一种联合骨折和死亡率风险指数，可用于髋部脆性骨折的治疗分层。

A combined fracture and mortality risk index useful for treatment stratification in hip fragility fractures.

机构信息

Aksaray Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 68200 Aksaray, Türkiye.

出版信息

Jt Dis Relat Surg. 2021;32(3):583-589. doi: 10.52312/jdrs.2021.382. Epub 2021 Nov 19.

DOI:10.52312/jdrs.2021.382

PMID:34842088

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8650669/

Abstract

OBJECTIVES

In this study, we aimed to assess the stratification ability of the Fracture and Mortality Risk Evaluation (FAME) index for reoperation, new fragility fracture, and mortality during one-year follow-up.

PATIENTS AND METHODS

Between November 2018 and July 2019, a total of 94 consecutive hip fragility fracture patients from two centers (20 males, 74 females; mean age: 79.3±8.9 years; range, 57 to 100 years) were retrospectively analyzed. The patients were classified into high, intermediate, and low fracture and mortality risk groups according to the Fracture Risk Assessment Tool (FRAX) score and Sernbo score, respectively, as well as nine combined categories according to the FAME index. Hospital records were reviewed to identify re-fractures (reoperations, implant failure, new fragility fractures on any site) and mortality at one year following the FAME index classification.

RESULTS

Overall re-fracture and mortality rates were 20.2% and 33%, respectively. High fracture risk category (FRAX-H) was significantly associated with higher re-fracture (odds ratio [OR]: 2.9, 95% confidence interval [CI]: 1-8.2, p=0.037) and mortality rates compared to others (OR: 3.7, 95% CI: 1.5-9.3, p=0.003). The patients classified within the FRAX-H category (n=35) had different mortality rates according to their Sernbo classification; i.e., patients classified as low mortality risk (Sernbo-L) (n=17) had lower mortality rates compared to others in this group (n=18) (35.3% and 66.7%, respectively), indicating a low statistical significance (OR: 0.3, 95% CI: 0.1-1.1, p=0.063). Similarly, within patients classified in Sernbo-L category (n=64), those classified as high fracture risk (FRAX-H) (n=17) had significantly higher re-fracture rates compared to others in this group (n=47) (35.3% and 8.5%, respectively), (OR: 5.9; 95% CI: 1.4-24.5), (p=0.017). Multivariate logistic regression analyses adjusting for covariates (age, sex, length of hospital stay and BMI) yielded similar results.

CONCLUSION

The FAME index appears to be a useful stratification tool for allocating patients in a randomized-controlled trial for augmentation of hip fragility fractures.

摘要

目的

本研究旨在评估骨折和死亡率风险评估（FAME）指数在一年内随访时对再次手术、新脆性骨折和死亡率的分层能力。

方法

2018 年 11 月至 2019 年 7 月，我们回顾性分析了来自两个中心的 94 例连续髋部脆性骨折患者（20 名男性，74 名女性；平均年龄：79.3±8.9 岁；范围：57-100 岁）。根据骨折风险评估工具（FRAX）评分和 Sernbo 评分，患者分别被分为高、中、低骨折和死亡率风险组，以及根据 FAME 指数的 9 个联合类别。回顾医院记录，以确定 FAME 指数分类后一年的再骨折（再手术、植入物失败、任何部位的新脆性骨折）和死亡率。

结果

总体再骨折和死亡率分别为 20.2%和 33%。高骨折风险组（FRAX-H）的再骨折（优势比[OR]：2.9，95%置信区间[CI]：1-8.2，p=0.037）和死亡率均显著高于其他组（OR：3.7，95%CI：1.5-9.3，p=0.003）。FRAX-H 组（n=35）的患者根据 Sernbo 分类有不同的死亡率；即，被分类为低死亡率风险（Sernbo-L）（n=17）的患者与该组中的其他患者（n=18）相比，死亡率较低（35.3%和 66.7%），具有统计学意义（OR：0.3，95%CI：0.1-1.1，p=0.063）。同样，在 Sernbo-L 组（n=64）的患者中，被分类为高骨折风险（FRAX-H）（n=17）的患者与该组中的其他患者（n=47）相比，再骨折率显著更高（35.3%和 8.5%）（OR：5.9；95%CI：1.4-24.5），（p=0.017）。调整协变量（年龄、性别、住院时间和 BMI）的多变量逻辑回归分析得出了类似的结果。