancements in medical technology. The purpose of this study was to investigate the outcome of elderly patients with displaced proximal hip fractures according to our positive criteria for surgical treatment. Exclusion criteria included (1) terminal-stage malignancy; (2) a combination of an inability to walk, a severe mental disorder, and caregiver refusal of surgery; and (3) nonapproval of the anesthesiologist for surgery. The study group comprised 666 elderly patients. They were categorized into surgically and nonsurgically treated groups, and their treatment outcomes were retrospectively analyzed. The majority of patients were treated surgically (97.0% vs 3.0%). One-year survival rate was higher among surgically treated patients (82.2%-91.8%) than non-surgically treated patients (55%). The major cause of death in nonsurgically treated patients was deterioration of comorbidities (66.7%), whereas this was the cause of death in 18.9% of surgically treated patients. One-year survival rates were worse in both groups with a lower American Society of Anesthesiologists grade. The 1-year survival rate of our patients suggests that our surgical criteria offer a reasonable outcome in surgically and nonsurgically treated patients. American Society of Anesthesiologists grade and preexisting comorbidities were strongly correlated with patient outcome.
在老龄化社会中，老年患者的股骨近端骨折是一个严重问题。近年来，由于医学技术的进步，手术指征发生了变化。本研究的目的是根据我们的手术治疗阳性标准，调查移位型近端髋部骨折老年患者的治疗结果。排除标准包括：（1）终末期恶性肿瘤；（2）无法行走、严重精神障碍以及护理人员拒绝手术的综合情况；（3）麻醉医生不批准手术。研究组包括666例老年患者。他们被分为手术治疗组和非手术治疗组，并对其治疗结果进行回顾性分析。大多数患者接受了手术治疗（97.0%对3.0%）。手术治疗患者的1年生存率（82.2%-91.8%）高于非手术治疗患者（55%）。非手术治疗患者的主要死亡原因是合并症恶化（66.7%），而在手术治疗患者中，这一比例为18.9%。美国麻醉医师协会分级较低的两组患者的1年生存率均较差。我们患者的1年生存率表明，我们的手术标准在手术治疗和非手术治疗患者中都能提供合理的结果。美国麻醉医师协会分级和既往合并症与患者预后密切相关。
