An estimate of the worldwide prevalence,mortality and disability associated with hip fracture

The aim of this study was to quantify the global burden of osteoporosis as judged by hip fracture and the burden in different socio-economic regions of the world. The population mortality in 1990 and the incidence of hip fracture in different regions were identified, where possible in 1990. Excess mortality from hip fracture used data for Sweden, and disability weights were assigned to survivors from hip fracture. In 1990 there were an estimated 1.31 million new hip fractures, and the prevalence of hip fractures with disability was 4.48 million. There were 740,000 deaths estimated to be associated with hip fracture. There were 1.75 million disability adjusted life-years lost, representing 0.1% of the global burden of disease world-wide and 1.4% of the burden amongst women from the established market economies. We conclude that hip fracture is a significant cause of morbidity and mortality worldwide.     

Medium-term mortality after hip fractures and COVID-19: A prospective multi-centre UK study

PurposeThe COVID-19 pandemic has caused 1.4 million deaths globally and is associated with a 3–4 times increase in 30-day mortality after a fragility hip fracture with concurrent COVID-19 infection. Typically, death from COVID-19 infection occurs between 15 and 22 days after the onset of symptoms, but this period can extend up to 8 weeks. This study aimed to assess the impact of concurrent COVID-19 infection on 120-day mortality after a fragility hip fracture.MethodsA multi-centre prospective study across 10 hospitals treating 8% of the annual burden of hip fractures in England between 1st March and 30th April, 2020 was performed. Patients whose surgical treatment was payable through the National Health Service Best Practice Tariff mechanism for “fragility hip fractures” were included in the study. Patients’ 120-day mortality was assessed relative to their peri-operative COVID-19 status. Statistical analysis was performed using SPSS version 27.ResultsA total of 746 patients were included in this study, of which 87 (11.7%) were COVID-19 positive. Mortality rates at 30- and 120-day were significantly higher for COVID-19 positive patients relative to COVID-19 negative patients (p < 0.001). However, mortality rates between 31 and 120-day were not significantly different (p = 0.107), 16.1% and 9.4% respectively for COVID-19 positive and negative patients, odds ratio 1.855 (95% CI 0.865–3.978).ConclusionHip fracture patients with concurrent COVID-19 infection, provided that they are alive at day-31 after injury, have no significant difference in 120-day mortality. Despite the growing awareness and concern of “long-COVID” and its widespread prevalence, this does not appear to increase medium-term mortality rates after a hip fracture.     

Excess mortality following hip fracture: the role of underlying health status

Summary We evaluated the long-term excess mortality associated with hip fracture, using prospectively collected data on pre-fracture health and function from a nationally representative sample of U.S. elders. Although mortality was elevated for the first six months following hip fracture, we found no evidence of long-term excess mortality. Introduction The long-term excess mortality associated with hip fracture remains controversial. Methods To assess the association between hip fracture and mortality, we used prospectively collected data on pre-fracture health and function from a representative sample of U.S. elders in the Medicare Current Beneficiary Survey (MCBS) to perform survival analyses with time-varying covariates. Results Among 25,178 MCBS participants followed for a median duration of 3.8 years, 730 sustained a hip fracture during follow-up. Both early (within 6 months) and subsequent mortality showed significant elevations in models adjusted only for age, sex and race. With additional adjustment for pre-fracture health status, functional impairments, comorbid conditions and socioeconomic status, however, increased mortality was limited to the first six months after fracture (hazard ratio [HR]: 6.28, 95% CI: 4.82, 8.19). No increased mortality was evident during subsequent follow-up (HR: 1.04, 95% CI: 0.88, 1.23). Hip-fracture-attributable population mortality ranged from 0.5% at age 65 among men to 6% at age 85 among women. Conclusions Hip fracture was associated with substantially increased mortality, but much of the short-term risk and all of the long-term risk was explained by the greater frailty of those experiencing hip fracture.     

