【摘要】 目的：探讨术前等待时间与老年髋部骨折患者预后的关系。方法：回顾分析2014年1月至2018年12月行手术治疗的333例老年髋部骨折患者，其中男104例，女229例；年龄60～99(77.93±8.49)岁；股骨颈骨折183例，股骨转子间骨折150例；269例（80.78%）患者术前等待时间2～8 d，根据术前等待时间分为<4 d组（91例）和≥4 d组（242例）。电话随访患者生存情况，随访时间为骨折入院至患者死亡，或至研究截止日期（2019年12月31日）。采用Kaplan-Meier法进行生存分析，Cox风险比例模型分析影响老年髋部骨折预后的独立危险因素。结果：333例老年髋部骨折患者随访12～75个月，平均35个月，59例患者死亡，病死率为17.72%(59/333)，其中≥4 d死亡50例，病死率20.66%(50/242)明显高于4 d内死亡（9.89%,9/91）（χ~2=5.263,P=0.022）。多因素Cox回归分析显示术前等待时间，年龄，男性和Charlson合并症指数（Charlson comorbidity index,CCI）是老年髋部骨折预后的独立危险因素（均P<0.05）；其中每延迟1 d手术，老年髋部骨折患者的死亡风险增加5%[HR=1.05,95%CI(1.00-1.10),P=0.045]。按CCI指数分层分析，术前等待时间≥4 d组在CCI<2分患者群中病死率更高，差异有统计学意义（P<0.05）。结论：针对老年髋部骨折患者，即使大部分医院暂时无法在48 h内实施手术，也应该努力缩短术前等待时间，从而改善其预后。更多还原

【Abstract】 Objective:To investigate the relationship between preoperative waiting time and prognosis of elderly patients with hip fracture.Methods:From January 2014 to December 2018,333 elderly hip fracture patients undergoing surgery were retrospectively analyzed,including 104 males and 229 females,aged from 60 to 99 years with an average of(77.93±8.49)years,and 183 patients were femoral neck fracture,150 patients were femoral intertrochanteric fracture.Among them,269 patients(80.78%) had a clustered preoperative waiting time of 2 to 8 days,and then divided into within 4-day group(91 cases)and over 4-day group(242 cases) according to their preoperative waiting time.The survival situation was followed by telephone,and follow-up time started from fracture admission to the death event,or to the research deadline(December 31,2019).The Kaplan-Meier method was used for survival analysis,and Cox risk proportion model was used to analyze the independent risk factors of hip fracture in elderly patients.Results:All patients were followed up for 12 to 75 months(means 35 months),59 patients died and the mortality rate was 17.72%(59/3 33).Compared with within 4-day group,the mortality rate was higher in over 4-day group [20.66%(50/242) vs.9.89%(9/91),χ~2=5.263,P=0.022].Multiariable Cox regression analysis showed that preoperative waiting time,age,male and Charlson comorbidity index were independent risk factors for the prognosis of hip fracture in elderly patients(all P<0.05),and every 1-day delay was associated with 5% increase of the risk of death [HR=1.05,95% CI(1.00-1.10),P=0.045].Subsequent analyse was stratified according to the Charlson comorbidity index(CCI),and found that over 4-day group had a higher mortality rate in patients with CCI<2,with statistically significant difference(P<0.05).Conclusion:For elderly patients with hip fracture,most of hospitals could not complete the hip fracture surgery within48 hours,we also need to shorten the waiting time before surgery,and thereby improve their prognosis.更多还原