老年患者髋臼骨折与股骨近端骨折术后 1 年死亡率较低。

Lower 1-Year Postoperative Mortality After Acetabular Versus Proximal Femoral Fractures in Elderly Patients.

机构信息

Department of Orthopaedic Surgery and Traumatology, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.

Department of Orthopaedic Surgery and Traumatology, Inselspital Bern, University of Bern, Bern, Switzerland.

出版信息

J Bone Joint Surg Am. 2021 Oct 6;103(19):1807-1816. doi: 10.2106/JBJS.20.01805.

DOI:10.2106/JBJS.20.01805

PMID:34019495

Abstract

BACKGROUND

Geriatric acetabular fractures are becoming more common due to demographic changes. Compared with proximal femoral fractures, surgical treatment is more complex and often does not allow full-weight-bearing. The aims of this study were to compare operatively treated acetabular and proximal femoral fractures with regard to (1) cumulative 1-year mortality, (2) perioperative complications, and (3) predictive factors associated with a higher 1-year mortality.

METHODS

This institutional review board-approved comparative study included 486 consecutive surgically treated elderly patients (136 acetabular and 350 proximal femoral fractures). After matching, 2 comparable groups of 129 acetabular and 129 proximal femoral fractures were analyzed. Cumulative 1-year mortality was evaluated through Kaplan-Meier survivorship analysis, and perioperative complications were documented and graded. After confirming that the proportionality assumption was met, Cox proportional hazard modeling was conducted to identify factors associated with increased 1-year mortality.

RESULTS

The acetabular fracture group had a significantly lower cumulative 1-year mortality before matching (18% compared with 33% for proximal femoral fractures, log-rank p = 0.001) and after matching (18% compared with 36%, log-rank p = 0.005). Nevertheless, it had a significantly higher overall perioperative complication rate (68% compared with 48%, p < 0.001). In our multivariable Cox regression analysis, older age, perioperative blood loss of >1 L, and wheelchair mobilization were associated with lower survival rates after acetabular fracture surgery. Older age and a higher 5-item modified frailty index were associated with a higher 1-year mortality rate after proximal femoral fractures, whereas postoperative full weight-bearing was protective.

CONCLUSIONS

Despite the complexity of operative treatment and a higher complication rate after acetabular fractures in the elderly, the 1-year mortality rate is lower than that after operative treatment of proximal femoral fractures, even after adjustment for comorbidities.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

由于人口结构的变化，老年髋臼骨折变得越来越常见。与股骨近端骨折相比，手术治疗更为复杂，且往往不允许完全负重。本研究旨在比较手术治疗的髋臼和股骨近端骨折，比较内容包括：（1）1 年累计死亡率，（2）围手术期并发症，（3）与 1 年死亡率较高相关的预测因素。

方法

本机构审查委员会批准的这项回顾性比较研究纳入了 486 例连续接受手术治疗的老年患者（髋臼骨折 136 例，股骨近端骨折 350 例）。经过匹配，分析了两组可比的髋臼骨折和股骨近端骨折患者各 129 例。通过 Kaplan-Meier 生存分析评估 1 年累计死亡率，并记录和分级围手术期并发症。在确认比例假设成立后，进行 Cox 比例风险建模以确定与 1 年死亡率增加相关的因素。

结果

在未匹配之前，髋臼骨折组的 1 年累计死亡率显著较低（18%比股骨近端骨折组的 33%，log-rank p=0.001），在匹配之后也较低（18%比 36%，log-rank p=0.005）。然而，其整体围手术期并发症发生率显著较高（68%比 48%，p<0.001）。在我们的多变量 Cox 回归分析中，年龄较大、围手术期失血>1 L 和轮椅移动与髋臼骨折手术后生存率降低相关。年龄较大和较高的 5 项改良衰弱指数与股骨近端骨折术后 1 年死亡率较高相关，而术后完全负重是保护性因素。