生理学和手术侵袭度评分及改良生理学和手术侵袭度评分对老年髋部骨折患者手术风险的评估

目的探讨生理学和手术侵袭度评分(POSSUM)及改良POSSUM(P-POSSUM)评估老年髋部骨折手术患者手术风险的价值。方法回顾性分析337例年龄≥60岁的老年髋部骨折患者的临床资料,应用POSSUM及P-POSSUM预测术后并发症发生率及病死率,与实际的术后并发症发生率及病死率进行比较。结果根据POSSUM评分公式预测术后发生并发症118例,实际发生并发症103例,两者间的差异无统计学意义(P>0.05)。有并发症组的生理学评分及手术侵袭度评分均显著高于无并发症组(P值均<0.05)。根据POSSUM评分公式预测术后死亡21例,实际死亡7例,两者间的差异有统计学意义(P<0.05)。根据P-POSSUM评分公式预测术后死亡10例,与实际值的差异无统计学意义(P>0.05)。结论 POSSUM对老年髋部骨折患者术后并发症发生率有较好的预测能力,P-POSSUM比POSSUM能更准确地预测患者的术后病死率。

Operative risk assessment in elderly patients with hip fracture by physiological and operative severity score versus Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity

Objective To evaluate the value of physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) in operative risk assessment for elderly patients with hip fracture. Methods The clinical data of 337 hip fracture patients (≥60 years old) with surgical treatment were analyzed retrospectively. POSSUM and P-POSSUM were used to predict the postoperative mortality and morbidity. Then the predictive values were compared with the actual ones. Results There were 103 patients with complications after surgery and 118 cases were predicted by POSSUM with complications, with no statistical difference between them (P>0.05). The average physiological score and operative severity score in the patients with complications were significantly higher than those without complications (P<0.05). The numbers of death predicted by POSSUM and P-POSSUM were 21 and 10, respectively, while postoperative death occurred in 7 patients. There was significant difference between the number of POSSUM-predicted death and actual death (P<0.05), but no significant difference between the number of P-POSSUM-predicted death and actual death (P>0.05). Conclusion POSSUM can make satisfactory prediction of postoperative complications in elderly patients with hip fracture. P-POSSUM can better predict postoperative mortality than POSSUM.