Peng Cheng, Wang Xiao-Wei, Li Shao-Guang, Liu Zhi, Sun Tian-Sheng, Zhang Jian-Zheng
General Hospital of PLA Army, Beijing 100700, China.
General Hospital of PLA Army, Beijing 100700, China;
Zhongguo Gu Shang. 2017 Oct 25;30(10):906-910. doi: 10.3969/j.issn.1003-0034.2017.10.006.
To determine the effect of site of fracture on the prognosis for patients of elderly hip fracture.
From January 2012 to December 2014, 667 patients with hip fractures were divided into femoral neck fracture group and intertrochanteric fracture group according to the site of fracture. There were 304 cases of intertrochanteric fracture, including 96 males and 208 females, with an average age of (80.33±7.94) years old. There were 217 cases of femoral neck fracture, including 74 males and 143 females, with an average age of (79.82±9.33) years old. Patients' data, mortality and activities of daily living were compared between two groups.
There were no significant differences in age, gender, comorbidity, ASA classification, and anesthesia between two groups, but the time of admission to surgery, duration of operation, blood loss of intra-operative, volume of drainage, and the average of transfusion were shown to have significant differences. The levels of White blood cell count (WBC) for intertrochanteric fracture group were shown to be higher than that of femoral neck fracture patients at admission, 1, 3 and 5 days after operation. The levels of hemoglobin, and albumin for intertrochanteric fracture were lower than that of femoral neck fracture patients at all period of time. The mortality of intertrochanteric fracture group during hospitalization, 1, 3, 6, and 12 months were higher than that of femoral neck fracture, but did not reach significant difference. In patients who survived, the scores of ADL for femoral neck fracture were higher than that of intertrochanteric fracture at discharge, 1, 3 months after operation, but there was no significant difference for ADL at 6 and 12 months between two groups.
The response of stress for intertrochanteric fracture were more than femoral neck fracture, but the mortality was similar than that of femoral neck fracture after excluding the influence of age, sex, comorbidity, and other factors. Compared to intertrochanteric fracture, the femoral neck fracture patients had a better functional recovery during early stage, and the two groups reached a similar functional recovery at 1 year after operation.
确定骨折部位对老年髋部骨折患者预后的影响。
2012年1月至2014年12月，667例髋部骨折患者根据骨折部位分为股骨颈骨折组和转子间骨折组。转子间骨折304例，其中男性96例，女性208例，平均年龄（80.33±7.94）岁。股骨颈骨折217例，其中男性74例，女性143例，平均年龄（79.82±9.33）岁。比较两组患者的数据、死亡率及日常生活活动能力。
两组患者在年龄、性别、合并症、美国麻醉医师协会（ASA）分级及麻醉方式方面无显著差异，但手术入院时间、手术时长、术中失血量、引流量及平均输血量存在显著差异。转子间骨折组患者入院时、术后1天、3天及5天的白细胞计数（WBC）水平高于股骨颈骨折患者。转子间骨折患者在各时间段的血红蛋白及白蛋白水平均低于股骨颈骨折患者。转子间骨折组患者住院期间、术后1个月、3个月、6个月及12个月的死亡率高于股骨颈骨折组，但差异无统计学意义。存活患者中，股骨颈骨折患者出院时、术后1个月及3个月的日常生活活动能力（ADL）评分高于转子间骨折患者，但两组术后6个月及12个月的ADL评分无显著差异。
排除年龄、性别、合并症等因素影响后，转子间骨折的应激反应大于股骨颈骨折，但其死亡率与股骨颈骨折相似。与转子间骨折相比，股骨颈骨折患者早期功能恢复较好，两组术后1年功能恢复情况相近。
