人工关节置换术治疗高龄股骨转子间粉碎性骨折

目的探讨人工关节置换术治疗高龄股骨转子间骨折的方法及疗效。方法对38例高龄（≥75岁）股骨转子间粉碎性骨折患者用骨水泥型人工髋关节置换术治疗,术中尽量复位大小转子并张力带钢丝固定。结果手术时间58~98 min,出血量200~380 ml。无切口感染及肺栓塞发生,2例出现尿道感染。患者均获随访,时间12~48个月。骨折愈合时间为3~6（4.5±0.5）个月。术后12个月Harris评分为76~94（84±3）分。结论人工关节置换术治疗高龄股骨转子间骨折患者手术时间短、出血少、可早期下地行走、关节功能恢复快、近期效果满意,是高龄股骨转子间骨折患者的一种理想手术方式,但掌握手术适应证及操作要点是关键。     

长短髓内钉治疗老年股骨反转子间骨折的疗效比较

目的通过分析比较短髓内钉与长髓内钉治疗老年股骨反转子间骨折的效果，为反转子间骨折内植物的选择提供临床参考。 方法回顾性分析2012年12月至2016年11月在枣庄市山亭诚德骨科医院治疗的47例老年股骨反转子间骨折的患者，根据内固定物的绝对长度与相对比例以及远端锁定器械不同分为短髓内钉（240 mm）与长髓内钉（300 mm以上）两组，其中短髓内钉组26例（55.3%），长髓内钉组21例（44.7%），观察两组患者的手术时间、术中出血量、输血量、术后负重时间、骨折愈合时间、术后并发症发生情况、髋关节功能恢复情况，日常生活能力评分按照Harris标准对患者功能进行评分。 结果术后1年内有5例患者因意外及心血管疾病等其它的原因死亡，其中短髓内钉组3例，长髓内钉组2例，均与骨折无关，40例纳入研究的患者均完成了1年的随访，随访率（85.1%）。在手术时间、出血量、输血量方面，短髓内钉组患者手术时间为（33.5±1.0）min、出血量为（192±5）ml、输血量为（192±116）ml，明显少于长髓内钉组[（68.7±12.3）min、（313±37）ml、（370±122）ml]，差异具有统计学意义（t=0.018，t=0.004，t=0.001，P<0.05）。短髓内钉组患者的术后负重时间[（8.3±2.8）d]、术后1年Harris评分[（81±3）分]、骨折愈合时间[（14.5±2.1）w]方面与长髓内钉组[（8.4±2.2）d、（80±4）分、（14.8±2.7）w）]比较，差异无统计学意义；两组术后均未发生切口不愈合或者感染、骨折延迟愈合或不愈合、下肢深静脉血栓形成、髋内翻、内固定松动及内固定周围骨折等情况。 结论短髓内钉治疗老年股骨反转子间骨折的手术时间、出血量、输血量要优于长髓内钉，并不存在"中裤效应"，建议使用短髓内钉进行固定。     

30例80岁以上高龄股骨转子间骨折的治疗体会

目的观察30例闭合复位股骨近端防旋髓内钉(PFNA)治疗80岁以上高龄股骨转子间骨折的临床效果,总结围手术期处理及手术的经验体会。 方法回顾性分析2017年10月至2019年2月间大理大学第一附属医院关节外科收治的30例采用PFNA治疗的80岁以上高龄股骨转子间骨折患者资料,进行术后随访并采用Harris髋关节功能评分标准评估治疗效果。 结果30例患者全部获得随访,时间为(10±2)个月。30例患者骨折愈合,按Harris评分标准,优19例,良7例,可4例,差0例,优良率86.67%。 结论PFNA内固定治疗80岁以上高龄股骨转子间骨折的疗效确切,C臂透视下的微创手术,是高龄患者早期功能锻炼及早期下床的基础保障,提高高龄患者的生活质量及临床疗效,降低死亡率,是治疗老年股骨转子间骨折的有效方法。     

