Liu Zhenning, Wang Hao, Wu Hao, Pan Liping, Ning Taiguo, Cao Yongping
Department of Orthopedics, Peking University First Hospital, Beijing, China.
Quant Imaging Med Surg. 2023 Oct 1;13(10):7247-7257. doi: 10.21037/qims-23-424. Epub 2023 Sep 11.
Pertrochanteric fracture is one of the most prevalent public health issues across the world for the elderly population. The purpose of this study was to investigate the association between surgical factors and postoperative mortality in patients with intramedullary nail-treated pertrochanteric fractures.
A retrospective cohort study was designed to evaluate the pertrochanteric fracture patients treated with intramedullary nail between January 2016 to February 2021. The surgical factors included the Dorr morphology, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classification of fractures, the tip-apex distance (TAD), location of the cephalic screw, reduction quality in anterior-posterior (AP) and lateral views, the integrity of the lateral wall, and the design of cephalic screws. Using univariate and multivariate Cox proportional hazard models, the association between these risk factors and postoperative mortality in patients with this type of fractures was evaluated.
A total of 169 pertrochanteric fracture patients treated with intramedullary nails were included in our study, with the average age of 82.68±5.93 years. The mortality rates at 3 months, 1 year, and the end of follow-up were 4.14%, 11.24%, and 26.04%, respectively. According to the univariate Cox analysis, age, gender, preoperative levels of hemoglobin (Hb) and albumin (Alb) were associated with a poor overall survival (OS) (P<0.05). After multivariate adjustment, the pre-operative level of Alb (P<0.001) and the reduction in lateral view (P<0.001) were shown to be independent risk factors for poor OS.
The preoperative hypoalbuminemia and reduction quality in lateral view were associated with postoperative mortality in our study. Therefore, optimizing both parameters could improve the prognosis in elderly pertrochanteric fracture patients.
转子间骨折是全球老年人群中最普遍的公共卫生问题之一。本研究的目的是探讨髓内钉治疗转子间骨折患者的手术因素与术后死亡率之间的关联。
设计一项回顾性队列研究，以评估2016年1月至2021年2月期间接受髓内钉治疗的转子间骨折患者。手术因素包括Dorr形态、骨折的 Arbeitsgemeinschaft für Osteosynthesefragen/骨科创伤协会（AO/OTA）分类、尖顶距（TAD）、头钉位置、前后位（AP）和侧位的复位质量、侧壁完整性以及头钉设计。使用单变量和多变量Cox比例风险模型，评估这些风险因素与这类骨折患者术后死亡率之间的关联。
本研究共纳入169例接受髓内钉治疗的转子间骨折患者，平均年龄为82.68±5.93岁。3个月、1年和随访结束时的死亡率分别为4.14%、11.24%和26.04%。根据单变量Cox分析，年龄、性别、术前血红蛋白（Hb）和白蛋白（Alb）水平与总体生存率（OS）较差相关（P<0.05）。多变量调整后，术前Alb水平（P<0.001）和侧位复位情况（P<0.001）被证明是OS较差的独立危险因素。
在我们的研究中，术前低白蛋白血症和侧位复位质量与术后死亡率相关。因此，优化这两个参数可以改善老年转子间骨折患者的预后。
