【摘要】 目的:比较新型诊疗模式下保守治疗与手术治疗老年髋部骨折的中长期疗效。方法:回顾性分析2015年5月至2017年4月收治的老年髋部骨折患者,按年龄、性别、骨折类型、查尔斯合并症指数(CCI)、是否存在心律失常等因素对保守治疗的患者和手术治疗的患者进行匹配,共纳入71例保守治疗患者和71例手术治疗患者,比较两组患者各时期死亡率、死亡原因、出院后患者日常活动能力等。结果:两组患者术前基线资料差异无统计学意义(P均>0.05),最短随访1382 d,最长随访2092 d,中位随访时间1644 d。在新型诊疗模式下手术治疗的老年髋部骨折患者在术后各时期死亡率均低于保守治疗患者,1年死亡率分别为11.3%和29.6%,3年死亡率分别为28.2%和45.1%,末次随访时死亡率分别为35.2%和70.0%,差异均有统计学意义(P=0.007、0.037、0.001)。两组患者的主要死亡原因均为肺部感染和心血管事件,保守治疗患者因肺部感染和压疮死亡的比例高于手术治疗患者,骨折后保守治疗组43.7%的患者没有活动能力,而手术治疗组仅5.6%的患者没有活动能力。结论:对于老年髋部骨折患者,新型诊疗模式下手术治疗的中长期疗效明显优于保守治疗,尽早手术治疗仍是首选的治疗手段。更多还原

【Abstract】 Objective: To compare medium and long-term outcomes between operative and non-operative treatment for geriatric hip fracture under geriatric orthopaedic co-management. Methods: This is a retrospective comparative study in geriatric hip fracture patients treated from May 2015 to April 2017. After match of age, gender, fracture type, Charlson comorbidity index(CCI) and the presence of arrhythmia, 71 patients with operative treatment and 71 patients with nonoperative treatment were included. The mortality, causes of death, and daily activities were compared between two groups.Results: There was no significant difference in baseline data between the two groups(P>0.05). The median follow-up time was1644 d(range, 1382-2092 d). The mortality of operative group was significantly lower than that of non-operative group at oneyear(11.3% vs 29.6%), three-year(28.2% vs 45.1%), and final follow-up(35.2% vs 70.0%)(P=0.007, 0.037 and 0.001). The main causes of death in the two groups were lung infection and cardiovascular events. The proportion of death due to lung infection and pressure sore in nonoperative patients was higher than that in operative patients. After fracture, 43.7% of nonoperative patients had no activity ability, while only 5.6% operative patients had no activity ability. Conclusions: For geriatric hip fracture, medium-and long-term outcome of operative treatment is significantly better than nonoperative treatment under geriatric orthopaedic co-management. Early operation is still the first-line treatment.更多还原