加速康复外科理念下多模式镇痛在老年股骨转子间骨折治疗中的应用

目的探讨加速康复外科理念下,围术期多模式镇痛在老年股骨转子间骨折治疗中的应用。 方法回顾性分析2016年6月至2017年6月南昌大学第一附属医院骨科采用PFNA手术治疗的45例老年（≥80岁）股骨转子间骨折患者,其中男性19例（42.2%）,女性26例（57.8%）,平均年龄为（81.3±1.0）岁。所有患者均在骨折后48 h内采取闭合复位PFNA内固定手术,并采取多模式镇痛方案进行干预,采用简式McGill疼痛问卷和Harris髋关节功能评分标准来观察患者疼痛缓解、髋关节功能恢复的情况。 结果所有患者均获得满意随访,随访率100%,随访时间为3~14个月,平均（9.0±2.0）个月。末次随访时,简式McGill疼痛问卷结果：无痛39例,轻度6例,中度0例,重度0例,无痛率约达86.67%;Harris髋关节功能评分结果：优25例,良13例,可7例,差0例,优良率约达84.44%。 结论围术期多模式镇痛应用于老年股骨转子间骨折患者的治疗中,有利于减少因骨折后疼痛带来的一系列负面影响,加快术后康复进程。     

闭合复位股骨近端防旋髓内钉微创治疗高龄股骨转子间骨折

目的探讨应用闭合复位股骨近端防旋髓内钉(PFNA)微创内固定治疗高龄股骨转子间骨折的临床疗效。方法采用牵引床牵引、闭合复位PFNA微创内固定术治疗63例高龄股骨转子间骨折患者。结果术前住院时间0.5~7 d;手术时间35~90 min;术中出血量30~150 ml。骨折愈合时间10~24周。患者均获得随访,时间6~22个月。无髋内翻畸形、螺旋刀片切割或退出、感染等并发症发生。末次随访根据髋关节Harris功能评分评定:优49例,良11例,可3例,优良率为95.2%。结论闭合复位PFNA微创内固定治疗高龄股骨转子间骨折具有术前住院时间短、创伤小、出血少、固定可靠、骨折愈合率高等优点。     

PFNA与DHS治疗高龄不稳定股骨转子间骨折的疗效比较

目的：比较股骨近端防旋髓内钉（proximal femoral nail anti-rotation，PFNA）与动力髋螺钉（dynamic hip screw，DHS）治疗高龄不稳定股骨转子间骨折的临床疗效。方法：2012年1月至2015年12月收治的83例高龄不稳定股骨转子间骨折患者分为采取PFNA治疗的45例与采取DHS治疗的38例。PFNA组中男24例，女21例；年龄82～94（88.35±6.12）岁；病程1.5～10（4.33±1.07） h；交通事故33例，高空坠落10例，跌倒伤2例；Evans-Jensen分型：ⅢA型21例，ⅢB型18例，Ⅳ型6例。DHS组中男20例，女18例；年龄83～95（88.77±5.52）岁；病程1～10（4.37±1.05） h；交通事故27例，高空坠落10例，跌倒伤1例；Evans-Jensen分型：ⅢA型18例，ⅢB型15例，Ⅳ型5例。观察比较两组手术时间、术中出血量、出院时并发症。利用健康调查简表（the Mos 36-item Short Form Health Survey，SF-36）测定术前及术后12个月生活质量。采用Harris评分评价术后12个月髋关节功能。结果：PFNA组手术时间、术中出血量、并发症发生率均明显低于DHS组（P<0.05）；两组患者均获得12个月随访，期间无脱落，两组术后12个月Harris评分、SF-36评分均高于术前（P<0.05），PFNA组均明显高于DHS组（P<0.05）；PFNA组优良率高于DHS组（P<0.05）。结论：与DHS相比，PFNA治疗高龄不稳定股骨转子间骨折操作更为简便、创伤更小、并发症更少、短期优良率与患者生活质量更高，可作为治疗高龄不稳定股骨转子间骨折的优选治疗方法。     

人工股骨头置换治疗高龄股骨转子间骨折

目的探讨人工股骨头置换治疗高龄股骨转子间骨折的可行性。方法 31例高龄不稳定性股骨转子间骨折患者采用双极人工股骨头置换,观察手术时间、出血量、Harris功能评分、并发症发生情况。结果手术时间60～105（75±12）min,术中出血300～700 ml。29例获随访（2例术后死亡）,时间6～28个月。患者均在术后1周逐步下地负重行走。按Harris评分标准：优19例,良7例,可3例。X线片示假体无松动、下沉。结论人工股骨头置换术治疗高龄不稳定性股骨转子间骨折合并骨质疏松患者具有卧床时间短、可早期下地负重、术后并发症低、早期髋关节功能恢复良好等优点,是一种有效的治疗方法。     

