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老年患者髋部骨折后1年死亡率的影响因素:一项回顾性临床研究。

Factors impacting 1-year mortality after hip fractures in elderly patients: A retrospective clinical study.

作者信息

Gurger M

机构信息

Department of Orthopaedics and Traumatology, Firat University Faculty of Medicine, Elazig, Turkey.

出版信息

Niger J Clin Pract. 2019 May;22(5):648-651. doi: 10.4103/njcp.njcp_327_18.

Abstract

BACKGROUND

This study aimed to evaluate risk factors that impact 1-year mortality in elderly patients with hip fractures after treatment with primary arthroplasty and proximal femoral nail.

PATIENTS AND METHODS

Overall, 109 patients aged ≥65 years with nonpathological hip fractures, treated between 2015 and 2016, were included in this study. Thirty-nine patients (35.8%) were treated with primary arthroplasty, and 70 patients (64.2%) were treated with proximal femoral nail. To determine whether the risk factors affected mortality, Kaplan-Meier and log-rank analyses were conducted, and a Cox regression analysis was conducted to include the factors determined to have an impact on mortality.

RESULTS

Twelve patients (11%) died during hospitalization, and 24 patients (22%) died within 1 year after discharge from the hospital. The mortality risk was high for patients who underwent surgery 72 h after fracture, who could not independently perform their daily activities before the operation, had accompanying diseases, had an American Society of Anaesthesiologists score of 3 or 4, and had postoperative complications. There was no statistically significant difference between primary arthroplasty group and proximal femoral nail group with respect to mortality risk.

CONCLUSION

Delayed surgery and postoperative complications may be the most important risk factors increasing 1-year mortality in elderly patients with hip fractures after treatment with primary arthroplasty and proximal femoral nail. These two risk factors can be prevented with proper precautions, and the rate of 1-year survival for these patients can be increased.

摘要

背景

本研究旨在评估影响老年髋部骨折患者初次关节置换术和股骨近端髓内钉治疗后1年死亡率的风险因素。

患者与方法

本研究纳入了2015年至2016年间治疗的109例年龄≥65岁的非病理性髋部骨折患者。39例患者(35.8%)接受了初次关节置换术,70例患者(64.2%)接受了股骨近端髓内钉治疗。为确定风险因素是否影响死亡率,进行了Kaplan-Meier分析和对数秩检验,并进行了Cox回归分析以纳入确定对死亡率有影响的因素。

结果

12例患者(11%)在住院期间死亡,24例患者(22%)在出院后1年内死亡。骨折后72小时接受手术、术前不能独立进行日常活动、有伴发疾病、美国麻醉医师协会评分为3或4以及有术后并发症的患者死亡风险较高。初次关节置换术组和股骨近端髓内钉组在死亡风险方面无统计学显著差异。

结论

手术延迟和术后并发症可能是老年髋部骨折患者初次关节置换术和股骨近端髓内钉治疗后增加1年死亡率的最重要风险因素。通过适当的预防措施可以预防这两个风险因素,并提高这些患者的1年生存率。

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