分析 30 天和 1 年病死率的因素，这些患者的股骨转子间骨折为临界稳定-不稳定型。
Analysis of factors among 30-day and 1-year mortality rates in patients with borderline stable-unstable intertrochanteric hip fracture.
机构信息
Department of Orthopedics and Traumatology, Kırıkkale University, School of Medicine, Kırıkkale, Turkey.
出版信息
Acta Orthop Traumatol Turc. 2021 Jan;55(1):16-21. doi: 10.5152/j.aott.2021.20071.
OBJECTIVE
This study aimed to evaluate the possible effects of surgical procedures on mortality and to identify the possible risk factors for mortality in the management of geriatric hip fractures.
METHODS
A total of 191 patients (105 women and 86 men; mean age 82.26±9.681 [60-108] years) with AO/OTA 31A2.2 intertrochanteric fractures and treated with sliding hip screw, proximal femoral nail, or hemiarthroplasty were included in this retrospective cohort study. The treatment type was decided by the responsible surgeon according to the patients' pre-injury activity level, bone quality, and features of the fracture. Age, sex, type of fracture, type of surgery performed, American society of anesthesiology (ASA) grade, type of anesthesia, time to surgery, type of physical therapy, length of hospital stay, and number of comorbidities were documented. We evaluated the 30-day and 1-year mortality of patients treated with sliding hip screw (SHS), proximal femoral nail antirotation (PFN-A), or hemiarthroplasty and identified the possible risk factors for mortality.
RESULTS
A total of 49 patients underwent SHS, 58 underwent PFN-A, and 84 underwent hemiarthroplasty. Of these, 2 patients with SHS, 2 with PFN-A, and 11 with hemiarthroplasty died within 30 days after surgery, whereas 7 patients with SHS, 15 with PFN-A, and 23 with hemiarthroplasty died 1 year after surgery. The 30-day and 1-year overall mortality rates were 7.9% and 23.6%, respectively. Both the 30-day and 1-year mortality risks were higher in patients undergoing hemiarthroplasty than in patients undergoing SHS (p=0.068 versus 0.058). The 30-day mortality was higher in patients receiving general anesthesia than in those receiving combined spinal and epidural anesthesia (p=0.009). The 1-year mortality risk was higher in patients with ASA grade 4 than in those with grade 1 and 2 (p=0.045). Advanced age (p=0.022) and male sex (p=0.007) were also found to be the risk factors for 1-year mortality.
CONCLUSION
We demonstrated that higher ASA grade, male sex, general anesthesia, and hemiarthroplasty procedures are associated with higher mortality rates in elderly patients with hip fractures. Thus, we highly recommend orthopedic surgeons to consider all these factors in the management of intertrochanteric hip fractures in the geriatric population.
LEVEL OF EVIDENCE
Level IV, Prognostic Study.
目的
本研究旨在评估手术操作对死亡率的可能影响，并确定老年髋部骨折治疗中与死亡率相关的可能危险因素。
方法
本回顾性队列研究纳入了 191 名（105 名女性和 86 名男性；平均年龄 82.26±9.681[60-108]岁）AO/OTA 31A2.2 股骨转子间骨折患者，采用滑动髋螺钉、股骨近端髓内钉或半髋关节置换术治疗。治疗类型由负责的外科医生根据患者术前活动水平、骨质量和骨折特点决定。记录年龄、性别、骨折类型、手术类型、美国麻醉医师协会（ASA）分级、麻醉类型、手术时间、物理治疗类型、住院时间和合并症数量。我们评估了接受滑动髋螺钉（SHS）、股骨近端髓内钉抗旋（PFN-A）或半髋关节置换术治疗的患者的 30 天和 1 年死亡率，并确定了死亡率的可能危险因素。
结果
共有 2 名患者接受 SHS、2 名患者接受 PFN-A 和 11 名患者接受 hemiarthroplasty 治疗，术后 30 天内死亡，7 名患者接受 SHS、15 名患者接受 PFN-A 和 23 名患者接受 hemiarthroplasty 治疗，术后 1 年死亡。30 天和 1 年的总死亡率分别为 7.9%和 23.6%。与 SHS 组相比，行半髋关节置换术的患者 30 天和 1 年的死亡率均更高（p=0.068 比 0.058）。全麻患者的 30 天死亡率高于联合脊髓-硬膜外麻醉患者（p=0.009）。ASA 分级为 4 级的患者 1 年死亡率高于分级为 1 级和 2 级的患者（p=0.045）。高龄（p=0.022）和男性（p=0.007）也是 1 年死亡率的危险因素。
结论
我们发现，ASA 分级较高、男性、全麻和半髋关节置换术与老年髋部骨折患者的高死亡率相关。因此，我们强烈建议骨科医生在治疗老年人群的股骨转子间骨折时考虑所有这些因素。
证据等级
IV 级，预后研究。
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