老年股骨粗隆间骨折后死亡原因调查及相关因素分析

发布时间：2018-02-17 00:15

本文关键词： 粗隆间骨折老年死亡危险因素　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：调查老年粗隆间骨折患者死亡原因,并分析相关危险因素,为临床上更好的治疗老年股骨粗隆间骨折、提高老年粗隆间骨折患者生存率及生存质量提供依据。方法：分析纳入研究的132例于我院住院治疗并获得随访的老年粗隆间骨折患者的临床资料,以患者1年死亡率为研究结局,通过行单因素分析及多因素二分类Logistic回归分析,探究影响患者死亡的因素。结果：132例老年粗隆间骨折患者1年内死亡35例,生存97例,1年随访期总死亡率为25.93%,死亡原因主要有：并发肺部感染13例、脑血管意外3例、急性心肌梗死6例、消化道大出血4例、多种疾病导致多脏器功能衰竭7例、其它2例,分别占37.14%、8.57%、17.14%、11.13%、20.00%、5.71%。经X2检验,各死亡原因在死亡总例数中的构成不同(P0.05),肺部感染为主要死亡原因。老年粗隆间骨折总并发症发生率中以肺部感染最高,为19.70%,其次为新发心律失常(6.06%)、泌尿系感染(5.30%)及多器官功能衰竭(5.30%)。发生并发症58例病例中肺部感染26例,脑血管意外5例、急性心肌梗死6例、消化道大出血2例、多种疾病导致多脏器功能衰竭7例、下肢深静脉血栓2例等。单因素方差分析死亡原因相关因素结果显示显示：年龄、骨折前合并症数量、保守治疗、骨折后存在合并症、入院血红蛋白、入院白蛋白、抗骨质疏松治疗对患者死亡率影响有差异的统计指标,logistic回归分析显示：除抗骨质疏松治疗外其他指标为导致老年粗隆间骨折患者死亡的独立危险因素。其中保守治疗14例,死亡9例,死亡率64.28%,手术治疗118例,死亡26例,死亡率22.03%,两种治疗方式比较差异有统计学意义(X2=11.467,P=0.0010.05)。老年粗隆间骨折患者早期恢复活动能力可明显降低死亡率,比较差异有统计学意义(P0.05),髓内固定与髓外固定术后死亡率无明显差异(P0.05)。抗骨质疏松治疗患者粗隆间骨折死亡率为15.56%明显低于对照组的32.18%,两组比较差异有统计学意义(P0.05)。结论：(1)老年粗隆间骨折患者死亡率较高、并发症发病率高,治疗期间需对骨折前合并症积极干预,并重视并发症的早期诊断及治疗,条件允许者建议行手术治疗,并根据患者情况选择合适的固定方式。(2)骨折后早期恢复活动能力,给予抗骨质疏松治疗,可明显降低老年粗隆间骨折死亡率,改善患者预后。对其危险因素的控制需重视基础疾病的治疗,并积极预防和治疗骨折后合并症,这对降低死亡率、改善患者的生存状况有积极意义。
[Abstract]:Objective: to investigate the causes of death in elderly patients with intertrochanteric fracture and to analyze the related risk factors for better clinical treatment of senile intertrochanteric fracture. Methods: the clinical data of 132 elderly intertrochanteric fracture patients who were hospitalized and followed up in our hospital were analyzed. Univariate analysis and multivariate two-classification Logistic regression analysis were performed to investigate the factors influencing the mortality of patients with 1 year mortality. Results 35 cases of senile intertrochanteric fractures died within one year. The main causes of death were pulmonary infection in 13 cases, cerebrovascular accident in 3 cases, acute myocardial infarction in 6 cases, gastrointestinal hemorrhage in 4 cases, and multiple organ failure in 7 cases. The other two cases, which accounted for 37.147.57 and 11.1320.00, respectively. By X2 test, the composition of each cause of death was different in the total death cases (P0.05N), and pulmonary infection was the main cause of death. The incidence of total complications of intertrochanteric fractures in the elderly was the highest, and the incidence of complications of intertrochanteric fractures in the elderly was the highest. It was 19.70, followed by new arrhythmia 6.06, urinary tract infection 5.30) and multiple organ failure 5.300.The complications occurred in 26 cases of pulmonary infection, 5 cases of cerebrovascular accident, 6 cases of acute myocardial infarction and 2 cases of massive hemorrhage of digestive tract. Multiple diseases resulted in multiple organ failure in 7 cases, deep venous thrombosis in 2 cases, etc. The results of univariate ANOVA showed that: age, number of complications before fracture, conservative treatment, complications after fracture, Admission hemoglobin, admission albumin, Logistic regression analysis showed that the risk factors of death in elderly patients with intertrochanteric fracture were related to the treatment of osteoporosis except anti-osteoporosis. Among them, 14 cases were treated conservatively. There were 9 cases of death, 64.28% of death rate, 118 cases of surgical treatment, 26 cases of death and 22.03% of mortality. The difference between the two treatment methods was statistically significant. The early recovery ability of senile intertrochanteric fracture patients could significantly reduce the mortality rate. There was no significant difference in mortality between intramedullary fixation and extramedullary fixation. The mortality rate of intertrochanteric fracture in patients with anti-osteoporosis treatment was significantly lower than that in control group (15.56% vs 32.18). The difference between the two groups was statistically significant. Conclusion the mortality rate of aged patients with intertrochanteric fracture is higher. The incidence of complications is high. During the period of treatment, active intervention should be taken to prevent the complications, and the early diagnosis and treatment of complications should be emphasized. According to the condition of the patients, choosing the appropriate fixation method. 2) the early recovery of activity after fracture, and the treatment of anti osteoporosis can obviously reduce the mortality rate of intertrochanteric fracture in the elderly. To improve the prognosis of patients, the control of risk factors should pay attention to the treatment of basic diseases, and actively prevent and treat post-fracture complications, which has a positive significance to reduce the mortality rate and improve the living conditions of patients.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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