第四代髓内固定系统治疗高龄股骨转子间骨折疗效分析

目的探讨第四代髓内固定系统(InterTan)治疗高龄股骨转子间骨折的手术疗效。方法采用InterTan治疗26例高龄股骨转子间骨折患者。按照Harris评分对患者髋关节功能进行评价。结果手术时间40~75 min,术中失血量200~500 ml。术后并发症:肺栓塞1例(于术后第2天死亡),谵妄2例,肺部感染1例。25例获得随访,时间12~24个月。随访12个月时Harris评分:优18例,良5例,可2例,优良率为23/25。结论 InterTan治疗高龄股骨转子间骨折创伤小,时间短,出血少,并发症少,髋关节功能恢复良好。     

股骨近端防旋髓内钉治疗高龄股骨转子间骨折

目的探讨闭合复位股骨近端防旋髓内钉(PFNA)治疗高龄股骨转子间骨折的临床疗效。方法采用闭合复位PFNA内固定治疗31例高龄股骨转子间骨折患者。结果手术时间25~85 min,术中出血量70~160 ml。2例术后4周死于肺部严重感染,29例获得随访,时间7~23个月。患者骨折复位固定满意且均临床愈合。末次随访根据髋关节Harris功能评分评定:优8例,良14例,可7例。结论闭合复位PFNA内固定治疗高龄股骨转子间骨折具有创伤小、术中出血少、操作简单、手术时间短、固定可靠、早期功能锻炼的优点。     

不同方法治疗老年股骨转子间合并转子下骨折的比较

目的比较不同方法治疗老年股骨转子间合并转子下骨折的临床疗效，以期为该类型骨折的临床治疗提供参考。 方法回顾性分析2013年3月至2017年3月在河北医科大学第三医院及围场县医院治疗的51例老年股骨转子间合并转子下骨折的患者资料，其中男性21例（41.2%），女性30例（48.8%）；平均年龄（71±4）岁。分别采用了股骨近端锁定接骨板（PFLP，18例）、重建髓内钉（RIN，16例）及股骨近端防旋髓内钉（PFNA，17例）内固定治疗方法。比较三组患者在性别、年龄、骨折患侧、术前牵引天数、手术时间、手术出血量、全部切口长度、骨折愈合时间、手术并发症、术后髋关节功能评分等方面的差异。 结果51例患者获得满意随访，随访率100%。随访时间12~44个月。PFLP组平均手术时间为（155±27）min、全部切口长度为（20.8±2.6）cm、术中出血量为（274±36）ml、术后引流量为（87±20）ml；RIN组平均手术时间为（122±16）min、所有切口长度为（11.8±1.5）cm、术中出血量为（144±43）ml、隐性失血量为（428±16）ml、出血总量为（558±16）ml；PFNA组平均手术时间为（44.4±4.2）min、所有切口长度为（8.5±0.6）cm、术中出血量为（94±24）ml、隐性失血量为（408±36）ml、出血总量为（520±24）ml。在手术时间、切口长度、术中出血量等方面，PFNA组均低于PFLP组和RIN组，PFLP组的术后引流量明显高于PFNA组和RIN组（P<0.01）；PFNA组和RIN组的手术总出血量高于PFLP组（P<0.05）。PFLP组骨折愈合时间为（16.2±2.5）w，高于RIN组[（14.9±1.1）w]和PFNA组[（14.2±1.5）w]，差异有统计学意义（F=5.224，P<0.05）。PFLP组的术后第12个月Harris评分[（80±7）分]低于RIN组[（88±4）分]和PFNA组[（91±4）分]，差异有统计学意义（F=19.673，P<0.01）。 结论本研究中所采用的3种固定方式中，PFNA与PFLP及RIN相比，具有手术切口小、手术时间短、术中出血少、骨折愈合所需时间短、术后髋关节功能恢复好的优点，是治疗老年股骨转子间骨折合并转子下骨折的理想固定方式。     

老年股骨转子间骨折术后1年死亡率及危险因素分析

目的探讨老年股骨转子间骨折术后1年死亡率的影响因素。 方法回顾性研究南京医科大学第一附属医院骨科2015年01月至2017年01月采用股骨近端髓内钉治疗并获得随访的161例股骨转子间骨折患者（年龄≥60岁）资料,分析术后1年死亡率,通过病历总结分析年龄、性别、骨折类型、术前合并疾病及其数量、受伤至手术时间、术前血红蛋白浓度、白细胞数、白蛋白、血钾、尿素氮、丙氨酸氨基转移酶等资料,并进行单因素及多因素回归分析。 结果共收集资料完整患者161例,随访时间12~24个月,1年累计死亡20例,死亡率为12.4%。单因素分析显示：骨折分型、术前高血压、慢性阻塞性肺病和糖尿病、术前合并疾病的数量、术前白蛋白以及丙氨酸氨基转移酶在存活组与死亡组间差异有统计学意义（P<0.05）。多因素回归分析显示：术前慢性阻塞性肺病和糖尿病,以及术前白蛋白<35 g/L是影响死亡的独立危险因素（P<0.05）。 结论术前健康状况是影响老年股骨转子间骨折疗效的危险因素。改善术前健康情况,提高生活自理能力,防治术后并发症以降低老年股骨转子间骨折患者术后1年的死亡率,提高手术疗效。     

