CAJ | 학술논문

目的：探讨股骨转子间骨折围手术期的并发症发生情况及死亡原因。方法回顾性分析2007年5月至2014年6月547例接受手术治疗股骨转子间骨折患者的病历资料，共499例符合条件纳入研究，男132例，女367例；年龄59~103岁,平均（78.3±7.3）岁。股骨转子间骨折根据Evans分型：Ⅰ型84例、Ⅱ型67例、Ⅲ型187例、Ⅳ型161例。将术前健康状况评估（APACHEⅡ评分系统）结果和预测死亡率分别与年龄、手术时间、出血量等相关因素进行统计学分析。对APACHEⅡ评分的有效性进行ROC曲线分析。结果围手术期间合并症或新出现并发症共354例次，依次是肺炎、泌尿系感染、下肢深静脉血栓、心脏事件。死亡30例，死亡率为6.0％。死亡原因依次为感染中毒性休克、呼吸功能衰竭、心脏事件、肾功能衰竭、肝破裂导致失血性休克。存活组和死亡组的APACHEⅡ评分分别是（12.0±5.2）分和（22.0±5.3）分，两组差异有统计学意义。多因素相关性分析显示，死亡组APACHEⅡ评分及预测死亡率与手术时间及出血量呈正相关， APACHEⅡ评分ROC曲线下面积为0.938，最佳截断值为17.5（约登指数为0.767），此时的敏感度为86.7%，特异度为90%。通过APACHEⅡ评分换算的死亡风险ROC曲线下面积为0.817，最佳截断值为16.765%（约登指数为0.483），此时的敏感度为93.3%，特异度为55.0%。结论股骨转子间骨折围手术期的并发症与合并症较多，死亡的主要原因是感染性休克。血红蛋白和手术时间与患者创伤的程度密切相关。APACHEⅡ评分系统被证实对股骨转子间骨折评估和预后具有一定的临床价值，值得推荐使用。
목적：탐토고골전자간골절위수술기적병발증발생정황급사망원인。방법회고성분석2007년5월지2014년6월547례접수수술치료고골전자간골절환자적병력자료，공499례부합조건납입연구，남132례，녀367례；년령59~103세,평균（78.3±7.3）세。고골전자간골절근거Evans분형：Ⅰ형84례、Ⅱ형67례、Ⅲ형187례、Ⅳ형161례。장술전건강상황평고（APACHEⅡ평분계통）결과화예측사망솔분별여년령、수술시간、출혈량등상관인소진행통계학분석。대APACHEⅡ평분적유효성진행ROC곡선분석。결과위수술기간합병증혹신출현병발증공354례차，의차시폐염、비뇨계감염、하지심정맥혈전、심장사건。사망30례，사망솔위6.0％。사망원인의차위감염중독성휴극、호흡공능쇠갈、심장사건、신공능쇠갈、간파렬도치실혈성휴극。존활조화사망조적APACHEⅡ평분분별시（12.0±5.2）분화（22.0±5.3）분，량조차이유통계학의의。다인소상관성분석현시，사망조APACHEⅡ평분급예측사망솔여수술시간급출혈량정정상관， APACHEⅡ평분ROC곡선하면적위0.938，최가절단치위17.5（약등지수위0.767），차시적민감도위86.7%，특이도위90%。통과APACHEⅡ평분환산적사망풍험ROC곡선하면적위0.817，최가절단치위16.765%（약등지수위0.483），차시적민감도위93.3%，특이도위55.0%。결론고골전자간골절위수술기적병발증여합병증교다，사망적주요원인시감염성휴극。혈홍단백화수술시간여환자창상적정도밀절상관。APACHEⅡ평분계통피증실대고골전자간골절평고화예후구유일정적림상개치，치득추천사용。
Objective To analyze the causes of complications and death of the femoral intertrochanteric fracture during perioperative period, and to assess the orthopedics surgery risk of aged. Methods 499 of 547 cases were retrospectively re?viewed (132 male, 367 female), who underwent operation from May 2007 to Jun 2014 in our hospital. Their age varied from 59 to 103 years old, with an average of 78.3 ± 7.3 years old. According to Evans classification, there were 84 cases of type I, 67 type II, 187 type III, and 161 type IV. The causes of death were analyzed and discussed. The factors including health assess?ment before operation, age, operating time and blood loss were studied statistically to find out their correlation with mortality of operation. Results There were altogether 354 complications, including pulmonary infection, urinary system infection, DVT, and cardiac events. There were 30 cases of death and the mortality was 6.0%. The major causes of death included infectious shock, pulmonary infection, cardiac events, kidney failure and hemorrhagic shock caused by hepatic rupture. Statistical results from the score of APACHEⅡshowed the factor which definitely influenced the mortality was the amount of blood loss during op?eration.APACHEⅡscoring area under the ROC curve was 0.938, and the best cutoff value was 17.5 (about an index of 0.767), with the sensitivity of 86.7%and specificity of 90%. The area of risk of death under the ROC curve by APACHE Ⅱscore was 0.817, the best cutoff value of 16.765%(about an index of 0.483), and the sensitivity and specificity of 93.3%and 55.0%. Conclu?sion There were a lot of complications and accompanied diseases when femoral intertrochanteric fractures happened in aged pa?tients. The main cause of death was septic shock. There were relationships between hemoglobin and the operating time and the de?gree of trauma. What’s more, it was confirmed that the APACHEⅡscoring system was very useful to value the condition of the patients with femoral intertrochanteric fractures, which can be recommended.