First-year mortality and long-term results of hemiarthroplasty for hip fractures in the elderly

Hip fractures are injuries that affect not only the joint in an elderly person, but also the patient's survival. The aim of this study was to asses hemiathroplasty as a treatment for these lesions and their complications; mortality within the first year after fracture was assessed and functional results were compared with the previous conditions. Between 1 January 1995 and 31 May 2001, we treated 29 patients who suffered hip fracture (2 bilateral). The average age was 80.7 years. The mean follow-up was 23 months. We obtained information by a telephone interview. We compared independence in daily activities before and after fracture. Moreover we examined the social surroundings in which the patients lived, before and after the fracture. Of the 24 patients available for follow-up, 4 (16.7%) had clinical and surgical complications. Mortality within the first year after fracture was 24.1% (7 patients). With respect to functional results, 47.4% of patients reached a score between 26 and 54 points (fair) in postoperative time. Furthermore, the percentage of patients who needed to live in geriatric institutions after the fracture increased from 15.8% to 42.1%. We consider hemiarthroplasty to be a treatment which has a lot of advantages, since it allows the immediate return to daily activities and avoids bedrest complications. However we believe that medical society has to advance more in prevention and care of this group of patients due to the high mortality within the first year after fracture, which causes them to lose independence in daily life and to become dependant on third-party assistance. Received: 15 February 2002, Accepted: 10 May 2002 Correspondence to: J. Boretto     

Survival and functional outcome according to hip fracture type: a one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture

We conducted a prospective study among elderly women with a first hip fracture to document survival and functional outcome and to determine whether outcomes differ by fracture type.

The design was a one-year prospective cohort study in the context of standard day-to-day clinical practice. The main outcome measures were survival and functional outcome, both at hospital discharge and 1 year later. Functional outcome was assessed using the Rapid Disability Rating Scale version-2.

Of the 170 women originally enrolled, 86 (51%) had an intertrochanteric and 84 (49%) a femoral neck fracture. There were no significant differences between the two groups with respect to median age (80 and 78 years, respectively), type and number of comorbidities and prefracture residence at the time of injury. At hospital discharge, intertrochanteric hip fracture patients had a higher mortality (p = 0.006) and were functionally more impaired (p = 0.005). One year later, mortality was still significantly higher after intertrochanteric fracture (relative risk 2.5; 95% confidence interval: 1.3 to 5.1; p = 0.008), but functional outcome among surviving patients was similar in both groups.

We conclude that intertrochanteric fractures are associated with increased mortality compared to femoral neck fractures. Functional outcome differs according to fracture type at hospital discharge, but these differences do not persist over time. These differences cannot be explained by differences in age or comorbidity. To address the mechanism(s) by which intertrochanteric fractures carry excess mortality compared to femoral neck fractures, future studies in hip fracture patients should include a comprehensive assessment of the degree of frailty, vitamin D status, and fall dynamics.     

肌少症对老年患者髋部骨折术后远近期死亡率的影响

目的探讨肌少症对老年患者髋部骨折术后近期及远期死亡率的影响。 方法2014年2月至2017年2月,共93例符合纳入及排除标准的老年髋部骨折患者纳入本研究。利用胸部CT测量T₁₂椎体（T₁₂）椎弓根水平肌肉组织的横截面积。以T₁₂椎弓根水平肌肉横截面积除以患者身高平方计算得到骨骼肌指数（SMI）。采用T₁₂水平SMI截断值：42.6 cm²/m²（男性）和30.6 cm²/m²（女性）,将患者分为肌少症组及非肌少症组,随访两组患者术后生存时间。采用Kaplan Meier分析两组患者的生存曲线,使用卡方检验对比两组在术后6个月和12个月的生存率差异。采用Cox比例风险模型分析肌少症、骨折类型（手术类型）、年龄、性别及ASA等级等多变量因素对髋部骨折术后死亡率的影响。 结果肌少症组患者共45例,非肌少症组患者共48例。肌少症组4例患者在术后6个月内死亡,死亡率为9.8%,非肌少症组3例患者在术后6个月内死亡,死亡率为8.3%,组间术后6个月死亡率差异无统计学意义（χ²=0.008,P=0.929）。肌少症组19例患者在术后24个月内死亡,死亡率为42.2%,非肌少症组10例患者在术后24个月内死亡,死亡率为18.8%,组间术后24个月死亡率差异具有统计学意义（χ²=6.081,P=0.014）。Cox比例风险模型分析结果为：患有肌少症及患者年龄和术后24个月死亡率显著相关（HR=2.015,95% CI：2.690,20.904,P=0.000;HR=0.062,95% CI：1.004,1.128,P=0.036）,患有肌少症及年龄较大的患者,术后24个月死亡率越高,而骨折类型（手术类型）、性别及ASA等级对术后24个月死亡率无明显影响。 结论肌少症会增加髋部骨折患者术后远期（24个月）的死亡风险,对近期（6个月）患者死亡率无明显影响。     