Surgical treatment of unstable intertrochanteric fractures by bipolar hip replacement or total hip replacement in elderly osteoporotic patients

A retrospective study was conducted to assess the complications, clinical and functional outcomes at 5 years of follow-up of a series of elderly osteoporotic patients with an unstable intertrochanteric fracture treated by bipolar or total hip replacement. Fifty-four patients with an A2 intertrochanteric osteoporotic fracture were identified between 1996 and 2000. The average age of the patients was 81 years (SD=5). The follow-up time was 5 years. Patients received a bipolar or total hip replacement. During follow-up, we analyzed postoperative complications, mortality rate, functional results using the Harris hip score, time to return to normal activities, and radiographic evidence of healing. One patient died intraoperatively; two patients died on the third and eighth postoperative days and seven patients died within 1 year. Twenty-five patients were living at the 5-year follow-up. Harris hip score at 1 month was 64±8 (mean±SD); at 3 months, 75±5; at 1 year, 76±5; and at 5 years, 76±9. Weight-bearing was permitted immediately after surgery, as tolerated. Time to return to normal daily activities was 27±5 days. No loosening or infection of the implants were observed. In elderly osteoporotic patients with an unstable intertrochanteric fracture, bipolar or total hip replacement in association with reduction of the greater trochanter is a valid alternative to the standard treatment of internal fixation. This surgical technique permits a more rapid recovery with immediate weight-bearing, and a maintenance of a good level of function, with little risk of mechanical failure.     

Functional outcome, mortality and in-hospital complications of operative treatment in elderly patients with hip fractures in the developing world

Hip fracture has been increasing in frequency for several decades, and 70–90% of patients who sustain a hip fracture survive for at least one year. Many of these survivors fail to regain their prefracture functional status. No work in this regard has been done in the developing world. Elderly patients with acute intertrochanteric fracture and fracture of the femoral neck were followed up prospectively for 12 months after surgery to record the mortality, morbidity, functional status and complications. Three hundred and forty-five patients (61% female) were assessed at six and 12 months after surgery, which included 62.9% intertrochanteric fractures and 37% femoral neck fractures. The mechanism of injury was from a fall in 67% of the cases. Nineteen patients died within six months after surgery while another eight died during the next six months. Obesity, male gender, multiple comorbidities and below normal ambulation status before fracture were identified as major determinants of bad functional outcome.     

肱骨近端骨折内固定术后影响肩关节功能的因素分析及生活质量的研究

目的探讨肱骨近端骨折术后影响肩关节功能恢复的相关因素及术后不同肩关节功能对患者健康相关生活质量的影响。 方法回顾性分析2017年1月至2019年1月西安交通大学附属红会医院采用内固定手术治疗的116例肱骨近端骨折患者的资料。男53例,女63例;侧别：右侧55例,左侧61例;年龄34~82岁,平均（60±13）岁。骨折Neer分型:一部分骨折12例,二部分骨折58例,三部分骨折29例,四部分骨折17例。术后12个月随访时采用Neer肩关节功能评分评估患者肩关节功能,并根据肩关节功能分为优良组和可差组,并对两组患者年龄、性别、骨折类型、骨密度、受伤至手术时间、肩袖损伤、侧别、人工骨植骨、术后开始功能康复锻炼时间和骨折复位质量等相关影响因素进行分析。通过健康调查简表（SF-12）、简明疼痛度量表（BPI）和EQ-5D视觉模拟量表（EQ-VAS）获取两组患者生活质量相关数据,比较评价肱骨近端骨折术后不同肩关节功能患者健康相关生活质量。 结果通过比较可能影响肩关节功能的相关风险因素得出骨折类型、骨密度、受伤至手术时间、肩袖损伤、术后开始功能康复锻炼的时间、复位质量在两组患者之间的差异具有统计学意义（P<0.05）;肩关节功能Neer评分优良率为75.9%（88/116）;肩关节功能优良组患者各项得分SF-12PCS（42.9±5.2）、SF-12MCS（47.5±6.0）、BPI-S（4.1±1.2）、BPI-I（3.6±1.1）、EQ-VAS（82.3±4.4）,可差组患者各项得分SF-12PCS（30.1±3.7）、SF-12MCS（33.1±3.5）、BPI-S（6.3±1.2）、BPI-I（6.2±1.3）、EQ-VAS（72.2±5.5）,并且两组患者在SF-12PCS、SF-12MCS、BPI-S、BPI-I、EQ-VAS方面统计差异均具有统计学意义（P<0.05）。 结论骨折类型、骨密度、受伤至手术时间、肩袖损伤、术后开始功能康复锻炼的时间、复位质量等影响术后肩关节功能的恢复并且肩关节功能差对患者的身心健康及生活质量也都产生了不同程度的消极影响。     

