中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (18): 2895-2900.doi: 10.12307/2024.027

• 骨科植入物相关临床实践 Clinical practice of orthopedic implant • 上一篇    下一篇

痴呆对老年髋部骨折术后并发症的影响

江  渝1，2，罗  燕3，林希圣4，王昳琳1，2，高泽福1，2，吕厚辰2，3，张里程2，3，唐佩福2，3，刘玉杰2，3   

  1. 1解放军医学院，北京市   100853；2 解放军总医院第四医学中心骨科医学部，北京市   100853；3国家骨科与运动康复临床医学研究中心，北京市   100853；4解放军总医院第二医学中心康复科，北京市   100853
  • 收稿日期:2022-12-26 接受日期:2023-03-23 出版日期:2024-06-28 发布日期:2023-08-26
  • 通讯作者: 刘玉杰，博士，主任医师，教授，解放军总医院第四医学中心骨科医学部，北京市 100853；国家骨科与运动康复临床医学研究中心，北京市 100853
  • 作者简介:江渝，男，1995年生，重庆市人，汉族，解放军医学院在读硕士，医师，主要从事骨质疏松性骨折的基础与临床研究。
  • 基金资助:
    国家自然科学基金(81972102)，项目负责人：唐佩福；北京市科学技术协会青年人才托举工程(BYESS2022021)，项目负责人：吕厚辰；解放军总医院优青培育项目(2020-YQPY-001)，项目负责人：吕厚辰

Effect of dementia on postoperative complications in older patients with hip fractures

Jiang Yu1, 2, Luo Yan3, Lin Xisheng4, Wang Yilin1, 2, Gao Zefu1, 2, Lyu Houchen2, 3, Zhang Licheng2, 3, Tang Peifu2, 3, Liu Yujie2, 3   

  1. 1Medical School of Chinese PLA, Beijing 100853, China; 2Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100853, China; 3National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China; 4Department of Rehabilitation, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2022-12-26 Accepted:2023-03-23 Online:2024-06-28 Published:2023-08-26
  • Contact: Liu Yujie, MD, Chief physician, Professor, Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
  • About author:Jiang Yu, Master candidate, Physician, Medical School of Chinese PLA, Beijing 100853, China; Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Supported by:
    National Natural Science Foundation of China, No. 81972102 (to TPF); Young Elite Scientist Sponsorship Program by Beijing Association for Science and Technology, No. BYESS2022021 (to LHC); Excellent Young Scholars Training Program by the Chinese PLA General Hospital, No. 2020-YQPY-001 (to LHC)

PDF

58

摘要：


文题释义：

痴呆：是一种以认知功能减退为特征的综合征，可累及多个认知领域，如学习、记忆、语言、执行功能、复杂注意力、知觉运动功能和社会认知功能，并导致患者日常生活、学习工作和社会交往能力明显减退。阿尔茨海默症是老年人中最常见的痴呆类型，占60%-80%。
髋部骨折：是指股骨近端骨折，主要包括股骨颈骨折和股骨转子间骨折，是中老年人常见的骨质疏松性骨折类型，具有高术后并发症发生率、高致残率、高致死率的特点。


背景：随着人口老龄化，合并痴呆的髋部骨折患者逐渐增加，给外科治疗带来挑战。

目的：明确痴呆对老年髋部骨折患者术后并发症的影响。
方法：分析2000-2019年在解放军总医院就诊的60岁以上首次髋部骨折患者，以入院时合并痴呆患者为研究对象，以年龄±5岁、性别、骨折类型为条件进行1∶10匹配非痴呆患者，比较两组术后并发症发生差异，包括肺炎、呼吸衰竭、胃肠道出血、泌尿系统感染、伤口感染、下肢深静脉血栓、肺栓塞、心绞痛、心律失常、心力衰竭、心肌梗死、脑卒中、死亡。采用多因素条件logistic回归评估痴呆对主要并发症的影响。

结果与结论：纳入2 887例患者，其中125例(4.3%)为痴呆患者，匹配 1 243例非痴呆患者。痴呆患者平均年龄为(80.6±7.4)岁，女性占64.8%，转子间骨折占53.6%，股骨颈骨折占46.4%。25例(20.0%)痴呆患者和123例(9.9%)非痴呆患者发生主要并发症(P < 0.01)。痴呆患者髋部骨折术后主要并发症发生风险为200.0/1 000 (95%CI，139.3-278.6)，非痴呆患者为99.0/1 000 (95%CI，83.6-116.9)。多因素条件logistic回归显示，痴呆患者髋部骨折术后主要并发症的发生风险是非痴呆患者的2倍(OR，2.11；95%CI，1.08-4.10)。结果可见，痴呆是老年髋部骨折患者发生术后并发症的独立危险因素。应对痴呆患者进行术前风险评估，开展相应的防治措施以减少术后并发症。

https://orcid.org/0000-0001-5026-7289 (江渝) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 老年, 髋部骨折, 痴呆, 手术, 并发症, 危险因素, 匹配, 队列研究

Abstract: BACKGROUND: The number of hip fracture patients with dementia is increasing with an aging population, posing challenges for surgical treatment. 
OBJECTIVE: To determine the effect of dementia on postoperative complications in older patients with hip fractures. 
METHODS: Patients aged over 60 years old with hip fractures from 2000 to 2019 at Chinese PLA General Hospital were included. Dementia patients with a preexisting diagnosis of dementia at admission were identified. Each dementia patient was matched, for age ± 5 years, gender, and fracture type with 10 non-dementia patients. The differences in postoperative complications were compared between the two groups, including pneumonia, respiratory failure, gastrointestinal bleeding, urinary tract infection, surgical site infection, deep venous thrombosis, pulmonary embolism, angina pectoris, arrhythmia, heart failure, myocardial infarction, stroke, and death. The impact of dementia on major complications was evaluated using multivariate conditional logistic regression. 
RESULTS AND CONCLUSION: A total of 2 887 patients were included, of whom 125 (4.3%) were dementia patients and matched with 1 243 non-dementia patients. The average age of dementia patients was (80.6±7.4) years; 64.8% were female; 53.6% were intertrochanteric fractures, and 46.4% were femoral neck fractures. Major complications occurred in 25 (20.0%) patients with dementia and 123 (9.9%) patients without dementia (P < 0.01). The risk of major complications was 200.0 per 1 000 persons (95%CI, 139.3-278.6) in dementia patients and 99.0 per 1 000 persons (95%CI, 83.6-116.9) in non-dementia patients. Multivariate conditional logistic regression showed that a 2-fold risk of major postoperative complications after hip fracture surgery was found in dementia patients than in those without dementia (adjusted OR, 2.11; 95%CI, 1.08-4.10). The results show that dementia is an independent risk factor for postoperative complications in elderly patients with hip fractures. Appropriate preoperative risk assessment and corresponding preventive and therapeutic measures should be given to this vulnerable population to mitigate postoperative complications.

Key words: older, hip fracture, dementia, surgery, complication, risk factor, matched, cohort study

中图分类号: