非医学的患者相关因素对肱骨近端骨折预后的影响：一项多中心研究。
Non-medical patient-related factor influence in proximal humeral fracture outcomes: a multicentric study.
作者信息
Miquel Joan, Elisa Cassart, Fernando Santana, Alba Romero, Torrens Carlos
机构信息
Orthopaedics and Trauma Department, Consorci Sanitari de l'Anoia, Avinguda de Catalunya, 11, 08700, Igualada, Barcelona, Spain.
Hospital Parc Taulí, Parc Taulí,1, 08028, Sabadell Barcelona, Spain.
出版信息
Arch Orthop Trauma Surg. 2021 Nov;141(11):1919-1926. doi: 10.1007/s00402-020-03643-9. Epub 2020 Nov 1.
PURPOSE
Age, sex, and type of fracture have traditionally been described as prognostic factors for proximal humeral fractures (PHFs). Some non-medical patient-related factors may play a role in the outcome. This paper evaluates the association of comorbidities and socioeconomic factors with clinical outcomes for PHF.
METHODS
A total of 217 patients with PHF were evaluated according to Neer's classification with X-ray. Comorbidities were assessed through the Charlson comorbidity index and, non-medical patient-related factors were determined with a 52-item questionnaire concerning personal behaviors such as social activities, family support, economic solvency, and leisure-time activities. The clinical outcome was assessed with the Constant-Murley Score (CMS), with a minimum 1-year follow-up. The minimal clinically relevant difference for the CMS was set at 10 points. A multivariable analysis was performed to adjust for comorbidities and non-medical patient-related factors, such as age, sex, fracture classification, and treatment.
RESULTS
One hundred and eighty-three patients completed the initial research protocol, while 126 of them completed the 1-year follow-up. The mean age was 71.6 years (SD ± 13.3), and 79.3% of the patients were women. In the bivariable analysis, age and comorbidities were correlated with the CMS (correlation coefficient: - 0.34 [- 0.49, 0.17] and 0.35 [0.18, 0.50], respectively), as well as non-medical patient-related factors and the fracture pattern (p value ANOVA < 0.001). In the multivariable regression model, the effects of considering oneself socially active, without economic problems, and self-sufficient were associated with a higher CMS than the effect of the fracture pattern (beta coefficient: 11.69 [6.09-17.30], 15.54 [8.32-22.75], and 10.61 [3.34-17.88], respectively).
CONCLUSION
Socioeconomic status had a higher impact on functional outcomes than fracture pattern in patients with PHF.
目的
年龄、性别和骨折类型传统上被描述为肱骨近端骨折（PHF）的预后因素。一些与患者相关的非医学因素可能对预后产生影响。本文评估了合并症和社会经济因素与PHF临床结局的相关性。
方法
对217例PHF患者进行X线检查，根据Neer分类法进行评估。通过Charlson合并症指数评估合并症，并通过一份包含52个项目的问卷确定与患者相关的非医学因素，问卷内容涉及社交活动、家庭支持、经济偿付能力和休闲活动等个人行为。采用Constant-Murley评分（CMS）评估临床结局，随访时间至少为1年。将CMS的最小临床相关差异设定为10分。进行多变量分析以调整合并症和与患者相关的非医学因素，如年龄、性别、骨折分类和治疗。
结果
183例患者完成了初始研究方案，其中126例完成了1年随访。平均年龄为71.6岁（标准差±13.3），79.3%的患者为女性。在双变量分析中，年龄和合并症与CMS相关（相关系数分别为：-0.34[-0.49,0.17]和0.35[0.18,0.50]），与患者相关的非医学因素和骨折类型也相关（方差分析p值<0.001）。在多变量回归模型中，认为自己社交活跃、没有经济问题和自给自足的影响与CMS升高相关，其相关程度高于骨折类型的影响（β系数分别为：11.69[6.09-17.30]、15.54[8.32-22.75]和10.61[3.34-17.88]）。
结论
在PHF患者中，社会经济状况对功能结局的影响高于骨折类型。
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