Sugawara Yutaro, Ishizu Hotaka, Arita Kosuke, Oue Tetsuro, Sato Komei, Takahashi Renya, Kusunoki Kenichi, Shimodan Shun, Asano Tsuyoshi, Iwasaki Norimasa, Shimizu Tomohiro
Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
Department of Orthopaedic Surgery, KKR Sapporo Medical Center, Sapporo, Japan.
J Bone Miner Metab. 2025 May;43(3):237-248. doi: 10.1007/s00774-024-01576-6. Epub 2025 Jan 7.
Proximal femoral fractures are critically associated with increased risk of mortality and secondary fractures. Identifying prognosis predictors related to sagittal imbalance that are known to have negative impact on fracture risk and mortality is crucial. This study aimed to explore the relationship between various sagittal imbalance parameters and the prognosis of proximal femoral fractures to identify the most important prognostic indicators.
This multi-center prospective cohort study included patients with proximal femoral fractures treated surgically from April 2020 to March 2021. Spinal standing radiographs were obtained to measure various sagittal spine parameters. Postoperative follow-ups were conducted at 6, 12, 18, 24, and 36 months to assess mortality and secondary fracture rates and examine the predictors and their effects.
Among the 137 patients who underwent spinal standing radiographs, 22 died and 23 developed secondary fractures. Multivariate analyses identified the number of previous vertebral fractures and thoracolumbar kyphosis (TLK) as significant risk factors for mortality and secondary fractures. Survival analysis revealed that patients with TLK < 20° had significantly higher survival rates than those with TLK ≥ 20° (P = 0.002 and P < 0.001 for mortality and secondary fractures, respectively). In addition, serum albumin was associated with mortality, and the intake of sleeping pills and antidepressants was associated with secondary fractures.
TLK after surgery and the number of previous vertebral fractures affected both mortality and secondary fractures. When each risk factor, such as low serum albumin levels, intake of sleeping pills and antidepressants, was also considered, it was found that comprehensive postoperative care is essential.
股骨近端骨折与死亡率增加及二次骨折风险密切相关。识别与矢状面失衡相关的预后预测因素至关重要，因为已知矢状面失衡会对骨折风险和死亡率产生负面影响。本研究旨在探讨各种矢状面失衡参数与股骨近端骨折预后之间的关系，以确定最重要的预后指标。
这项多中心前瞻性队列研究纳入了2020年4月至2021年3月接受手术治疗的股骨近端骨折患者。获取脊柱站立位X线片以测量各种脊柱矢状面参数。在术后6、12、18、24和36个月进行随访，以评估死亡率和二次骨折发生率，并检查预测因素及其影响。
在137例行脊柱站立位X线片检查的患者中，22例死亡，23例发生二次骨折。多因素分析确定既往椎体骨折数量和胸腰段后凸（TLK）为死亡率和二次骨折的显著危险因素。生存分析显示，TLK＜20°的患者生存率显著高于TLK≥20°的患者（死亡率和二次骨折的P值分别为0.002和＜0.001）。此外，血清白蛋白与死亡率相关，服用安眠药和抗抑郁药与二次骨折相关。
术后TLK和既往椎体骨折数量影响死亡率和二次骨折。当同时考虑每个危险因素，如低血清白蛋白水平、服用安眠药和抗抑郁药时，发现全面的术后护理至关重要。
