Zhang Man-Yu, Song Wei, Wang Jing-Bo, Lv Rui-Qian, Zhao Fu-Hao, Yang Ding-Wei
Department of Nephrology, Tianjin Hospital of Tianjin University, Tianjin, China.
Department of Hip Traumatology, Tianjin Hospital of Tianjin University, Tianjin, China.
Front Surg. 2024 Dec 6;11:1471101. doi: 10.3389/fsurg.2024.1471101. eCollection 2024.
HSip Osteoporotic fractures are common complications with high mortality in patients undergoing maintenance hemodialysis (MHD). It remains unclear whether surgical or conservative should be adopted for hip fractures in MHD patients.
A retrospective analysis was conducted in Tianjin Hospital of Tianjin University from August 2019 to August 2023. A total of 43 MHD patients with hip fracture were included, with 30 cases in the surgical group and 13 cases in the conservative group. The differences in cumulative survival rates, time to first ambulation, Harris score, Barthel index, and incidence of complications were compared.
The surgical group had remarkable lower mortality rates as compared with the conservative group at 1, 2, 3, 6, 12, 24 months (13.33 VS. 38.46%, 26.67 VS. 53.85%, 26.67 VS. 53.85%, 26.67 VS. 61.54%, 26.67 VS. 61.54%, and 26.67 VS. 69.23%). In the surgical treatment group, the first ambulation time was reduced to 28 (26) days, which was superior to the conservative group (134.17 ± 43.18 days, < 0.001). The Harris score at 1 month (61.50 ± 4.10) and the Barthel index at 3 months (95, 11.25) were also significantly higher ( < 0.001). Furthermore, the surgical group had a significantly lower overall incidence of complications (60.00 vs. 92.31%, = 0.034). The risk of death and complications of surgical treatment was only 23.0 and 32.4% of conservative treatment in MHD patients with hip fracture.
Surgical treatment is effective and safe and should be the first choice for hip fracture in MHD patients.
髋部骨质疏松性骨折是维持性血液透析（MHD）患者常见的并发症，死亡率较高。对于MHD患者的髋部骨折应采用手术治疗还是保守治疗仍不明确。
对天津医科大学天津医院2019年8月至2023年8月期间进行回顾性分析。共纳入43例MHD髋部骨折患者，手术组30例，保守组13例。比较两组累积生存率、首次下地行走时间、Harris评分、Barthel指数及并发症发生率的差异。
手术组在1、2、3、6、12、24个月时的死亡率显著低于保守组（13.33%对38.46%，26.67%对53.85%，26.67%对53.85%，26.67%对61.54%，26.67%对61.54%，26.67%对69.23%）。手术治疗组首次下地行走时间缩短至28（26）天，优于保守组（134.17±43.18天，P<0.001）。1个月时的Harris评分（61.50±4.10）和3个月时的Barthel指数（95，11.25）也显著更高（P<0.001）。此外，手术组并发症总发生率显著更低（60.00%对92.31%，P=0.034）。MHD髋部骨折患者手术治疗的死亡和并发症风险仅为保守治疗的23.0%和32.4%。
手术治疗有效且安全，应作为MHD患者髋部骨折的首选治疗方法。
