Fu Hua-Jun, Chen Min-Li, Han Lei, Hu Yun-Gen, Bi Da-Wei
Department of Orthopaedics, the Second Affiliated Hospital Zhejiang University School of Medicine International Medical Center, Hangzhou 311201, Zhejiang, China.
Zhongguo Gu Shang. 2022 Apr 25;35(4):353-6. doi: 10.12200/j.issn.1003-0034.2022.04.011.
To investigate the incidence and related risk factors of healthy side fracture after hip fracture surgery in the elderly, so as to provide basis for the prevention of re-fracture.
The data of 452 patients over 65 years old with femoral neck fracture or intertrochanteric fracture treated with hip arthroplasty or proximal femoral intramedullary nailing from June 2012 to June 2017 were analyzed, including 168 males and 284 females, the age ranged from 65 to 97(75.5±7.5) years. There were 191 cases of femoral neck fracture and 261 cases of femoral intertrochanteric fracture. According to whether there was a fracture in the healthy hip after operation, the patients were divided into fracture group and no fracture group. The gender, age, body mass index, fracture type, initial treatment method, bone mineral density, bed time, medical compliance, postoperative short-term delirium, whether there were medical diseases before injury and Harris score of hip joint in the final follow-up were recorded. Univariate Logistic regression analysis was used to screen out the risk factors of healthy side fracture after operation, and then statistically significant risk factors were included in multi factor Logistic regression analysis to screen out the independent risk factors of healthy side fracture after operation of hip fracture in the elderly.
Among them, 42 of the 452 patients had hip fractures on the healthy side with an incidence of 9.3%. The average interval between the two fractures was (2.9±2.1) years. Univariate Logistic regression analysis showed that there were significant differences in age, bone mineral density, medical compliance, short-term postoperative deliriun, pre-injury complicated with medical diseases and Harris score of hip joint in the final follow-up (<0.05). Multivariate Logistic analysis showed that age(=4.227), bone mineral density(=4.313), combined with medical diseases (=5.616) and low hip Harris score at the final follow-up (=3.891) were independent risk factors for healthy side fractures after hip fracture surgery in elderly(<0.05).
The age, bone mineral density, combined with medical diseases and low Harris score of hip joint in the final follow-up are the main risk factors of healthy side fracture after hip fracture in the elderly. It is necessary to strengthen the treatment of medical diseases, anti osteoporosis and improve hip joint function within 3 years after operation, so as to prevent the occurrence of healthy side hip fracture.
探讨老年人髋部骨折术后健侧骨折的发生率及相关危险因素，为预防再骨折提供依据。
分析2012年6月至2017年6月行髋关节置换术或股骨近端髓内钉治疗的452例65岁以上股骨颈骨折或转子间骨折患者的资料，其中男性168例，女性284例，年龄65～97（75.5±7.5）岁。股骨颈骨折191例，股骨转子间骨折261例。根据术后健侧髋关节是否发生骨折，将患者分为骨折组和无骨折组。记录患者的性别、年龄、体重指数、骨折类型、初始治疗方式、骨密度、卧床时间、医疗依从性、术后短期谵妄、伤前是否患有内科疾病以及末次随访时髋关节Harris评分。采用单因素Logistic回归分析筛选出术后健侧骨折的危险因素，再将有统计学意义的危险因素纳入多因素Logistic回归分析，筛选出老年人髋部骨折术后健侧骨折的独立危险因素。
452例患者中，42例健侧发生髋部骨折，发生率为9.3%。两次骨折的平均间隔时间为（2.9±2.1）年。单因素Logistic回归分析显示，年龄、骨密度、医疗依从性、术后短期谵妄、伤前合并内科疾病以及末次随访时髋关节Harris评分差异有统计学意义（P<0.05）。多因素Logistic分析显示，年龄（OR=4.227）、骨密度（OR=4.313）、合并内科疾病（OR=5.616）以及末次随访时髋关节Harris评分低（OR=3.891）是老年人髋部骨折术后健侧骨折的独立危险因素（P<0.05）。
年龄、骨密度、合并内科疾病以及末次随访时髋关节Harris评分低是老年人髋部骨折后健侧骨折的主要危险因素。术后3年内需加强内科疾病治疗、抗骨质疏松以及改善髋关节功能，以预防健侧髋部骨折的发生。
