股骨近端骨折和女性性别是再次骨折的危险因素：对292例75岁以上反复发生骨质疏松性骨折患者的队列研究。

Proximal femoral fracture and female gender are risk factors for recurrent fracture: Cohort study of 292 patients over 75 years-old with iterative osteoporotic fractures.

作者信息

Rougereau Grégoire, Naline Charlotte, Boisrenoult Philippe, Langlais Tristan, Pujol Nicolas

机构信息

Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France.

Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France; Department of Geriatrics, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France.

出版信息

Injury. 2023 Feb 27. doi: 10.1016/j.injury.2023.02.052.

DOI:10.1016/j.injury.2023.02.052

PMID:36931968

Abstract

PURPOSE

The purpose of this study was to: 1/ describe the characteristics of a cohort of patients over 75 years of age hospitalized in perioperative geriatric units (UPOG) for iterative fractures; 2/ investigate the risks of institutionalization related to the first fracture; and 3/ search for potential risk factors for iterative fracture.

METHODS

This is a retrospective single-center study analyzing patients over 75 years old, hospitalized in UPOG.

RESULTS

Of the 3207 patients hospitalized, 292 patients had a refracture (9.1%), with a mean age of 85.4+/-5.8 years. Initial fractures were mainly intertrochanteric (43.2%) and the femoral neck (32.9%). Refractures occurred mainly in the first year (55.5%), with a median delay of 9.6 months. Refractures were mainly intertrochanteric (29.5%), peri‑implant (prosthesis, osteosynthesis) (28.8%), and femoral neck (26.7%). Dementia was the only factor for institutionalization after the first fracture episode (p = 0.0002). Proximal femoral fracture (PFF) and female gender were risk factors for iterative fracture (10.2% vs. 6.8%, p = 0.003; 10.7% vs. 6.8%, p = 0.005 respectively), but not age (85.4 vs. 85.8 years, p = 0.24). PFF were more likely to result in the same fracture type in the second episode (58.1% vs 7.1%, p<0.0001). The time to refracture was shorter in case of peri‑implant fracture (p = 0.0002), or discharge directly to home (p = 0.04).

CONCLUSION

PFF and female gender are risk factors for recurrent fracture, which is even more likely to occur early in case of home discharge or peri‑implant fracture.

摘要

目的

本研究的目的是：1. 描述在围手术期老年病房（UPOG）因反复骨折住院的75岁以上患者队列的特征；2. 调查首次骨折后入住机构护理的风险；3. 寻找反复骨折的潜在风险因素。

方法

这是一项回顾性单中心研究，分析在UPOG住院的75岁以上患者。

结果

在3207例住院患者中，292例发生再骨折（9.1%），平均年龄为85.4±5.8岁。初次骨折主要为粗隆间骨折（43.2%）和股骨颈骨折（32.9%）。再骨折主要发生在第一年（55.5%），中位延迟时间为9.6个月。再骨折主要为粗隆间骨折（29.5%）、植入物周围（假体、骨固定）骨折（28.8%）和股骨颈骨折（26.7%）。痴呆是首次骨折事件后入住机构护理的唯一因素（p = 0.0002）。股骨近端骨折（PFF）和女性是反复骨折的风险因素（分别为10.2%对6.8%，p = 0.003；10.7%对6.8%，p = 0.005），但年龄不是（85.4岁对85.8岁，p = 0.24）。PFF在第二次发作时更有可能导致相同的骨折类型（58.1%对7.1%，p<0.0001）。植入物周围骨折或直接出院回家的情况下，再骨折时间较短（p = 0.0002，p = 0.04）。