脆性髋部骨折的近期死亡率及相关危险因素研究

 目的观察脆性髋部骨折患者3个月、1年及随访期总的死亡率并分析与死亡率相关的危险因素。方法 回顾性分析2010年1月至2012年12月治疗且获得随访的286例年龄超过50岁的脆性髋部骨折患者资料,男100例,女 186例;年龄50～97岁,平均（77.09±10.65）岁。统计患者3个月、1年、随访期总的死亡率,并分析与死亡率相关的危险因素,包括年龄、性别、是否手术、受伤到手术时间、住院期间是否出现肺部感染、伤前合并内科疾病数量及种类。结果286例患者随访时间为6～42个月,平均（21.42±9.88）个月,3个月累计死亡率为7.69%（22/286）;随访超过1年的患者有231例,1年累计死亡率为16.02%（37/231）;随访期累计总的死亡率为17.48%（50/286）。单因素分析结果显示,与死亡率相关的危险因素包括年龄、性别、是否手术、受伤到手术时间、伤前合并内科疾病数量、住院期间肺部感染、伤前合并心血管疾病及呼吸系统疾病。多因素Logistic回归分析显示年龄（OR=5.385,P=0.003）、是否手术（OR=21.217,P=0.000）、伤前合并内科疾病数量（OR=9.038,P=0.000）、伤前合并心血管疾病（OR=3.201,P=0.041）是影响脆性髋部骨折患者近期死亡率的独立危险因素。结论脆性髋部骨折患者近期死亡率高,3个月时为7.69%,1年时为16.02%;多种因素与死亡率相关,其中年龄、是否手术、伤前合并内科疾病数量、伤前合并心血管疾病是影响脆性髋部骨折患者近期死亡率的独立危险因素。伤后积极处理内科合并症,条件允许下尽早手术,可降低患者近期死亡率。     

Pre-operative factors associated with increased mortality in elderly patients with a hip fracture: A cohort study in a developing country

BackgroundHip fractures are a public health problem worldwide, and several factors are involved with post-operative mortality. The aim of this study was to identify the pre-operative factors associated with increased mortality in elderly patients with hip fractures in a developing country during the first post-operative year.MethodsAn ambidirectional cohort study was conducted with patients ≥ 65 years of age who underwent hip surgery due to a hip fracture caused by a fall from a standing position. Socio-demographic data, time to surgery, and comorbidities measured by the Charlson Comorbidity Index (CCI) were recorded. One-year mortality from all causes was the primary outcome, and 30-day and 6-month mortality were the secondary outcomes. Log-rank test was used to evaluate survival, and Cox’s proportional hazard regression was used to detect the factors associated with increased mortality.Results478 patients who underwent hip surgery were included in this study. The mean age was 80.2 ± 9.9, and 297 (62%) were females. There were 150 (31.4%) deaths at the end of the first follow-up year, and the mean of surgical delay was 8.8 days ± 6.4. Patients who underwent surgery during the first 4 days (Log-rank test < 0.001) after hip fracture occurred and patients with a CCI ≤ 2 (Log-rank test < 0.001) showed better survival (90%), comparing to mortality (52%) of patients with a CCI ≥ 3 and surgical delay > 4 days. The age ≥ 80 years (Hazard ratio 2.55 (HR), 95% confidence interval (CI) 1.70 to 3.84, p < 0.001), CCI ≥ 3 (HR 1.61, 95% CI 1.14–2.26, p 0.006), surgical delay > 4 days (HR 2.41, 95% CI 1.38–4.21, p 0.006), and haemoglobin < 10 g/dl (HR 1.51, 95% CI 1.06–2.15, p 0.02) were associated with increased 1-year mortality. In addition, 30-day mortality was associated with age ≥ 80 years (HR 4.15, 95% CI 1.98–8.70, p < 0.001), CCI ≥ 3 (HR 1.80, 95% CI 1.08–2.99, p 0.023), pre-surgical time >48 h (HR 3.0, 95% CI 1.58–5.92, p 0.001), and surgical delay > 4 days (HR 3.0, 95% CI 1.33–6.81, p 0.008); and 6-month mortality was associated with surgical delay > 4 days (HR 2.72, 95% CI 1.42–5.23, p 0.003), and haemoglobin < 10 g/dl (HR 1.56, 95% CI 1.04–2.33, p < 0.028).ConclusionsSurgical delay greater than 4 days and Charlson Comorbidity Index ≥ 3 were found as factors associated with increased mortality, along with anaemia < 10 g/dl and age ≥ 80 years. A similar mortality rate was found in this study compared to the rates reported by the literature, despite a surgical delay of 8.8 days.     

