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终末期肾病非手术治疗髋部骨折患者的预后不良和危险因素。

Poor prognosis and risk factors of nonoperative treatment hip fracture patients with end-stage renal disease.

机构信息

Department of General Practice, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, China.

Department of Orthopedics, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, China.

出版信息

Medicine (Baltimore). 2024 Jan 19;103(3):e36446. doi: 10.1097/MD.0000000000036446.

Abstract

This study aims to summarize the prognosis and risk factors of nonoperative treatment patients of hip fracture with end-stage renal disease (ESRD). A total of 113 individuals of hip fracture with nonoperative treatment were retrospectively enrolled, 38 patients with ESRD were defined as the observation group, and the other 75 patients without ESRD were served as the control group. The difference in 30-day and 1-year mortality rate between the 2 groups was compared. The effects of risk factors on survival were estimated by the Cox proportional-hazards model. The survival difference was estimated by the method of Kaplan-Meier. In the subsequent subgroup analysis of the observation group, as before, the Cox proportional-hazards model and the Kaplan-Meier method were used. The 1-year mortality rate of the observation group was considerably higher than that of the control group, which was 86.84% and 32.0%, respectively (P < .005). For nonoperative treatment hip fracture subjects, ESRD, age ≥ 82, BMI (BMI) < 20, high Charlson Comorbidity Index (CCI) and low Barthel Index (BI) were associated with a low survival curve (P < .05). In the subsequent multivariable subgroup analyses, for nonoperative treatment hip fracture subjects with ESRD, high CCI and low BI were also the independent risk factors of mortality. For nonoperative treatment hip fracture subjects, ESRD, old age, low BMI, high CCI and low BI were the independent risk factors of mortality. For hip fracture subjects with ESRD, nonoperative treatment was associated with excess high 1-year mortality rate, especially for patients with high CCI and low BI.

摘要

本研究旨在总结终末期肾病(ESRD)合并髋部骨折非手术治疗患者的预后和危险因素。回顾性纳入 113 例髋部骨折非手术治疗患者,其中 38 例 ESRD 患者定义为观察组,另 75 例非 ESRD 患者为对照组。比较两组患者 30 天和 1 年死亡率的差异。采用 Cox 比例风险模型估计危险因素对生存的影响。采用 Kaplan-Meier 法估计生存差异。在观察组的后续亚组分析中,同样采用 Cox 比例风险模型和 Kaplan-Meier 法。观察组的 1 年死亡率明显高于对照组,分别为 86.84%和 32.0%(P<.005)。对于非手术治疗的髋部骨折患者,ESRD、年龄≥82 岁、BMI(BMI)<20、高 Charlson 合并症指数(CCI)和低 Barthel 指数(BI)与低生存曲线相关(P<.05)。在随后的多变量亚组分析中,对于 ESRD 的非手术治疗髋部骨折患者,高 CCI 和低 BI 也是死亡的独立危险因素。对于非手术治疗的髋部骨折患者,ESRD、高龄、低 BMI、高 CCI 和低 BI 是死亡的独立危险因素。对于 ESRD 合并髋部骨折患者,非手术治疗与 1 年高死亡率相关,尤其是 CCI 高和 BI 低的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f445/10798693/2f6cca4256e5/medi-103-e36446-g001.jpg

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