Department of Emergency Surgery, Affiliated Hospital of Jining Medical University, No. 89, Guhuai Road, Jining City, 272029, Shandong Province, China.
Department of Orthopedic Trauma, Affiliated Hospital of Jining Medical University, No. 89, Guhuai Road, Jining City, 272029, Shandong Province, China.
J Orthop Surg Res. 2024 Oct 30;19(1):701. doi: 10.1186/s13018-024-05219-4.
To investigate the risk factors influencing 1-year mortality after intramedullary nail fixation for fragile intertrochanteric fracture in elderly individuals.
The medical records of 622 consecutive elderly patients (aged ≥ 65 years) with fragile intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA) and followed-up were retrospectively analyzed. The patients were divided into death and survival groups according to their survival status within 1 year after surgery, and the differences in age, sex, region of residence, tobacco use, alcohol use, body mass index (BMI), comorbidities (hypertension, diabetes mellitus, coronary heart disease, stroke, dementia, chronic obstructive pulmonary disease, pneumonia), preoperative hemoglobin, preoperative albumin, deep vein thrombosis, fracture type (AO classification), injury-to-surgery time, American Society of Anesthesiologists (ASA) score, anesthesia modality, duration of surgery, intraoperative blood loss, and blood transfusion were compared. The Kaplan-Meier method was used for univariate analysis to screen for statistically significant differences between the two groups, and the data were entered into the Cox proportional hazards model for multivariate analysis to determine independent risk factors affecting 1-year postoperative mortality. For subgroup analysis, we explored the varying effects of hypoproteinemia and being underweight in patients of different genders, as well as the effects of different age ranges, different injury-to-surgery times, and different blood transfusion volumes on 1-year postoperative mortality.
The mortality rates at 1, 3, and 6 months, and 1 year after surgery were 3.9%, 7.2%, 10.1%, and 15.3%, respectively. Univariate analysis showed that advanced age, male sex, tobacco use, underweight (BMI < 18.5), coronary heart disease, stroke, dementia, pneumonia, number of comorbidities ≥ 3, hypoproteinemia and injury-to-surgery time ≤ 2 days were associated with the 1-year postoperative survival status (P < 0.1). Multivariate analysis revealed that advanced age, male sex, dementia, number of comorbidities ≥ 3, hypoalbuminemia, and being underweight were independent risk factors for 1-year postoperative mortality. Subgroup analysis showed that being underweight was associated with 1-year postoperative mortality only in male patients but not in female patients, whereas hypoproteinemia was associated with 1-year postoperative mortality in both male and female patients. Furthermore, an injury-to-surgery time of less than 2 days improved patient survival, and patients more than 80 years old showed an elevated risk of postoperative mortality.
Preoperative health status is a critical predictor of postoperative outcomes in elderly patients with fragile intertrochanteric fractures. Priority care should be given to the patients who are elderly, male, have dementia, have comorbidities, or are malnourished. Prompt nutritional reinforcement should be provided to patients with intertrochanteric fractures with comorbid hypoproteinemia and underweight. Furthermore, surgery should be performed as early as possible in patients with fewer comorbidities.
探讨影响老年股骨近端防旋髓内钉（PFNA）固定治疗脆性股骨转子间骨折患者 1 年死亡率的危险因素。
回顾性分析 622 例年龄≥65 岁、采用 PFNA 治疗的脆性股骨转子间骨折患者的病历资料。根据术后 1 年内的生存状态，将患者分为死亡组和存活组，比较两组患者的年龄、性别、居住地区、吸烟、饮酒、体质量指数（BMI）、合并症（高血压、糖尿病、冠心病、脑卒中、痴呆、慢性阻塞性肺疾病、肺炎）、术前血红蛋白、术前白蛋白、深静脉血栓形成、骨折类型（AO 分类）、伤至手术时间、美国麻醉医师协会（ASA）评分、麻醉方式、手术时间、术中出血量和输血情况。采用 Kaplan-Meier 法进行单因素分析，筛选两组间有统计学差异的指标，将有统计学差异的指标纳入 Cox 比例风险回归模型进行多因素分析，确定影响 1 年术后死亡率的独立危险因素。对亚组分析，我们探讨了不同性别患者低蛋白血症和消瘦的不同影响，以及不同年龄范围、不同伤至手术时间和不同输血量对 1 年术后死亡率的影响。
术后 1、3、6 个月和 1 年的死亡率分别为 3.9%、7.2%、10.1%和 15.3%。单因素分析显示，高龄、男性、吸烟、消瘦（BMI<18.5）、冠心病、脑卒中、痴呆、肺炎、合并症≥3 项、低蛋白血症和伤至手术时间≤2 天与 1 年术后生存状态相关（P<0.1）。多因素分析显示，高龄、男性、痴呆、合并症≥3 项、低白蛋白血症和消瘦是 1 年术后死亡率的独立危险因素。亚组分析显示，消瘦仅与男性患者的 1 年术后死亡率相关，而与女性患者无关，而低蛋白血症与男性和女性患者的 1 年术后死亡率均相关。此外，伤至手术时间小于 2 天可改善患者的生存状况，80 岁以上的患者术后死亡率升高。
术前健康状况是影响老年脆性股骨转子间骨折患者术后结局的重要预测因素。应优先关注高龄、男性、痴呆、合并症或营养不良的患者。对于合并低蛋白血症和消瘦的转子间骨折患者，应及时给予营养支持。此外，对于合并症较少的患者，应尽早进行手术。