Functional outcome and survival after hip fracture in elderly: a prospective study of 106 consecutive patients

Abstract Hip fracture is one of the most common, costly, and devastating injuries suffered by elderly. We prospectively analysed the recovery of hip fracture patients in an area of 92 500 inhabitants comprising six municipalities (A-F). Ambulation, functional capacity and survival of 106 consecutive hip fracture patients whose mean age was 79 years (SD=10) were followed for one year. Functional capacity was measured at two weeks, four months and twelve months postoperatively. Locomotor ability was evaluated pre- and postoperatively. Life table method was used in survival analysis. There was a significant decrease in the mean functional capacity of the patients at twelve months compared to the situation prior to the fracture (p=0.001). Prior to the fracture, 59% of the patients were moving without any assistive devices, but one year after fracture only 19% were able to do this. Similarly, not one of the patients was confined to bed before the fracture, but 11% of those who were alive after one year had become bed-ridden (p<0.001). Overall mortality rate was 32%. Age <80 years (OR=7.3; 95% CI, 2.3–23.1), residence in municipalities A and B (OR=4.2; 95% CI, 1.4–12.4 ) and ASA classes 1–3 (OR=5.2; 95% CI, 1.8–15.4) were positive factors for one-year survival. Patients from municipalities A and B (49% of all patients) whose post-acute care was given in the same rehabilitation department of one hospital recovered best. The locomotor ability of the patients decreased significantly in the first postoperative year. It seems that the centralisation of post-acute rehabilitation improves the functional outcome of these patients.     

Predictors of functional outcome following intracapsular hip fracture in elderly women. A one-year prospective cohort study

OBJECTIVES: To explore potential predictors of functional outcome one year after the injury in elderly women who sustained a displaced intracapsular hip fracture and who were treated with internal fixation, hemiarthroplasty, or total hip arthroplasty. PARTICIPANTS AND METHODS: Eighty-four women aged > or =50 years were enrolled on a consecutive basis in this one-year prospective cohort study reflecting standard day-to-day clinical practice. The main outcome measure was the rapid disability rating scale version-2 (RDRS-2) applied at hospital discharge and one year later. RESULTS: At hospital discharge, the total hip arthroplasty group was younger and had a better functional status than the internal fixation or hemiarthroplasty groups. One year later, the best function was still observed in the total arthroplasty group, but the differences were small and failed to achieve the level of statistical significance. During that one-year period, walking ability or mobility did not change significantly after total hip arthroplasty, but a significant proportion of the women developed cognitive impairment, including mental confusion, uncooperativeness, and depression. Overall, the most significant predictors of poor functional status one year after fracture were increasing age, living in an institution at time of injury, and poor functional status at discharge. CONCLUSIONS: In elderly women with a displaced intracapsular hip fracture, total hip arthroplasty is associated with a functional benefit within the first months after surgery. However, the extent to which this functional benefit is maintained over time, is less clear. These results support the need for randomised studies to quantify the extent to which, in elderly women, the early functional benefit of total hip arthroplasty is maintained in the long run or compromised by progressive cognitive impairment and other negative determinants of functional outcome.     

