Department of Geriatrics, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China.
Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China.
J Orthop Surg Res. 2021 Dec 20;16(1):727. doi: 10.1186/s13018-021-02874-9.
The 1-year mortality rate after femoral intertrochanteric fracture is higher than that of femoral neck fracture, which also belongs to hip fracture (Cui et al. in Arch Osteoporos 14(1):55, 2019). With the application of the concept of co-management model of orthopedics and geriatrics, the short-term and long-term mortality of all types of hip fractures has decreased (Van Heghe et al. in Calcif Tissue Int, 2021, https://doi.org/10.1007/s00223-021-00913-5 ). However, the mortality of Chinese femoral intertrochanteric fracture patients under this model has not been reported in the literatures.
This paper aims to study the risk factors of postoperative all-cause mortality in aged patients with femoral intertrochanteric fracture under the co-management model of orthopedics and geriatrics.
This is a single-center prospective cohort study based on the real world, under the co-management of orthopedics and geriatrics, 363 patients aged ≥ 65 years with femoral intertrochanteric fracture were enrolled and followed up for 2-3 years; 52 patients were lost to follow up. Age, gender, body mass index (BMI), history of comorbidities, hip Bone Mineral Density (BMD), fracture history, 25(OH)D level, hemoglobin level, anti-osteoporosis treatment were risk factors to be tested. Kaplan-Meier survival curves and multivariate Cox proportional hazards models were constructed to analyze the impact of factors on all-cause mortality.
(1) Most of the dead patients were older (the mean age was 83.4 years, compared with 79.8 years for surviving patients), with more complications and without anti-osteoporosis medication; gender, pre-fracture history, BMI, total hip BMD, hemoglobin, 25(OH)D had no difference between the dead and the living patients. (2) Elderly patients with Intertrochanteric fracture can benefit from the early treatment of Zoledronic Acid (within 3 days after the operation).
Under the co-management of orthopedics and geriatrics, to Chinese patients with Femoral Intertrochanteric fracture, Doctors should pay more attention to their age and chronic disease, and give anti-osteoporosis treatment if allowed.
股骨粗隆间骨折 1 年死亡率高于股骨颈骨折，也属于髋部骨折（崔等人，2019 年，《骨质疏松症档案》14（1）：55）。随着骨科和老年医学共管模式概念的应用，各种类型髋部骨折的短期和长期死亡率均有所下降（范·赫格等人，2021 年，《钙组织国际》，https://doi.org/10.1007/s00223-021-00913-5）。然而，在这种模式下，中国股骨粗隆间骨折患者的死亡率在文献中尚未报道。
本研究旨在探讨骨科与老年医学共管模式下老年股骨粗隆间骨折患者术后全因死亡率的危险因素。
这是一项基于真实世界的单中心前瞻性队列研究，在骨科与老年医学共管模式下，纳入 363 例年龄≥65 岁的股骨粗隆间骨折患者，并进行了 2-3 年的随访；52 例患者失访。对年龄、性别、体重指数（BMI）、合并症病史、髋部骨密度（BMD）、骨折病史、25（OH）D 水平、血红蛋白水平、抗骨质疏松治疗等因素进行测试。采用 Kaplan-Meier 生存曲线和多因素 Cox 比例风险模型分析各因素对全因死亡率的影响。
（1）大多数死亡患者年龄较大（平均年龄 83.4 岁，与存活患者的 79.8 岁相比），合并症更多，且未进行抗骨质疏松治疗；性别、骨折前病史、BMI、全髋关节 BMD、血红蛋白、25（OH）D 在死亡和存活患者之间无差异。（2）老年股骨粗隆间骨折患者术后早期应用唑来膦酸治疗（术后 3 天内）可获益。
在骨科和老年医学共管模式下，对于中国股骨粗隆间骨折患者，医生应更加关注患者的年龄和慢性疾病，并在允许的情况下进行抗骨质疏松治疗。
