目的探讨老年髋部骨折患者术后早期并发症发生的危险因素及其预警效能。
方法采用回顾性队列研究分析2022年1月至2023年12月中国人民解放军联勤保障部队第九〇八医院和南昌大学第一附属医院骨科医院收治的203例老年髋部骨折患者的临床资料，其中男54例，女149例；年龄65~100岁［（80.5±7.7）岁］。股骨颈骨折96例，股骨转子间骨折107例。AO/OTA分型：31A型107例，31B型96例。采取股骨近端防旋髓内钉（PFNA）固定81例，半髋关节置换术65例，全髋关节置换术（THA）52例，闭合复位空心钉内固定术5例。根据术后15 d内是否发生并发症（主要包括谵妄、肺部感染、应激性溃疡、下肢深静脉血栓），将患者分为并发症组（65例）与无并发症组（138例）。记录2组性别、年龄、年龄段、文化程度、致伤原因、术前合并基础疾病、AO/OTA分型、美国麻醉医师协会（ASA）分级、改良衰弱指数（mFI-5）评分、预后营养指数（PNI）、麻醉方式、手术方式、手术时长、术中失血量、住院时长等。采用单因素及多因素二元Logistic回归分析评估上述指标与老年髋部骨折患者术后早期并发症发生的相关性并确定其独立危险因素。绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC），评估各危险因素对老年髋部骨折患者术后早期并发症发生的预警效能。
结果单因素分析结果显示，年龄、年龄段、术前合并基础疾病、AO/OTA分型、ASA分级、mFI-5评分、PNI、手术方式、住院时长与老年髋部骨折患者术后早期并发症发生存在一定的相关性（ P<0.05），而性别、文化程度、致伤原因、麻醉方式、手术时长、术中失血量与老年髋部骨折患者术后早期并发症发生不相关（ P>0.05）。多因素二元Logistic回归分析结果表明，术前合并基础疾病（ OR=5.46，95% CI 1.33，22.39， P<0.05）、mFI-5评分（ OR=15.90，95% CI 5.36，47.15， P<0.01）、PNI（ OR=0.70，95% CI 0.60，0.81， P<0.01）与老年髋部骨折患者术后早期并发症发生显著相关。ROC曲线分析结果显示，mFI-5评分（AUC=0.85，95% CI 0.80，0.91）和PNI（AUC=0.87，95% CI 0.82，0.93）均具有中等预警效能，而术前合并基础疾病预警效能较低（AUC=0.54，95% CI 0.45，0.62）；上述危险因素联合对老年髋部骨折患者术后早期并发症发生的预警效能更优（AUC=0.95，95% CI 0.92，0.98）。
结论mFI-5评分、PNI、术前合并基础疾病是老年髋部骨折患者术后早期并发症发生的独立危险因素。mFI-5评分和PNI对老年髋部骨折患者术后早期并发症发生的预警效能较高，术前合并基础疾病的预警效能较低，而上述危险因素联合的预警效能更优。
ObjectiveTo investigate the risk factors and their predictive efficacy for early postoperative complications in elderly patients with hip fracture.
MethodsA retrospective cohort study was conducted on the clinical data of 203 elderly patients with hip fracture admitted to the 908th Hospital of the Joint Logistics Support Force of the PLA and the First Affiliated Hospital of Nanchang University from January 2022 to December 2023, including 54 males and 149 females, aged 65-100 years [(80.5±7.7)years]. There were 96 patients with femoral neck fracture and 107 patients with intertrochanteric fracture. According to the AO/OTA classification, the fracture was classified as type 31A in 107 patients and type 31B in 96. Among them, 81 patients were treated with proximal femoral nail antirotation (PFNA), 65 with semi-hip arthroplasty, 52 with total hip arthroplasty (THA), and 5 with closed reduction and cannulated nail internal fixation. The patients were divided into complication group ( n=65) and non-complication group ( n=138) according to whether complications (mainly including delirium, lung infection, stress ulcer, and deep vein thrombosis of the lower limbs) occurred within 15 days after surgery. The gender, age, age stage, educational level, cause of injury, associated underlying diseases before surgery, AO/OTA classification, American Society of Anesthesiologists (ASA) classification, 5-factor modified frailty index (mFI-5) score, prognostic nutritional index (PNI), anesthesia method, operation method, operation time, intraoperative blood loss, length of hospital stay, etc., were recorded in the two groups. Univariate analysis and multivariate binary logistic regression analysis were used to evaluate the correlation between the above indexes and the occurrence of early postoperative complications in elderly patients with hip fracture and to determine their independent risk factors. The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated to evaluate the predictive efficacy of each risk factor for the occurrence of early postoperative complications in elderly patients with hip fracture.
ResultsUnivariate analysis showed a certain correlation between age, age stage, associated underlying diseases before surgery, AO/OTA classification, ASA classification, mFI-5 score, PNI, operation method, and length of hospital stay and the occurrence of early postoperative complications in elderly patients with hip fracture ( P<0.05), while gender, educational level, cause of injury, anesthesia method, operation time, and intraoperative blood loss were not correlated with the occurrence of early postoperative complications in elderly patients with hip fracture ( P>0.05). The results of multivariate binary logistic regression analysis showed that the associated underlying diseases before surgery ( OR=5.46, 95% CI 1.33, 22.39, P<0.05), mFI-5 score ( OR=15.90, 95% CI 5.36, 47.15, P<0.01), and PNI ( OR=0.70, 95% CI 0.60, 0.81, P<0.01) were significantly correlated with the occurrence of early postoperative complications in elderly patients with hip fracture. The results of ROC curve analysis showed that mFI-5 score (AUC=0.85, 95% CI 0.80, 0.91) and PNI (AUC=0.87, 95% CI 0.82, 0.93) had moderate predictive efficacy, while the early warning efficacy of associated underlying diseases was low (AUC=0.54, 95% CI 0.45, 0.62). The combination of the above risk factors was more effective in predicting early postoperative complications in elderly patients with hip fracture (AUC=0.95, 95% CI 0.92, 0.98).
ConclusionsThe mFI-5 score, PNI, and associated underlying diseases before surgery are independent risk factors for early postoperative complications in elderly patients with hip fracture. The mFI-5 score and PNI have a higher predictive efficacy than associated diseases before surgery on the occurrence of early postoperative complications in elderly patients with hip fracture, while the combination of the above risk factors provides a significantly better predictive performance.
万得恩,颜永周,双峰,等. 老年髋部骨折患者术后早期并发症发生的危险因素及其预警效能[J]. 中华创伤杂志,2025,41(03)：274-281.
DOI:10.3760/cma.j.cn501098-20241016-00605版权归中华医学会所有。
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万得恩：研究实施、数据采集、统计学分析、论文撰写；颜永周：数据整理及统计学分析；双峰：研究设计、统计学分析、论文指导及修改；李浩：研究指导、论文审定；曾智、黄牡丹、韩露：研究实施、数据整理及统计学分析；彭祥、杨迪：数据采集；陈明：论文指导及修改、经费支持；刘启欣：数据采集
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