新疆老年股骨转子间骨折患者术后预后影响因素分析

Influencing factors for postoperative prognosis of elderly patients with femoral intertrochanteric fracture in Xinjiang，China

摘要:

目的：回顾性分析新疆老年股骨转子间骨折患者术后临床资料，探讨影响患者术后生存率的主要因素。方法：收集2013年1月至2017年12月在新疆医科大学第一附属医院行手术治疗的131例患者临床资料。Kaplan-Meier法用于计算患者术后总的6个月、1年、3年和5年生存率、单因素分析、计算累积生存率和绘制生存曲线。Log-Rank检验用于组间比较。COX回归分析用于多因素分析。结果：全组患者术后总的6个月、１年、３年和５年生存率分别为87.0%、95%CI=81.3%~92.7%；80.6%、95%CI=73.7%~87.5%；65.1%、95%CI =55.7%~74.5%和52.1%、95%CI=37.4%~66.8%。单因素分析结果显示：年龄（ ?字2=18.190，P=0.000）、合并内科疾病数目（ ?字2=36.142，P=0.000）、合并神经系统疾病（ ?字2=4.093，P=0.043）、合并肾功能不全（ ?字2=11.992，P=0.001）、术前白蛋白水平（ ?字2=3.872，P=0.049）、麻醉ASA分级（ ?字2=7.369，P=0.025）、ICU观察时间（ ?字2=24.474，P=0.000）为老年股骨转子间骨折术后生存率的影响因素。多因素分析显示，合并内科疾病数目（≥3种）（HR=5.133，95%CI=2.690~9.790，P=0.000）和ICU观察时间（36 h以上）（HR=9.229，95%CI=2.546~33.457，P=0.001）为老年股骨转子间骨折患者预后的独立危险因素。结论：老年股骨转子间骨折患者术后生存率的影响因素有多种。应根据当地医疗条件，结合患者具体情况，加强多学科间协作，选择合适的治疗方案，从而提高患者术后的生存质量，延长生存期，改善预后。

Abstract:

Objective：To investigate the main factors for the postoperative survival rate of elderly patients with femoral intertrochanteric fracture in Xinjiang，China through a retrospective analysis of their clinical data after surgery. Methods：A retrospective analysis was performed for the clinical data of 131 patients who underwent surgical treatment in The First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2017. The Kaplan-Meier method was used to calculate survival rates at 6 months，1 year，3 years，and 5 years after surgery. Cumulative survival rate was calculated and survival curves were plotted. A univariate analysis was performed. The log-rank test was used for comparison between groups，and the Cox regression analysis was used for the multivariate analysis. Results：The survival rates at 6 months，1 year，3 years，and 5 years after surgery were 87.0%（95%CI＝81.3%-92.7%），80.6%（95%CI＝73.7%-87.5%），65.1%（95%CI＝55.7%-74.5%），and 52.1%（95%CI＝37.4%-66.8%），respectively. The univariate analysis showed that age（ ?字2=18.190，P=0.000），number of chronic comorbidities（ ?字2=36.142，P=0.000），presence of nervous system disease （ ?字2=4.093，P=0.043），presence of renal insufficiency（ ?字2 =11.992，P=0.001），preoperative albumin level（ ?字2 =3.872，P=0.049），Ameri－can Society of Anesthesiologists score（ASA）（ ?字2=7.369，P=0.025），length of stay in the intensive care unit（ICU）（ ?字2=24.474，P=0.000） were influencing factors for the postoperative survival rate of elderly patients with femoral intertrochanteric fracture. The multivariate analysis showed that ≥3 chronic comorbidities（hazard ratio[HR]=5.133，95%CI＝2.690-9.790，P=0.000） and a length of stay in the ICU of ≥36 hours（HR=9.229，95%CI＝2.546-33.457，P=0.001） were independent risk factors for poor postoperative prognosis of elderly patients with femoral intertrochanteric fracture. Conclusion：There are various influencing factors for the postoperative survival rate of elderly patients with femoral intertrochanteric fracture. With reference to local medical conditions and patient’s individual conditions，physicians should strengthen multidisciplinary collaboration and select appropriate treatment plans，so as to improve postoperative quality of life，prolong survival time，and improve prognosis.