Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China.
Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China.
BMC Musculoskelet Disord. 2022 Jul 5;23(1):642. doi: 10.1186/s12891-022-05585-2.
Patients with acute ischemic stroke (AIS) after hip fracture in the elderly have worse prognosis. We aimed to describe the characteristics and complications of hip fracture with AIS in the elderly.
This cross-sectional study selected patients with hip fracture (age ≥65 years) from January 2018 to September 2020. The collected data included age, sex, fracture types, comorbidities. In above screened patients, we further collected cerebral infarction related information of AIS patients. The least absolute shrinkage and selection operator (LASSO) logistic regression was performed to identify the strongest predictors of AIS after hip fracture. Multivariate logistic regression analysis was conducted to find independent risk factors for AIS after hip fracture.
Sixty patients (mean age 79.7 years;female 56.7%) occurred AIS after hip fracture in 1577 cases. The most common infarction type was partial anterior circulation infarction (PACI) (70.0%). The majority of these infarction lesions were single (76.7%) and most infarction lesions(65.0%) were located in the left side. 81.7% of AIS patients had mild (Health stroke scale NIHSS <4) AIS. Older patients with AIS after hip fracture were more frequently complicated by hypertension(73.3%), prior stroke (46.7%), diabetes(35.0%) and were more likely to have hypoproteinemia(68.3%), electrolyte disorders ( 66.7%), anemia (65.0%), deep vein thrombosis (51.6%), pneumonia (46.6%),cardiac complications (45.0%). Combined with hypertension (OR 2.827, 95%CI 1.557-5.131) and male sex(OR 1.865, 95%CI 1.095-3.177) were associated with the increased risk of AIS after hip fracture.
Older patients combined with hypertension are more likely to have AIS after hip fracture. For these patients, early preventions should be administered. AIS patients after hip fracture are prone to have multiple complications under traumatic stress, and we should enhance the management of these patients to reduce the stress and avoid occurrence of complications.
老年髋部骨折合并急性缺血性脑卒中（AIS）患者预后较差。本研究旨在描述老年髋部骨折合并 AIS 的特点和并发症。
本回顾性研究纳入 2018 年 1 月至 2020 年 9 月期间年龄≥65 岁的髋部骨折患者。收集的数据包括年龄、性别、骨折类型、合并症等。在上述筛选出的患者中，我们进一步收集了 AIS 患者与脑梗死相关的信息。采用最小绝对收缩和选择算子（LASSO）逻辑回归分析确定髋部骨折后发生 AIS 的最强预测因素。采用多变量逻辑回归分析确定髋部骨折后发生 AIS 的独立危险因素。
在 1577 例髋部骨折患者中，60 例（平均年龄 79.7 岁，女性 56.7%）发生了 AIS。最常见的梗死类型为部分前循环梗死（PACI）（70.0%）。这些梗死灶大多数为单发（76.7%），且大多数梗死灶（65.0%）位于左侧。81.7%的 AIS 患者为轻度（NIHSS 评分＜4）AIS。髋部骨折后发生 AIS 的老年患者常合并高血压（73.3%）、既往卒中（46.7%）、糖尿病（35.0%），且更易发生低蛋白血症（68.3%）、电解质紊乱（66.7%）、贫血（65.0%）、深静脉血栓形成（51.6%）、肺炎（46.6%）、心脏并发症（45.0%）。合并高血压（OR=2.827，95%CI=1.557-5.131）和男性（OR=1.865，95%CI=1.095-3.177）与髋部骨折后发生 AIS 的风险增加相关。
合并高血压的老年患者更易发生髋部骨折后 AIS。对于这些患者，应进行早期预防。髋部骨折后 AIS 患者在创伤应激下易发生多种并发症，应加强对这些患者的管理，减轻应激，避免并发症的发生。
