CAJ | 학술논문

目的分析老年股骨颈骨折患者术后病死危险因素.方法 2007年1月至2011年6月北京中日友好医院232例年龄≥70岁的股骨颈骨折行关节置换术患者,男64例,女133例.将患者依照年龄分成3组:A组70 ～79岁,B组80 ～ 89岁,C组＞90岁.对3组患者进行了病例回顾,对比分析患者入院时年龄、性别、受伤至手术的间隔时间、血清白蛋白水平、血红蛋白水平、术前并发疾病、美国麻醉学会(ASA)术前身体状况分级和淋巴细胞数量与术后随访1年期间病死率的关系.结果 14例患者病死于术后和随访1年期间,其中1例患者病死于住院期间,其余l3例患者病死于随访期间.A组病死例数为3例,病死率为3.9％,B组病死例数为5例,病死率为7.2％,C组病死例数为6例,病死率为24.0％;对比显示,相比于A组和B组,C组病死率显著增高.13例病死患者ASA评分为Ⅲ级或Ⅳ级(9例为ASAⅢ级,4例为ASAⅣ级),13例患者血清白蛋白＜35g/L,11例患者血清淋巴细胞数量＜1 500/L.病死患者与存活患者血清白蛋白水平、血红蛋白水平、淋巴细胞数量ASA分级比较差异有统计学意义(P＜0.05),病死患者与存活患者平均年龄比较差异有统计学意义(P＜0.05).受伤至手术间隔时间5d内手术者与5d后手术者病死患者构成差异无统计学意义(P＞0.05).结论年龄＞ 90岁、低血清淋巴细胞数量、合并2种以上疾病、血清白蛋白＜35g/L、血红蛋白＜ 10 g/L和术前身体状况ASAⅢ级或Ⅳ级是老年股颈骨折患者关节置换术后和随访1年期间发生死亡的重要危险因素.
목적 분석노년고골경골절환자술후병사위험인소.방법 2007년1월지2011년6월북경중일우호의원232례년령≥70세적고골경골절행관절치환술환자,남64례,녀133례.장환자의조년령분성3조:A조70 ～79세,B조80 ～ 89세,C조＞90세.대3조환자진행료병례회고,대비분석환자입원시년령、성별、수상지수술적간격시간、혈청백단백수평、혈홍단백수평、술전병발질병、미국마취학회(ASA)술전신체상황분급화림파세포수량여술후수방1년기간병사솔적관계.결과 14례환자병사우술후화수방1년기간,기중1례환자병사우주원기간,기여l3례환자병사우수방기간.A조병사례수위3례,병사솔위3.9％,B조병사례수위5례,병사솔위7.2％,C조병사례수위6례,병사솔위24.0％;대비현시,상비우A조화B조,C조병사솔현저증고.13례병사환자ASA평분위Ⅲ급혹Ⅳ급(9례위ASAⅢ급,4례위ASAⅣ급),13례환자혈청백단백＜35g/L,11례환자혈청림파세포수량＜1 500/L.병사환자여존활환자혈청백단백수평、혈홍단백수평、림파세포수량ASA분급비교차이유통계학의의(P＜0.05),병사환자여존활환자평균년령비교차이유통계학의의(P＜0.05).수상지수술간격시간5d내수술자여5d후수술자병사환자구성차이무통계학의의(P＞0.05).결론 년령＞ 90세、저혈청림파세포수량、합병2충이상질병、혈청백단백＜35g/L、혈홍단백＜ 10 g/L화술전신체상황ASAⅢ급혹Ⅳ급시노년고경골절환자관절치환술후화수방1년기간발생사망적중요위험인소.
Objective To explore the risk factors for mortality in nonagenarians with femoral neck fractures and clarity the relationships between risk factors and postoperative mortality.Methods For this retrospective study,a total of 197 patients with consecutive isolated nonpathologic hip fractures undergoing hemiarthroplasty were recruited.There were 64 males and 133 females with an age range of 70 years or above.They were divided into three age groups:A,70-79 years; B,80-89 years; and C,≥90 years.A retrospective chart review was conducted to compare these groups in terms of age,gender,nutritional status,blood albumin,total lymphocyte count,hemoglobin levels at admission,comorbidities,American Society of Anesthesiologists (ASA) rating of operative risk and time period between injury and surgery.Results Among them,14 patients died within 1 year.There was one in-hospital death and 13 patients died during follow-ups.The mortality rates of groups A,B and C were (n =3,3.9％),(n =5,7.2％) and (n =6,24.0％).The ASA scores were Ⅲ(n =9) and Ⅳ (n =4).And 13 patients had a preoperative blood albumin level ＜ 35 g/L while 11 patients showed a preoperative lymphocyte count level ＜ 1 500 cells/ml.The mortality rates were similar in groups A and B but were significantly lower than that of group C.Conclusion The nonagenarians have a significantly higher mortality.And lower lymphocyte count,nonagenarian,＞ 2 comorbidities,high ASA score,low blood albumin level and low hemoglobin levels at admission are significant factors for assessing 1-year mortality in elders with femoral neck fractures.