代谢综合征与老年股骨转子间骨折内固定术后不良事件发生的相关性分析
摘要点击次数: 2313   全文下载次数: 532   投稿时间:2020-12-20    
作者Author单位AddressE-Mail
张忠良 ZHANG Zhong-liang 浙江中医药大学附属金华市中医医院关节外科, 浙江 金华 321017 Department of Joint Surgery, Traditional Chinese Medical Hospital of Jinhua Affiliated to Zhejiang University of Chinese Medicine, Jinhua 321017, Zhejiang, China 36436549@qq.com 
费霖莉 FEI Lin-li 浙江中医药大学附属金华市中医医院关节外科, 浙江 金华 321017 Department of Joint Surgery, Traditional Chinese Medical Hospital of Jinhua Affiliated to Zhejiang University of Chinese Medicine, Jinhua 321017, Zhejiang, China  
傅俊伟 FU Jun-wei 浙江中医药大学附属金华市中医医院关节外科, 浙江 金华 321017 Department of Joint Surgery, Traditional Chinese Medical Hospital of Jinhua Affiliated to Zhejiang University of Chinese Medicine, Jinhua 321017, Zhejiang, China  
方立 FANG Li 浙江中医药大学附属金华市中医医院关节外科, 浙江 金华 321017 Department of Joint Surgery, Traditional Chinese Medical Hospital of Jinhua Affiliated to Zhejiang University of Chinese Medicine, Jinhua 321017, Zhejiang, China  
期刊信息:《中国骨伤》2021年,第34卷,第10期,第900-905页
DOI:10.12200/j.issn.1003-0034.2021.10.003
基金项目:
中文摘要:

目的:探讨代谢综合征对老年股骨转子间骨折内固定术后15 d不良事件发生的影响。

方法:2011年1月至2019年6月,采用内固定治疗老年股骨转子间骨折986例,男312例,女674例,年龄(77.71±7.58)岁,其中伴有代谢综合征的患者97例,不伴代谢综合征的患者889例。通过电子病历系统收集患者年龄、性别、骨折分型、外伤原因、体重指数(body mass index,BMI),吸烟史,术前合并病,术前输血情况,手术时机,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级,麻醉方式,内固定类型,手术时间以及术后15 d内并发不良事件,包括术后15 d内手术部位感染,急性心功能衰竭,急性呼吸衰竭,肺部感染,急性肾功能衰竭,下肢深静脉血栓(deep venous thrombosis,DVT),心肺脑重要脏器栓塞,尿路感染,死亡,以及术后是否进行输血治疗。用t检验及单因素χ2检验对两组间患者术前、术中基线资料及术后15 d内不良事件进行比较分析。校正术前及术中基线资料P<0.05的混杂因素,将P<0.05的术后不良事件纳入多因素Logistic回归分析,进一步研究代谢综合征对术后15 d内不良事件的独立影响。

结果:两组患者间的年龄,BMI,心功能不全病史,慢性阻塞性肺病(chronic obstruvtive pulmonary disease,COPD)病史,肾功能不全病史,手术时机,ASA分级、手术时间以及术后15 d内并发手术部位感染、急性心功能衰竭、DVT、尿路感染及输血情况差异有统计学意义(P<0.05)。校正术前及术中基线资料混杂因素,多因素Logistic回归分析结果显示代谢综合征会增高老年股骨转子间骨折内固定术后15 d内的手术部位感染率[OR=3.785,95% CI(1.086-13.188),P=0.037],DVT发生率[OR=2.265,95% CI(1.096-4.682),P=0.027]),尿路感染率[OR=2.703,95% CI(1.049-6.963),P=0.039]及输血率[OR=1.811,95% CI(1.142-2.870),P=0.012]。

结论:伴有代谢综合征的老年股骨转子间骨折患者术后存在更高的手术部位感染率、下肢深静脉血栓形成率、尿路感染率及术后输血率,因此骨科治疗团队应联合内科及麻醉科等多学科协作下,在患者围术期给予更多的关注并优化治疗方案。
【关键词】代谢综合征  股骨转子间骨折  骨折固定术,内  不良事件
 
Correlation between metabolic syndrome and adverse events after internal fixation of femoral intertrochanteric fracture in the elderly
ABSTRACT  

Objective: To explore the effect of metabolic syndrome on 15 days postoperative adverse events of femoral intertrochanteric fractures with internal fixation.

Methods: From January 2011 to June 2019,986 elderly patients with intertrochanteric fracture were treated with internal fixation,including 312 males and 674 females,with an average age of(77.71±7.58) years old. And there were 97 patients with metabolic syndrome and 889 patients without metabolic syndrome. Through the electronic medical record system,the patient's age,gender,fracture type,cause of trauma,body mass index,smoking history,preoperative comorbidities,preoperative blood transfusion,operation timing,ASA classification,anesthesia method,internal fixation type,operation duration,and 15 days postoperative adverse events,which include surgical site infection,acute heart failure,acute respiratory failure,pulmonary infection,acute renal failure,DVT,embolism in important organs,urinary tract infection,death,and blood transfusion after surgery were collected. The differences of preoperative and intraoperative baseline datas and 15 days postoperative adverse events between the two groups were compared and analyzed by t text or univariate χ2 test. Adjusted for the preoperative and intraoperative mixed factors with P<0.05,and 15 days postoperative adverse events with P<0.05 were then analyzed by multivariate unconditional Logistic regression analysis to further study the independent effects of metabolic syndrome on 15 days postoperative adverse events.

Results: There were statistical differences in age,body mass index,history of cardiac insufficiency,history of COPD,history of renal insufficiency,operation timing,ASA classification,operation duration,surgical site infection,acute heart failure,DVT,urinary tract infection and blood transfusion between two groups(P<0.05). Adjusted for the preoperative and intraoperative mixed factors,multivariate unconditional logistic regression analysis showed that metabolic syndrome could increase the infection rate of the surgical site[OR=3.785,95% CI(1.086-13.188),P=0.037],DVT incidence rate[OR=2.265,95% CI(1.096-4.682),P=0.027],urinary tract infection rate[OR=2.703,95% CI(1.049-6.963),P=0.0390],and blood transfusion rate[OR=1.811,95% CI(1.142-2.870),P=0.012].

Conclusion: Elderly patients with intertrochanteric fracture with metabolic syndrome had higher postoperative surgical site infection rate,DVT incidence rate,urinary tract infection rate,and postoperative blood transfusion rate. Therefore,the orthopedic treatment team should give more attention and optimize the treatment plan during the perioperative period with the cooperation of internal physician and anesthesiologist.
KEY WORDS  Metabolic syndrome  Femoral intertrochanteric fracture  Fracture fixation,internal  Adverse events
 
引用本文,请按以下格式著录参考文献:
中文格式:张忠良,费霖莉,傅俊伟,方立.代谢综合征与老年股骨转子间骨折内固定术后不良事件发生的相关性分析[J].中国骨伤,2021,34(10):900~905
英文格式:ZHANG Zhong-liang,FEI Lin-li,FU Jun-wei,FANG Li.Correlation between metabolic syndrome and adverse events after internal fixation of femoral intertrochanteric fracture in the elderly[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(10):900~905
阅读全文  下载  查看/发表评论  下载PDF阅读器
关闭




版权所有:《中国骨伤》杂志社京ICP备12048066号-2  版权声明
地址:北京市东直门内南小街甲16号,100700
电话:010-64089487 传真:010-64089792 Email:zggszz@sina.com

京公网安备 11010102004237号