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。

The factors influencing the prognosis of senile hip fracture patients

Objective： To find out the risk factors that may lead to postoperative complications or death in se- nile hip fracture patients. Methods： From January 2006 to December 2010, the data of 265 hip fracture pa- tients, 110 male and 155 female, aged from 65 to 95 years, was analyzed retrospectively. The patients＇ gender, age, type of fracture, preoperative medical complications, time and way of the operation, anesthesia method and perioperative blood transfusion were recorded accurately, and the patient＇s survival status within 1 year was fol- lowed-up. The risk factors of postoperative complications or death within 1 year were analyzed with logistic re- gression analysis. Results： The incidence rate of postoperative complications in patients with three and above preoperative medical complications was 4.793 times higher than those without patients, with a significant differ- ence （P=0.000, OR=4.793）. Meanwhile, the results indicates that both the time of operation performed more than 72 hours after injury （P=0.001, OR=3.836） and patients with over three preoperative complications （P=0.011, OR= 7.752）, which can increase the death risk within 1 year after surgery, and with a significant difference. But other factors did not show obvious difference. Conclusion： Among the risk factors in this study, a relationship only can be found between preoperative medical complications and postoperative complications. And preoperative medical complications and the time of operation are the risk factors which can lead to the senile patients＇ death. Base on above reasons, the senile patients with hip fracture should be treated by surgery as soon as possible to improve their prognosis by reducing the morbidity and mortality related to postoperative complications.