老年患者不同部位的髋部骨折对预后的影响

目的:研究骨折部位对老年髋部骨折预后的影响。方法:自2012年1月至2014年12月,共收治髋部骨折患者667例,根据骨折部位将髋部骨折分为股骨转子间骨折组和股骨颈骨折组,其中股骨转子间骨折组304例,男96例,女208例,平均年龄(80.33±7.94)岁;股骨颈骨折组217例,男74例,女143例,平均年龄(79.82±9.33)岁。比较两组患者入院资料、术后死亡率及独立生活能力的差异。结果:两组年龄、性别、合并症、ASA分级、麻醉方式差异不明显,但入院至手术等待时间、手术时间、术中出血量、术后引流量以及输血量差异有统计学意义。股骨转子间骨折术前、术后1、3、5 d白细胞计数较高,血红蛋白、白蛋白较低。股骨转子间骨折住院期间、术后1、3、6、12个月内死亡率较股骨颈骨折高,但差异无统计学意义。在存活患者中,出院时、术后1、3个月股骨颈骨折患者日常生活能力较股骨转子间骨折患者恢复更为满意,术后6、12个月,两组患者相比,日常独立生活能力差异无统计学意义。结论:尽管股骨转子间骨折对机体应激较大,但排除年龄、性别、合并症等因素的影响后,股骨转子间骨折和股骨颈骨折术后1年内死亡率差异不明显。和股骨转子间骨折患者相比,股骨颈骨折关节置换后早期功能恢复良好,但手术后1年,两者功能恢复差异不明显。

Effect of hip fracture at different sites in elderly patients on prognosis

Objective:To determine the effect of site of fracture on the prognosis for patients of elderly hip fracture.Methods:From January 2012 to December 2014,667 patients with hip fractures were divided into femoral neck fracture group and intertrochanteric fracture group according to the site of fracture. There were 304 cases of intertrochanteric fracture,including 96 males and 208 females,with an average age of (80.33±7.94) years old. There were 217 cases of femoral neck fracture,including 74 males and 143 females,with an average age of (79.82±9.33) years old. Patients'' data,mortality and activities of daily living were compared between two groups.Results:There were no significant differences in age,gender,comorbidity,ASA classification,and anesthesia between two groups,but the time of admission to surgery,duration of operation,blood loss of intra-operative,volume of drainage,and the average of transfusion were shown to have significant differences. The levels of White blood cell count (WBC) for intertrochanteric fracture group were shown to be higher than that of femoral neck fracture patients at admission,1,3 and 5 days after operation. The levels of hemoglobin,and albumin for intertrochanteric fracture were lower than that of femoral neck fracture patients at all period of time. The mortality of intertrochanteric fracture group during hospitalization,1,3,6,and 12 months were higher than that of femoral neck fracture,but did not reach significant difference. In patients who survived,the scores of ADL for femoral neck fracture were higher than that of intertrochanteric fracture at discharge,1,3 months after operation,but there was no significant difference for ADL at 6 and 12 months between two groups.Conclusion:The response of stress for intertrochanteric fracture were more than femoral neck fracture,but the mortality was similar than that of femoral neck fracture after excluding the influence of age,sex,comorbidity,and other factors. Compared to intertrochanteric fracture,the femoral neck fracture patients had a better functional recovery during early stage,and the two groups reached a similar functional recovery at 1 year after operation.