老年髋部骨折术后对侧髋部再骨折的危险因素分析

目的 :探讨老年髋部发生二次骨折的相关风险因素,为预防对侧髋部再骨折提供临床依据。方法 :回顾性分析2008年12月至2014年2月378例老年髋部初次骨折患者的资料,男175例,女203例;年龄60~90岁,平均(75.53±8.04)岁;股骨颈骨折125例,股骨粗隆间骨折253例。术后随访12~36个月,平均24.9个月,32例患者发生对侧髋部再骨折,男13例,女19例;年龄72~95岁,平均(81.25±5.94)岁;股骨颈骨折7例,股骨粗隆间骨折25例。根据患者术后有无对侧髋部再骨折分为骨折组和无骨折组,比较两组患者的年龄、性别、初次骨折类型、内固定方式、卧床时间、骨质疏松情况、合并内科疾病情况、术后功能锻炼、治疗的依从性、生活环境(农村/城市)和末次随访时Harris评分,对于P0.05的因素进行多因素Logistic回归性分析。结果:骨折组与无骨折组的年龄、骨质疏松情况、合并内科疾病情况、术后功能锻炼、医疗依从性及末次随访时Harris评分比较差异均有统计学意义(P0.05)。多因素Logistic分析结果显示:骨质疏松(OR=6.793,P=0.001),高龄(OR=4.170,P=0.002),合并内科疾病(OR=3.828,P=0.005),术后功能锻炼(OR=0.297,P=0.005)以及医疗依从性(OR=0.295,P=0.007)是老年髋部骨折术后对侧髋部再骨折的主要危险因素。结论:老年髋部骨折术后对侧再骨折主要危险因素是高龄、骨质疏松、合并内科疾病、术后功能锻炼和医疗依从性。术后需加强抗骨质疏松治疗、积极治疗内科疾病,坚持功能锻炼,以预防髋部再次骨折的发生。

Analysis of the risk factors of the contra-lateral hip re-fractures after operation of hip fractures in elderly patients

Objective:To analyze the related risk factors of the second hip fractures in elderly patients,in order to provide clinical basis for the prevention of contra lateral hip re-fractures. Methods:A retrospective study was conducted of the 378 elderly patients with hip fractures who had been treated from December 2008 to February 2014. There were 175 males and 203 females with an average age of (75.53±8.04) years old ranging from 72 to 90,involving 125 cases of femur neck fractures and 253 cases of femoral intertrochanteric fractures. All patients were followed up from 12 to 36 months with an average of 24.9 months; 32 patients had the re-fractures of the contra-lateral hip,including 13 males and 19 females with an average age of (81.25±5.94) years old ranging from 72 to 95 years old; among them 7 cases were femur neck fractures and 25 cases were femoral intertrochanteric fractures. The patients were divided into a re-fracture group and no-re-fracture group according to presence or absence of re-fracture on the contra-lateral hip after operation. Age,gender,primary fracture type,internal fixation type,bed time,osteoporosis,combined disease,postoperative functional training,therapy compliance,living environment(rural/town)and Harris score at the last follow-up were compared between patients with or without re-fractures. Factors with P<0.05 were analyzed by multivariate Logistic regression. Results:There were significant differences between the re-fracture group and the no-re-fracture group in age,osteoporosis,combined disease,postoperative functional training,therapy compliance and Harris score at the last follow-up(P<0.05). The multivariate Logistic regression analysis showed that osteoporosis (OR=6.793,P=0.001),age (OR=4.170,P=0.002),combined disease (OR=3.828,P=0.005),postoperative functional training (OR=0.297,P=0.005) and therapy compliance(OR=0.295,P=0.007)were the major risk factors for re-fracture of the contra-lateral hip. Conclusion:Age,osteoporosis,combined disease,postoperative functional training,therapy compliance may be the major factors for re-fracture of the contra-lateral hip in elderly patients following the surgery for primary hip fracture. To prevent contra-lateral hip fracture,effective treatment of anti-osteoporosis and combined disease,postoperative functional training is great importance.