Postoperative mortality and morbidity in octogenarians and nonagenarians with hip fracture: an analysis of perioperative risk factors

Objective:To evaluate the role of high risk factors in octogenarians and nonagenarians with hip trauma,which may lead to excessive mortality and morbidity postoperatively.Methods:Fifty-four octogenarians and nonagenarians patients were enrolled in the study,receiving surgical repair of hip fracture in our hospital from January 2006 to January 2010.High risk factors were recorded preoperatively in detail.Complications and survival state were followed up by telephone for 2 years postoperatively.All the data were analyzed by Chi-square test with SPSS 13.0.Results:Twenty-six males (48.1％),aged from 80 to 94years with a mean age of 84.2 years,and twenty-eight females (51.9％),aged from 80 to 95 years with a mean age of 83.4 years,were presented in the cohort study.The hip traumas were caused by daily slight injuries (52 cases) and car accidents (2 cases),respectively.Twenty-eight patients (51.9％) with femoral neck fracture while 26 patients (48.1％)with intertrochanteric fracture were diagnosed through an anterior-posterior pelvic radiophotograph.In this series,39patients (72.2％) suffered from one or more comorbidities preoperatively.The morbidity was 48.1％ and the major cause was urinary tract infection,while a significant difference was noted between females and males.The mortality was 20.4％ with a predominant cause of acute renal failure.Conclusions:The gender should be considered as a critical high risk factor in octogenarians and nonagenarians with hip trauma postoperatively.Females are more likely to suffer complications postoperatively,which is especially obvious in senile patients over 80 years (P＜0.05).Urinary tract infection is the most frequent complication after hip surgery,followed by low limb embolism and malnutrition.The mortality is dramatically greater in patients over 80 years old than those below,and major causes are acute renal failure,multiple organ dysfunction syndrome and mental deterioration.Multidisciplinary consultations and mental assessment are encouraged in patients over 80 years old after hip trauma and surgery.Hip fractures in octogenarians and nonagenarians deserve special attention because of their advanced age and comorbidities.     

老年髋部骨折患者术后2年内再发对侧髋部骨折的危险因素研究

目的:探讨老年髋部骨折患者术后2年内再发对侧髋部骨折的相关危险因素。方法:回顾性分析2015年5月至2018年4月期间北京积水潭医院创伤骨科采用手术治疗的1 962例老年髋部骨折患者资料。男573例,女1 389例;首次骨折时的年龄中位数为81（75,86）岁。根据术后2年内是否发生对侧髋部骨折分为两组：对侧髋部骨折组...     

老年股骨转子间骨折术后一年死亡率及其危险因素分析

目的 总结老年股骨转子间骨折患者术后1年的死亡率,并探讨与死亡相关的危险因素.方法 回顾性分析2005年8月至2011年8月杭州地区6家医院经手术治疗且获得随访的1854例老年股骨转子间骨折患者资料,男705例,女1149例;年龄65 ～98岁,平均79.4岁.统计患者术后1年内的死亡率及主要死亡原因,并应用logistic回归模型分析与术后1年死亡相关的危险因素. 结果 术后1年内共有297例患者死亡,死亡率为16.0％ (297/1854).主要死亡原因包括感染93例,心脏疾患38例,神经系统疾患53例,肿瘤63例.Logistic回归分析结果显示:患者年龄[OR=5.053,95％CI(1.517,16.829),P=0.000]、性别[OR=0.376,95％ CI (0.122,1.161),P=0.002]、术前内科合并症[OR =3.236,95％CI (1.553,6.746),P=0.001]、美国麻醉医师协会(ASA)分级[OR=6.057,95％CI (1.968,18.641),P=0.000]、受伤至手术时间[OR=1.928,95％CI(0.979,3.796),P=0.009]和住院时间[OR=3.875,95％CI(0.368,6.542),P=0.001]是术后1年死亡的独立危险因素. 结论 年龄、性别、术前内科合并症、ASA分级、受伤至手术时间及住院时间为老年股骨转子间骨折患者术后1年死亡的独立危险因素.     

