本文關(guān)鍵詞： 粗隆間骨折 老年 死亡 危險(xiǎn)因素　出處：《山東大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：調(diào)查老年粗隆間骨折患者死亡原因,并分析相關(guān)危險(xiǎn)因素,為臨床上更好的治療老年股骨粗隆間骨折、提高老年粗隆間骨折患者生存率及生存質(zhì)量提供依據(jù)。方法：分析納入研究的132例于我院住院治療并獲得隨訪的老年粗隆間骨折患者的臨床資料,以患者1年死亡率為研究結(jié)局,通過行單因素分析及多因素二分類Logistic回歸分析,探究影響患者死亡的因素。結(jié)果：132例老年粗隆間骨折患者1年內(nèi)死亡35例,生存97例,1年隨訪期總死亡率為25.93%,死亡原因主要有：并發(fā)肺部感染13例、腦血管意外3例、急性心肌梗死6例、消化道大出血4例、多種疾病導(dǎo)致多臟器功能衰竭7例、其它2例,分別占37.14%、8.57%、17.14%、11.13%、20.00%、5.71%。經(jīng)X2檢驗(yàn),各死亡原因在死亡總例數(shù)中的構(gòu)成不同(P0.05),肺部感染為主要死亡原因。老年粗隆間骨折總并發(fā)癥發(fā)生率中以肺部感染最高,為19.70%,其次為新發(fā)心律失常(6.06%)、泌尿系感染(5.30%)及多器官功能衰竭(5.30%)。發(fā)生并發(fā)癥58例病例中肺部感染26例,腦血管意外5例、急性心肌梗死6例、消化道大出血2例、多種疾病導(dǎo)致多臟器功能衰竭7例、下肢深靜脈血栓2例等。單因素方差分析死亡原因相關(guān)因素結(jié)果顯示顯示：年齡、骨折前合并癥數(shù)量、保守治療、骨折后存在合并癥、入院血紅蛋白、入院白蛋白、抗骨質(zhì)疏松治療對(duì)患者死亡率影響有差異的統(tǒng)計(jì)指標(biāo),logistic回歸分析顯示：除抗骨質(zhì)疏松治療外其他指標(biāo)為導(dǎo)致老年粗隆間骨折患者死亡的獨(dú)立危險(xiǎn)因素。其中保守治療14例,死亡9例,死亡率64.28%,手術(shù)治療118例,死亡26例,死亡率22.03%,兩種治療方式比較差異有統(tǒng)計(jì)學(xué)意義(X2=11.467,P=0.0010.05)。老年粗隆間骨折患者早期恢復(fù)活動(dòng)能力可明顯降低死亡率,比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),髓內(nèi)固定與髓外固定術(shù)后死亡率無明顯差異(P0.05)�？构琴|(zhì)疏松治療患者粗隆間骨折死亡率為15.56%明顯低于對(duì)照組的32.18%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：(1)老年粗隆間骨折患者死亡率較高、并發(fā)癥發(fā)病率高,治療期間需對(duì)骨折前合并癥積極干預(yù),并重視并發(fā)癥的早期診斷及治療,條件允許者建議行手術(shù)治療,并根據(jù)患者情況選擇合適的固定方式。(2)骨折后早期恢復(fù)活動(dòng)能力,給予抗骨質(zhì)疏松治療,可明顯降低老年粗隆間骨折死亡率,改善患者預(yù)后。對(duì)其危險(xiǎn)因素的控制需重視基礎(chǔ)疾病的治療,并積極預(yù)防和治療骨折后合并癥,這對(duì)降低死亡率、改善患者的生存狀況有積極意義。
[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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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