老年股骨转子间骨折手术时机对术后1年死亡率的影响

目的 :探讨手术时机对老年转子间骨折术后1年死亡率的影响,并分析影响患者术后1年内死亡的危险因素。方法:回顾性分析2012年12月至2014年12月接受手术治疗的老年转子间骨折350例患者的临床资料,根据患者骨折受伤到手术开始时间的不同节点(72 h、96 h)分为72 h组、72~96 h组及96 h组。比较不同手术时间节点分组的患者术后1年内死亡率,并采用Logistic回归分析,研究影响患者术后1年内死亡的危险因素。结果:不同手术时机(72 h、72~96 h、96 h)组别的患者术后1年内死亡率差异有统计学意义,死亡率分别为1.8%、8.1%、10.3%。72 h组的患者术后1年死亡率低于72~96 h组和96 h组(P0.05)。多因素回归分析,发现年龄、术前合并疾病及手术时机是影响患者术后1年死亡率的独立危险因素(P0.05,OR1)。结论:早期手术治疗能降低老年转子间骨折患者术后1年内死亡率,患者年龄越大、术前疾病越多及手术延迟越久则术后1年内死亡的风险越大。     

Analysis of factors among 30-day and 1-year mortality rates in patients with borderline stable-unstable intertrochanteric hip fracture

ObjectiveThis study aimed to evaluate the possible effects of surgical procedures on mortality and to identify the possible risk factors for mortality in the management of geriatric hip fractures.MethodsA total of 191 patients (105 women and 86 men; mean age 82.26±9.681 [60–108] years) with AO/OTA 31A2.2 intertrochanteric fractures and treated with sliding hip screw, proximal femoral nail, or hemiarthroplasty were included in this retrospective cohort study. The treatment type was decided by the responsible surgeon according to the patients’ pre-injury activity level, bone quality, and features of the fracture. Age, sex, type of fracture, type of surgery performed, American society of anesthesiology (ASA) grade, type of anesthesia, time to surgery, type of physical therapy, length of hospital stay, and number of comorbidities were documented. We evaluated the 30-day and 1-year mortality of patients treated with sliding hip screw (SHS), proximal femoral nail antirotation (PFN-A), or hemiarthroplasty and identified the possible risk factors for mortality.ResultsA total of 49 patients underwent SHS, 58 underwent PFN-A, and 84 underwent hemiarthroplasty. Of these, 2 patients with SHS, 2 with PFN-A, and 11 with hemiarthroplasty died within 30 days after surgery, whereas 7 patients with SHS, 15 with PFN-A, and 23 with hemiarthroplasty died 1 year after surgery. The 30-day and 1-year overall mortality rates were 7.9% and 23.6%, respectively. Both the 30-day and 1-year mortality risks were higher in patients undergoing hemiarthroplasty than in patients undergoing SHS (p=0.068 versus 0.058). The 30-day mortality was higher in patients receiving general anesthesia than in those receiving combined spinal and epidural anesthesia (p=0.009). The 1-year mortality risk was higher in patients with ASA grade 4 than in those with grade 1 and 2 (p=0.045). Advanced age (p=0.022) and male sex (p=0.007) were also found to be the risk factors for 1-year mortality.ConclusionWe demonstrated that higher ASA grade, male sex, general anesthesia, and hemiarthroplasty procedures are associated with higher mortality rates in elderly patients with hip fractures. Thus, we highly recommend orthopedic surgeons to consider all these factors in the management of intertrochanteric hip fractures in the geriatric population.Level of EvidenceLevel IV, Prognostic Study     

Basicervical versus intertrochanteric fractures: an analysis of radiographic and functional outcomes