老年髋部骨折的手术时机选择与预后分析

目的探讨手术时机选择对老年髋部骨折预后的影响。方法回顾性分析2012年1月至2015年12月期间解放军总医院第七医学中心骨科收治的814例老年髋部骨折患者资料。男272例,女542例;年龄为60~99岁,平均79.9岁;根据美国麻醉师协会(ASA)分级将患者分为全身状态好(ASA分级Ⅰ、Ⅱ级,403例)和全身状态较差(ASA分级Ⅲ、Ⅳ级,411例)两类,每类患者根据是否在入院后48 h内手术再分为2组:早期手术组和晚期手术组。分别比较早期手术组与晚期手术组患者的住院时间、并发症发生率、术后30 d和1年死亡率、术后1年日常生活活动(ADL)评分等。结果在全身状态好的患者中,两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。早期手术组患者术后30 d死亡率[0%(0/94)]、术后1年死亡率[5.3%(5/94)]显著低于晚期手术组患者[4.2%(13/309)、14.2%(44/309)],住院时间[(9.6±5.2)d]显著短于晚期手术组患者[(12.3±5.9)d]、术后1年ADL评分[75(70,85)分]显著高于晚期手术组患者[70(60,80)分],差异均有统计学意义(P<0.05)。两组患者的并发症发生率比较差异无统计学意义(P>0.05)。在全身状态较差的患者中,两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。早期手术组患者住院期间并发症发生率[42.2%(35/83)]显著高于晚期手术组患者[30.5%(100/328)],差异有统计学意义(P<0.05)。而两组患者术后30 d和1年死亡率、住院时间及术后1年ADL评分比较差异均无统计学意义(P>0.05)。结论对于老年髋部骨折,若患者身体状态好,可尽快实施手术;若患者一般状况差,不能一味强调早期手术,需评估身体状态后再选择合适的手术时机。     

卒中后偏瘫的老年髋部骨折患者术后一年内死亡相关因素分析

目的 探讨卒中后偏瘫的老年髋部骨折患者的一般特征及术后1年内死亡的相关影响因素.方法 回顾性分析2000年1月至2007年5月手术治疗的老年髓部骨折患者资料.比较偏瘫组与非偏瘫组患者的一般特点,分析偏瘫组患者1年内死亡的相关影响因素.分析的变量包括:年龄、性别、美国麻醉医师协会(ASA)分级、术前合并疾病数量及种类、骨折类型、骨折前活动能力、认知能力、住院时间、受伤至手术时间、麻醉方式及手术方式等.结果 共有1379例患者符合纳入标准,平均年龄为(76.4±7 0)岁(65 ～99岁);其中101例患者髋部骨折前患有卒中后偏瘫.偏瘫组与非偏瘫组患者的ASA分级、术前合并疾病数量、骨折前活动能力、认知能力、住院时间及术后1年存活情况差异均有统计学意义(P＜0.05).偏瘫组患者术后1年髓访,25例患者死亡,病死率为24.8％.多因素Logistic回归分析结果显示:性别(P=0.017)、ASA分级(P=0.009)、术前合并疾病数量(P=0.048)、骨折前活动能力(P=0.000)及慢性呼吸系统疾病(P=0.022)是偏瘫患者术后1年死亡的危险因素. 结论 偏瘫组患者较非偏瘫组患者住院时间长,死亡率高.男性患者、ASA分级为Ⅲ或Ⅳ级、术前合并疾病≥3种、慢性呼吸系统疾病及弱的骨折前活动能力是影响卒中后偏瘫的老年髋部骨折患者术后1年内死亡的危险因素.     

