老年髋部骨折病人手术耐受力及术后髋关节功能的影响因素分析

摘要

目的:探讨老年髋部骨折病人手术耐受力及影响术后髋关节功能的因素.方法 :选取119例股骨粗隆骨折病人作为研究对象,根据病人手术耐受力评价结果 分为手术组和非手术组.采用髋关节Harris评分评价手术组病人术后髋关节功能,并以病人术后髋关节功能评分作为因变量,以可能影响术后髋关节功能的因素作为自变量进行单因素和多因素logistic回归分析.结果:手术组病人手术耐受力评分为(78.6±12.2)分,明显优于非手术组的(61.8±10.1)分(P<0.01).单因素分析显示,高龄、骨折时间长、非稳定型骨折、复位质量满意度低、术后恢复不佳、术后有并发症、行髋关节置换术、术前有合并症和术前ASA分级高的病人髋关节功能评分较低(P<0.01).多因素logistic回归分析显示,高龄、骨折时间长、非稳定型骨折、复位质量满意度低、术后恢复不佳和术前有合并症均为影响病人术后髋关节功能的独立危险因素(P<0.05~P<0.01).结论 :髋部骨折手术前应对老年病人进行必要的手术耐受力综合评估,并针对术后影响髋关节功能恢复的相关危险因素进行及早干预.%Objective:To explore the influencing factors of the surgical tolerance and postoperative hip function in elderly patients with hip fractures. Methods:A total of 119 patients with femur intertrochanteric fractures were divided into the operation group and non-operation group according to the surgical tolerance of patients. The function of hip joint in operation group after operation was evaluated using hip joint Harris scare. The single factor and multiple factors regression analysis were carried out using the postoperative function of hip joint as dependent variable,and the influencing factor of postoperative function of hip joint as independent variable. Results:The score of surgical tolerance in the operation group [(78. 6 ± 12. 2) points] was significantly better than that in non-operation group [(61. 8 ± 10. 1)points](P<0. 01). The results of single factor analysis showed that the function scores of hip joint in patients with advanced age,long fracture time,non-stable fracture,low quality reduction,postoperatively poor recovery,postoperative complications, hip replacement,preoperative complication,and preoperative high grade ASA were lower(P <0. 01). The results of multiple factors regression analysis showed that the advanced age, long fracture time, non-stable fracture, low quality reduction, postoperatively poor recovery,postoperative complications were the independent risk factor of hip joint function after operation(P<0. 05 to P<0. 01). Conclusions:The surgical tolerance in elderly patients with hip fractures should be evaluated before operation, and the related risk factors of affecting the hip joint function should timely be intervened.