中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (15): 3920-3928.doi: 10.12307/2026.727

• 骨科植入物Orthopedic implants • 上一篇    下一篇

老年髋部骨折术后二次骨折发生危险因素分析

喇  瑞，吴  乾，张中泰，徐  五，丁庆丰，张志刚，蒋定华，黄立新，王晟昊   

  1. 苏州大学附属第一医院骨科，江苏省苏州市  215006
  • 接受日期:2025-06-27 出版日期:2026-05-28 发布日期:2025-11-07
  • 通讯作者: 王晟昊，博士，主治医师，苏州大学附属第一医院骨科，江苏省苏州市 215006 共同通讯作者：黄立新，副教授，博士生导师，主任医师，苏州大学附属第一医院骨科，江苏省苏州市 215006
  • 作者简介:第一作者：喇瑞，男，1998年生，新疆维吾尔自治区乌鲁木齐市人，汉族，硕士，医师，主要从事关节外科与运动医学方面的研究。 共同第一作者：吴乾，男，1995年生，江苏省无锡市人，汉族，博士，医师，主要从事骨关节与运动医学方面的研究。
  • 基金资助:
    国家自然科学基金项目(82102619)，项目负责人：王晟昊；江苏省中医药科技发展计划项目(ZD202232)，项目负责人：黄立新

Analysis of risk factors for secondary fractures after hip fracture surgery in the elderly

La Rui, Wu Qian, Zhang Zhongtai, Xu Wu, Ding Qingfeng, Zhang Zhigang, Jiang Dinghua, Huang Lixin, Wang Shenghao   

  1. Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
  • Accepted:2025-06-27 Online:2026-05-28 Published:2025-11-07
  • Contact: Wang Shenghao, PhD, Attending physician, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China Huang Lixin, Associate professor, Doctoral supervisor, Chief physician, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
  • About author:La Rui, MS, Physician, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China Wu Qian, MD, Physician, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China La Rui and Wu Qian contributed equally to this article.
  • Supported by:
    National Natural Science Foundation of China, No. 82102619 (to WSH); Jiangsu Provincial Traditional Chinese Medicine Science and Technology Development Project, No. ZD202232 (to HLX)

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摘要：

文题释义：

髋部骨折：主要包括股骨颈骨折和股骨转子间骨折，好发于老年人群，多在患者遭受低能量暴力如平地跌倒或扭伤时发生，易发生肺炎、压疮和血栓等危险并发症，死亡率高，为改善预后多主张采取手术治疗。
危险因素：指个体具有的、可增加某种疾病或不良健康事件发生概率的生物特征、环境暴露或行为习惯等。

摘要
背景：二次骨折已逐渐成为老年髋部骨折患者术后最棘手的健康威胁，然而目前对于二次骨折的发生情况及危险因素的研究结论仍存在争议。
目的：探究老年髋部骨折患者术后二次骨折的发生情况及发生部位分布，进一步探究术后二次骨折的危险因素。
方法：回顾性分析2018年1月至2020年12月因初次股骨颈骨折或股骨转子间骨折于苏州大学附属第一医院行手术治疗的573例60-85岁患者。根据末次随访时患者二次骨折的发生情况将患者分为二次骨折组和无二次骨折组，比较两组间各指标的差异，并将可能有意义的指标纳入多因素Logistic回归分析以探究术后二次骨折的独立危险因素。
结果与结论：①老年髋部骨折患者术后二次骨折的发生率为20.2%(116/573)；二次骨折的发生部位及比例为：下肢骨折68例，占比58.6%；脊柱骨折33例，占比28.5%；上肢骨折15例，占比12.9%；②基线资料比较显示，二次骨折组和无二次骨折组患者在年龄、脑血管疾病史、帕金森病病史、术前前白蛋白水平、初次髋部骨折损伤机制、健侧Singh指数分级和术后早期行动能力方面差异有显著性意义(P < 0.05)；③多因素Logistic回归分析显示帕金森病病史(OR=3.00，95%CI=1.05-8.43，P=0.036)和术后早期行动需帮助(OR=2.78，95%CI=1.39-5.51，P=0.003)是二次骨折的独立危险因素；④提示老年髋部骨折患者术后二次骨折的发生率不低，未来应加强对患者，特别是合并帕金森病病史患者的多学科联合管理，并坚持推进加速康复外科策略，从而降低二次骨折的发生。



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, 二次骨折, Logistic回归分析, 危险因素, 血管疾病, 帕金森病

Abstract: BACKGROUND: Secondary fracture has gradually become the most problematic postoperative health threat in elderly hip fracture patients. However, the findings on the occurrence of secondary fracture and risk factors are still controversial.
OBJECTIVE: To investigate the incidence and distribution of postoperative secondary fractures in elderly patients with hip fractures, and to further investigate the risk factors for postoperative secondary fractures in these patients.
METHODS: A total of 573 patients aged 60-85 years who underwent surgical treatment at the First Affiliated Hospital of Soochow University for initial femoral neck fracture or intertrochanteric femoral fracture between January 2018 and December 2020 were retrospectively analyzed. Patients were categorized into the secondary fracture group and the no secondary fracture group according to the occurrence of secondary fracture at the final follow-up. The differences in indicators between the two groups were compared, and indicators that might be meaningful were included in multivariate logistic regression analysis to explore the independent risk factors for postoperative secondary fracture.
RESULTS AND CONCLUSION: (1) The incidence of postoperative secondary fractures in elderly hip fracture patients was 20.2% (116/573). The sites and proportions of secondary fractures were as follows: 68 lower extremity fractures, accounting for 58.6%; 33 spine fractures, accounting for 28.5%; and 15 upper extremity fractures, accounting for 12.9%. (2) Comparison of baseline data showed that there was a significant difference between patients in the secondary fracture group and patients in the group without secondary fracture in terms of age, history of cerebrovascular disease, history of Parkinson's disease, preoperative prealbumin level, mechanism of injury for the initial hip fracture, Singh index grading on the healthy side, and early postoperative mobility (P < 0.05). (3) Multivariate logistic regression analysis showed that history of Parkinson's disease (OR=3.00, 95%CI=1.05-8.43, P=0.036) and need for assistance in early postoperative mobility (OR=2.78, 95%CI=1.39-5.51, P=0.003) were independent risk factors for secondary fractures. (4) The incidence of postoperative secondary fractures in elderly hip fracture patients is not low. In the future, multidisciplinary co-management of patients, especially those with a history of comorbid Parkinson's disease, should be strengthened and enhanced recovery after surgery strategy should be persistently promoted to reduce the incidence of secondary fractures.

Key words: elderly, hip fracture, secondary fracture, Logistic regression analysis, risk factor, vascular disease, Parkinson's disease

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