髋部骨折患者中股骨颈强度的测定

目的：了解老年髋部骨折和老年骨质疏松的关系。方法：选择1998年至2003年收治的50岁以上老年髋部骨折80例,测定其健侧股骨上端强度（Singh指数）,同时选择门诊50岁以上其他原因摄骨盆X线片而无骨盆和股骨上端骨折的患者90例,测定其左侧股骨上端强度,将测得的数值作对比分析。结果：50～60岁组和61～70岁组股骨上端强度与对照组比较差异有统计学意义（P〈0.01）,而70岁以上组的强度与对照组比较差异无统计学意义（P〉0.05）。结论：老年髋部骨折患者其股骨上端强度明显下降,测定Singh指数对预测髋部骨折有重要意义。     

入院血尿素及肌酐水平对老年髋部骨折患者病死率的影响

目的:观察老年髋部骨折患者的入院血尿素及肌酐水平对病死率的影响。方法:自2013年1月至2014年12月,收住入院治疗的767例老年髋部骨折患者,男253例,女514例,年龄65~96岁,平均年龄(75.67±6.81)岁。根据入院血尿素、肌酐水平分为4组,A组:尿素≥5 mmol/L、肌酐≥70μmol/L;B组:尿素≥5 mmol/L、肌酐70μmol/L;C组:尿素5 mmol/L、肌酐≥70μmol/L;D组:尿素5 mmol/L、肌酐70μmol/L。其中A组:患者211例,男70例,女141例,年龄65~95(80.24±6.51)岁;B组:患者355例,男125例,女230例,年龄65~93(78.46±7.09)岁;C组:患者36例,男11例,女25例,年龄65~95(77.83±6.78)岁;D组:患者165例,男47例,女118例。年龄65~96(76.71±8.35)岁。随访获得四组患者的存活情况,并统计患者在住院期间、术后3、12、18个月病死率,对所获资料进行COX回归分析,并分析入院血尿素及肌酐水平对老年髋部骨折患者病死率的影响。结果:767例患者获随访18~24(21.33±1.25)个月。随访期间159例患者死亡。入院血尿素、肌酐水平均高者(尿素≥5 mmol/L、肌酐≥70μmol/L)的院内病死率为2.37%,3、12、18个月病死率分别为9.95%、16.11%及26.07%,均高于其他组(P0.05)。COX回归分析示年龄[P=0.000,OR=1.378,95%CI(1.172,1.621)],入院血尿素水平[P=0.000,OR=1.375,95%CI(1.155,1.637)]及血肌酐水平[P=0.037,OR=1.213,95%CI(1.121,1.484)]是患者18个月死亡的独立预测因素。结论:老年髋部骨折患者入院血尿素及肌酐水平高预示着较高的病死率,年龄、入院时血尿素及肌酐水平是老年髋部骨折的独立预测因素。     

老年髋部骨折患者术后1年死亡率与术前血清指标及术后营养指导的相关性分析

目的:分析老年髋部骨折患者术前血清营养学指标及术后营养指导对术后1年死亡率的影响.方法:将2015年1月至2017年12月行手术治疗的396例老年髋部骨折患者纳入研究,其中女267例,男129例,年龄68-80(75.48±2.62)岁;病程2～10(6.12±1.35)d;所有患者术后进行为期1年随访,根据患者是否死...     

老年患者髋部骨折术后1年病死率及危险因素分析:一项回顾性队列研究

目的 调查老年髋部骨折患者术后1年病死率,并分析其危险因素. 方法 研究为回顾性队列研究,收集2011年～2014年因髋部骨折行手术治疗的老年(年龄≥65岁)患者信息,随访术后1年存活情况,采用Logistic回归分析筛选术后死亡的危险因素. 结果 共295名老年髋部骨折患者纳入本研究,平均年龄(78.4±6.7)岁,女性占71.5％,术前有3种以上合并症的占38％,平均随访(31.2±0.7)个月.住院期间、术后30 d、术后1年以及随访结束时病死率分别为0.7％、1.7％、3.7％和5.8％. 结论 高龄、术前合并呼吸系统疾病、既往有脑卒中病史及采用内固定手术是老年髋部骨折患者术后1年死亡的危险因素.