老年患者股骨近端骨折后的死亡率：一项大型回顾性队列研究的发病率和危险因素。

Mortality following proximal femoral fractures in elderly patients: a large retrospective cohort study of incidence and risk factors.

机构信息

Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

出版信息

BMC Musculoskelet Disord. 2023 Aug 30;24(1):693. doi: 10.1186/s12891-023-06825-9.

DOI:10.1186/s12891-023-06825-9

PMID:37649030

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10466793/

Abstract

BACKGROUND

Global prevalence of osteoporosis and fragility fractures is increasing due to the aging population. Proximal femoral fractures are among the most common orthopedic conditions in elderly that significantly cause health deterioration and mortality. Here, we aimed to evaluate the mortality rates and risk factors, besides the functional outcomes after these injuries.

METHODS

In a retrospective cohort study, all patients admitted with a femoral neck or intertrochanteric fracture between 2016 and the end of 2018 were enrolled in this study. Medical records were reviewed to include patients over 60 years of age who had a proximal femoral fracture and had a complete medical record and radiographs. Exclusion criteria included patients with pathological fractures, cancer under active treatment, follow-up loss, and patient access loss. Demographic and clinical features of patients alongside the details of fracture and patient management were recorded and analyzed. In-hospital and post-discharge mortalities due to included types of fractures at one and 12 months were the primary outcome. Modified Harris Hip Scores (mHHS) was the measure of functional outcome.

RESULTS

A total of 788 patients including 412 females (52.3%) and 376 males (47.7%) with a mean age of 76.05 ± 10.01 years were included in this study. Among patients, 573 (72.7%) had an intertrochanteric fracture, while 215 (27.3%) had a femoral neck fracture, and 97.1% of all received surgical treatment. With a mean follow-up of 33.31 months, overall mortality rate was 33.1%, and 5.7% one-month and 20.2% 12-months rates. Analysis of 1-month mortality showed a significant mortality difference in patients operated after 48 h of fracture (p = 0.01) and in patients with American Society of Anesthesiologists (ASA) scores of 3-4 compared to ASA scores of 1-2 (p = 0.001). One-year mortality data showed that the mortality rate in femoral neck fractures was lower compared to other types of fracture. Surgical delay of > 48 h, ASA scores of 3-4, and treatment by proximal femoral plate were associated with shorter survival. The overall mean mHHS score was 53.80 ± 20.78.

CONCLUSION

We found several risk factors of mortality, including age ≥ 80 years, a > 48-hour delay to surgery, and pre-operative ASA scores of 3-4 in patients with proximal femoral fracture. Furthermore, the use of a proximal femoral plate was a significant risk factor for mortality and lower mHHS scores.

摘要

背景

由于人口老龄化，全球骨质疏松症和脆性骨折的患病率正在增加。股骨近端骨折是老年人中最常见的骨科疾病之一，严重导致健康恶化和死亡率增加。在这里，我们旨在评估这些损伤后的死亡率和危险因素，以及功能结果。

方法

在一项回顾性队列研究中，我们招募了 2016 年至 2018 年底期间因股骨颈或转子间骨折入院的所有患者。回顾病历，纳入年龄超过 60 岁、有股骨近端骨折且病历和影像学完整的患者。排除标准包括病理性骨折、正在接受积极治疗的癌症患者、随访丢失和患者无法联系。记录并分析患者的人口统计学和临床特征，以及骨折和患者管理的详细信息。因包括的骨折类型，在入院后 1 个月和 12 个月时的院内和出院后死亡率是主要结局。改良 Harris 髋关节评分（mHHS）是功能结果的衡量标准。

结果

共纳入 788 例患者，包括 412 名女性（52.3%）和 376 名男性（47.7%），平均年龄为 76.05±10.01 岁。其中 573 例（72.7%）患者为转子间骨折，215 例（27.3%）患者为股骨颈骨折，所有患者均接受了手术治疗。平均随访 33.31 个月，总体死亡率为 33.1%，1 个月和 12 个月的死亡率分别为 5.7%和 20.2%。分析 1 个月死亡率发现，骨折后 48 小时内接受手术的患者（p=0.01）和美国麻醉师协会（ASA）评分 3-4 分的患者与 ASA 评分 1-2 分的患者之间存在显著的死亡率差异（p=0.001）。1 年死亡率数据显示，与其他类型骨折相比，股骨颈骨折的死亡率较低。手术延迟>48 小时、ASA 评分 3-4 分和股骨近端钢板治疗与较短的生存期相关。总体平均 mHHS 评分为 53.80±20.78。