Hung Li-Wei, Hwang Yi-Ting, Huang Guey-Shiun, Liang Cheng-Chih, Lin Jinn
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei Department of Statistics, National Taipei University, Taipei Department of Nursing, National Taiwan University College of Medicine, Taipei Department of Statistics, National Taipei University, New Taipei City Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Medicine (Baltimore). 2017 Sep;96(37):e7618. doi: 10.1097/MD.0000000000007618.
Hip fractures in older people requiring dialysis are associated with high mortality. Our study primarily aimed to evaluate the specific burden of dialysis on the mortality rate following hip fracture. The secondary aim was to clarify the effect of the fracture site on mortality. A retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database to analyze nationwide health data regarding dialysis and non-dialysis patients ≥65 years who sustained a first fragility-related hip fracture during the period from 2001 to 2005. Each dialysis hip fracture patient was age- and sex-matched to 5 non-dialysis hip fracture patients to construct the matched cohort. Survival status of patients was followed-up until death or the end of 2011. Survival analyses using multivariate Cox proportional hazards models and the Kaplan-Meier estimator were performed to compare between-group survival and impact of hip fracture sites on mortality. A total of 61,346 hip fracture patients were included nationwide. Among them, 997 dialysis hip fracture patients were identified and matched to 4985 non-dialysis hip fracture patients. Mortality events were 155, 188, 464, and 103 in the dialysis group, and 314, 382, 1505, and 284 in the non-dialysis group, with adjusted hazard ratios (associated 95% confidence intervals) of 2.58 (2.13-3.13), 2.95 (2.48-3.51), 2.84 (2.55-3.15), and 2.39 (1.94-2.93) at 0 to 3 months, 3 months to 1 year, 1 to 6 years, and 6 to 10 years after the fracture, respectively. In the non-dialysis group, survival was consistently better for patients who sustained femoral neck fractures compared to trochanteric fractures (0-10 years' log-rank test, P < .001). In the dialysis group, survival of patients with femoral neck fractures was better than that of patients with trochanteric fractures only within the first 6 years post-fracture (0-6 years' log-rank, P < .001). Dialysis was a significant risk factor of mortality in geriatric hip fracture patients. Survival outcome was better for non-dialysis patients with femoral neck fractures compared to those with trochanteric fractures throughout 10 years. However, the survival advantage of femoral neck fractures was limited to the first 6 years postinjury among dialysis patients.
需要透析的老年人髋部骨折与高死亡率相关。我们的研究主要旨在评估透析对髋部骨折后死亡率的具体负担。次要目的是阐明骨折部位对死亡率的影响。我们进行了一项回顾性队列研究，使用台湾国民健康保险研究数据库来分析2001年至2005年期间首次发生与脆性相关髋部骨折的65岁及以上透析和非透析患者的全国性健康数据。每例透析髋部骨折患者按年龄和性别与5例非透析髋部骨折患者匹配，以构建匹配队列。对患者的生存状况进行随访直至死亡或2011年底。使用多变量Cox比例风险模型和Kaplan-Meier估计器进行生存分析，以比较组间生存率以及髋部骨折部位对死亡率的影响。全国共纳入61346例髋部骨折患者。其中，识别出997例透析髋部骨折患者并与4985例非透析髋部骨折患者匹配。透析组的死亡事件分别为155例、188例、464例和103例，非透析组分别为314例、382例、1505例和284例，骨折后0至3个月、3个月至1年、1至6年和6至10年的调整后风险比（及相关95%置信区间）分别为2.58（2.13 - 3.13）、2.95（2.48 - 3.51）、2.84（2.55 - 3.15）和2.39（1.94 - 2.93）。在非透析组中，与转子间骨折患者相比，股骨颈骨折患者的生存率在各时间段均持续更好（0至10年对数秩检验，P < 0.001）。在透析组中，仅在骨折后的前6年内，股骨颈骨折患者的生存率高于转子间骨折患者（0至6年对数秩，P < 0.001）。透析是老年髋部骨折患者死亡的一个重要危险因素。在整个10年中，非透析股骨颈骨折患者的生存结局优于转子间骨折患者。然而，透析患者中股骨颈骨折的生存优势仅限于受伤后的前6年。
