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控制死亡率:影响老年股骨近端骨折患者半髋关节置换术预后的关键因素

Managing Mortality: Key Factors Influencing Hemiarthroplasty Outcomes in Geriatric Patients with Proximal Femur Fractures.

作者信息

Bayar Ercan, Cengiz Tolgahan, Aydın Şimşek Şafak, Albayrak Bedirhan, Büyükceran İsmail, Tomak Yılmaz

机构信息

Department of Orthopedics and Traumatology, Tosya State Hospital, Kastamonu 37300, Türkiye.

Department of Orthopedics and Traumatology, İnebolu State Hospital, Kastamonu 37500, Türkiye.

出版信息

Medicina (Kaunas). 2025 Mar 22;61(4):568. doi: 10.3390/medicina61040568.

Abstract

: Proximal femur fractures represent a significant health issue in the elderly, associated with high morbidity and mortality rates. This retrospective cohort study investigated factors influencing mortality (age, gender, infection, mobilization status, hospital stay length, surgical delay) in patients undergoing hemiarthroplasty for proximal femur fractures in a tertiary university hospital in Turkey. : A retrospective analysis was conducted on 481 patients who underwent hemiarthroplasty at 19 Mayıs University hospital in Turkey between 2012 and 2022, with final follow-up data collected in 2022. Data collected included demographic information, the type of surgical approach, the duration of surgery, comorbidities, postoperative complications, and mobilization status at 1 and 6 months post-surgery. Statistical analyses were performed using the Mann-Whitney U test for age and surgery delay; the Kruskal-Wallis test for comparisons of mortality subgroups; the Chi-square test for categorical variables such as gender, fracture type, anesthesia type, and postoperative complications; and the Z test for post hoc analysis of categorical data. : The overall mortality rate at final follow-up was 56.1% over the entire study period (2012-2022), with a 6-month mortality rate of 21.8% and a 1-year mortality rate of 33.2%. Age and male gender were significant predictors of mortality. Infection rates were significantly associated with higher mortality within the first year. The study found no significant relationship between surgical approach, duration of surgery, or anesthesia type and mortality. However, increased length of hospital stay and delayed surgery correlated with higher mortality rates. Mobilization status significantly impacted survival, with immobilized patients demonstrating the highest mortality rates. : Mortality following hemiarthroplasty for proximal femur fractures is influenced by various factors, including age, comorbidities, infection, and mobilization status. Implementing strategies for early surgery and mobilization while maintaining strict aseptic techniques could potentially reduce mortality rates in this high-risk population.

摘要

股骨近端骨折是老年人面临的一个重大健康问题,与高发病率和死亡率相关。这项回顾性队列研究调查了土耳其一所三级大学医院中接受股骨近端骨折半髋关节置换术患者的死亡影响因素(年龄、性别、感染、活动状态、住院时间、手术延迟)。

对2012年至2022年期间在土耳其19 Mayıs大学医院接受半髋关节置换术的481例患者进行了回顾性分析,并于2022年收集了最终随访数据。收集的数据包括人口统计学信息、手术入路类型、手术持续时间、合并症、术后并发症以及术后1个月和6个月时的活动状态。采用Mann-Whitney U检验分析年龄和手术延迟;采用Kruskal-Wallis检验比较死亡亚组;采用卡方检验分析性别、骨折类型、麻醉类型和术后并发症等分类变量;采用Z检验对分类数据进行事后分析。

在整个研究期间(2012 - 2022年),最终随访时的总死亡率为56.1%,6个月死亡率为21.8%,1年死亡率为33.2%。年龄和男性性别是死亡的重要预测因素。感染率与第一年较高的死亡率显著相关。研究发现手术入路、手术持续时间或麻醉类型与死亡率之间无显著关系。然而,住院时间延长和手术延迟与较高的死亡率相关。活动状态对生存率有显著影响,固定不动的患者死亡率最高。

股骨近端骨折半髋关节置换术后的死亡率受多种因素影响,包括年龄、合并症、感染和活动状态。在保持严格无菌技术的同时,实施早期手术和活动的策略可能会降低这一高危人群的死亡率。

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