改良POSSUM评分系统在预测老年人股骨粗隆间骨折手术风险中的应用价值

目的 探讨应用POSSUM评分系统预测老年人股骨粗降间骨折术后病死率及并发症发牛率的价值.方法 2007年1月至2008年12月回顾性分析119例老年股骨粗隆间骨折患者,按照适用于骨科的改良型POSSUM评分系统评估量表对每例患者进行生理学评分及手术严重度评分,将数据代人原始POSSUM回归公式计算出术后死亡概率及术后并发症发生概率,据此概率计算出预测死亡人数和发生并发症人数,并与观察到的实际死亡人数和发生并发症人数进行比较.结果 POSSUM评分系统预测术后30 d内42例(35.3%)发生并发症,实际发生并发症39例(32.8%),(χ2=0.168,P=0.682);预测术后30 d内死亡11例(9.2%),实际死亡5例(4.2%)(χ2=2.412,P=0.120).结论 改良POSSUM评分系统能较好的预测老年患者股骨粗隆间骨折术后30 d内的并发症发生率及病死率,对于高危患者(预测病死率>20%)的预测结果更加准确;其生理学评分量表可用于老年股骨粗隆间骨折患者的术前评估;肺部疾病是导致老年股骨粗隆间骨折患者术后死亡的首要因素.

The value of modified POSSUM scoring system in predicting mortality and morbidity for the intertrochanteric fracture in elder patients

Objective To evaluate the value of modified physiological and operative severity score for the enumeration of mortality and morbidity ( POSSUM) scoring system in predicting mortality and morbidity for the intertrochanteric fracture in elder patients. Methods A retrospective study was conducted over a period of nearly 2 years from January 2007 to December 2008. Complete data from 119 patients were analyzed to compare the mortality and morbidity predicted by the POSSUM and the observed mortality and morbidity. POSSUM risk was calculated using the original POSSUM equation. Results POSSUM predicted 11 (9.2% ) deaths,which had no statistical significance with the observed mortality 5(4.2% ) ( χ2 = 2.412, P = 0.120). The estimated incidence of postoperative complications was 42 (35.3% ) , which also has no statistical significance with the observed morbidity 39 (32.8% ) ( χ2 = 0.168, P = 0.682 ). Conclusions The modified POSSUM scoring system can predict accurately postoperative mortality and morbidity for the patients underwent intertrochanteric fracture and it predict more accurately in high risk band. The physiological score can be used to evaluate the physiological conditions preoperative and the pulmonary disease is the most important factor lead to death of the elder patients underwent intertrochanteric fracture.