This retrospective study compared the long-term stability and functional outcomes of basicervical versus intertrochanteric fractures, and evaluated the use of an additional derotational screw in the treatment of basicervical fractures. Sixty-six patients (28 with basicervical fractures and 38 treated for stable and unstable intertrochanteric fractures) were identified. All intertrochanteric fractures were treated with a sliding hip screw. Basicervical fractures were treated with a sliding hip screw with or without a derotational screw. Radiographically measured fracture collapse and tip-apex distance were measured at least 6 weeks after surgery; SF-36 score and Functional Recovery Score data was collected at least 1 year after surgery. The proportion of fractures with > 10% collapse was significantly greater in the basicervical group than the subset of stable intertrochanteric fractures (P = .009), but not than the subset of unstable intertrochanteric fractures. The mean SF-36 bodily pain section domain was greater (less pain) in the basicervical group than the unstable intertrochanteric group (P = .02). No other significant differences in SF-36 scores were noted between the basicervical and either intertrochanteric group. Basicervical fractures collapse more than stable intertrochanteric fractures, suggesting that they may have greater biomechanical instability. This instability, however, does not translate into clinically significant decreases in functional outcome. Using a derotational screw with a sliding hip screw does not affect fracture stability or clinical outcome.     

Chronic kidney disease patients with intertrochanteric fracture have a high mortality rate

AimsThe prognosis of patients with chronic kidney disease (CKD) and intertrochanteric fractures is unclear. This study was aimed to analyze the mortality and complication rates among CKD patients with intertrochanteric femoral fractures and the risk factors of one-year mortality after surgery.Patients and methodsThis retrospective cohort study included 49 patients diagnosed with grades III, IV, or V CKD who were surgically treated for an intertrochanteric fracture between January 2011 and February 2019 at a tertiary university hospital. Preoperative parameters, including age, gender, bone mineral density, follow-up period (mean: 8.6 months range: 1~82 months), underlying disease, American Society of Anesthesiologists classification, fracture classification, and grade of CKD were identified, and complications and mortality rates after surgery were examined. The patients were divided into two groups according to whether one-year mortality after surgery had occurred or not, and a logistic regression analysis was performed to analyze the risk factors of mortality.ResultsOf the 49 total patients, 16 died <1 year postoperatively. Pneumonia (n = 11) was the most common postoperative complication. Twenty-one patients died during the follow-up period. Significant differences in gender (p = 0.006) and grade of CKD (p = 0.022) distributions were found between the two groups, divided according to whether one-year mortality had occurred or not. In a univariate analysis, CKD grade and postoperative septic shock were highly associated with one-year mortality. In a multivariate analysis, septic shock, acute kidney injury, and CKD grade were identified as the risk factors of one-year mortality.ConclusionThe mortality and complication rates were high among the CKD patients with intertrochanteric fractures. Grades of CKD significantly correlated with one-year mortality after surgery; therefore, they and an important factor that must be considered when developing a strategy to improve the postoperative survival rate of patients with CKD.     

影响老年髋部骨折患者预后的多因素分析

目的：探讨老年髋部骨折患者术后并发症发生及死亡的危险因素。方法：回顾性分析2006年1月-2010年12月间手术治疗的265例65岁以上的老年髋部骨折患者资料,其中男110例（41．51％）,女155例（58．49％）,平均年龄76．43岁（65～95岁）,准确记录患者围手术期可能存在的危险因素包括：性别、年龄、骨折类型、术前内科合并症、手术时机、麻醉方法、手术方式和围手术期输血量,并随访患者术后1年内的生存情况,通过logistic回归分析确定导致老年髋部骨折患者术后1年内并发症发生及死亡的危险因素。结果：术前合并3种及以上内科系统疾病的患者与无术前合并症的患者相比,其术后并发症发生率明显升高,是无术前合并症患者的4．793倍,具有统计学差异（P=0．000,OR-4．793）。手术时机超过伤后72h（P=0．001,OR=3．836）或术前合并症≥3种时（P=0.011,OR=7．752）,会增加患者术后1年内死亡的风险,且均具有统计学差异。其余因素对患者的术后并发症及生存情况无明显影响。结论：在所纳入研究的众多高危因素中,仅术前的内科合并症与术后并发症之间存在因果关联,而术前合并症与手术时机均是导致老年患者术后死亡的危险因素。建议老年髋部骨折患者应尽早行手术治疗,以避免因长期卧床而加重内科系统合并症,从而减小相关术后并发症的发病率和死亡率,改善患者的预后情况。