半髋关节置换和股骨近端防旋髓内钉内固定治疗高龄患者髋部骨折的风险评估
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摘要
背景:髋部骨折修复方式包括人工关节置换和股骨近端防旋髓内钉置入。Portsmouth死亡率和并发症发病率的生理学和手术严重程度评分系统(P-POSSU)是否能应用于骨科患者的术前风险评估其价值尚值得研究。目的:应用P-POSSUM评分系统比较不同植入物治疗老年髋部骨折的术前预测与实际病死率,探索P-POSSUM评分系统的临床应用价值。方法:通过病案室查找到郑州市骨科医院2016年1月至2017年1月收治70岁以上老年髋部骨折且经过手术治疗的患者病历共166例,根据内植物分为2组,其中半髋关节置换组85例股骨颈骨折患者全部行半髋关节置换(双极人工股骨头置换),股骨近端防旋髓内钉组81例股骨转子间骨折病例全部行闭合复位股骨近端防旋髓内钉内固定治疗。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。先计算出166例髋部骨折患者的总病死率,再分别计算出2组患者的实际病死率,然后通过用P-POSSUM评分系统算出总体患者及2组患者的预测病死率,对计算所得实际数据与预测数据进行对比分析。结果与结论:(1)70岁以上老年髋部骨折患者总体样本共166例(含12例死亡患者)的实际病死率为7.2%,P-POSSUM预测的病死率为5.4%;(2)半髋关节置换组85例患者(死亡4例)实际病死率为4.7%,通过P-POSSUM计算预测病死率为3.5%;(3)股骨近端防旋髓内钉组81例(死亡8例)患者实际病死率为9.9%,通过P-POSSUM计算预测病死率为6.2%;(4)以上实际病死率与P-POSSUM系统预测病死率进行统计学分析,差异均无显著性意义(P> 0.05);(5)证实P-POSSUM系统可以客观有效的预测高龄老年髋部骨折行半髋关节置换及股骨近端防旋髓内钉内固定患者的手术风险。
BACKGROUND: Methods of hip fracture repair include arthroplasty and proximal femoral nail antirotation placement. Whether Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity is feasible for risk assessment bef ore bone surgeries needs to be investigated. OBJECTIVE: To compare the preoperative prediction and actual mortality in senile hip fracture treated with different implants based on Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity, so as to explore the clinical application value of the scoring system. METHODS: One hundred and sixty-six cases of hip fractures with the age of above 70 years admitted in the Zhengzhou Orthopaedics Hospital from January 2016 to January 2017 were collected, and assigned into hemiarthroplasty group(bipolar artificial femoral head replacement, n=85, femoral neck fracture), and proximal femoral nail antirotation group(n=81, intertrochanteric fracture). All patients signed the informed consents, and the study was approved by the ethics committee of the hospital. The total mortality rate of 166 patients was calculated, and then the actual mortality rate in the two groups was calculated. The predictive mortality rate of all patients and two groups was calculated by Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity system. The actual and predictive data were compared and analyzed. RESULTS AND CONCLUSION:(1) The actual mortality rate of 166 patients(including 12 cases of death) was 7.2%, and the predictive mortality rate was 5.4%.(2) The actual mortality rate in the hemiarthroplasty group(totally 85 cases, 4 cases of death) was 4.7%, and the predictive mortality rate was 3.5%.(3) The actual mortality rate in the proximal femoral nail antirotation group(totally 81 cases, 8 cases of death) was 9.9%, and the predictive mortality rate was 6.2%.(4) There was no significant difference in the actual mortality rate and predictive mortality rate(P > 0.05).(5) In summary, Portsmouth-Physiological and Operative Severity Score system for the Enumeration of Mortality and Morbidity system can objectively and effectively predict the risk of the older adults with hip fractures undergoing hemiarthr oplasty and internal fixation of proximal femoral nail antirotation.
BACKGROUND: Methods of hip fracture repair include arthroplasty and proximal femoral nail antirotation placement. Whether Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity is feasible for risk assessment bef ore bone surgeries needs to be investigated. OBJECTIVE: To compare the preoperative prediction and actual mortality in senile hip fracture treated with different implants based on Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity, so as to explore the clinical application value of the scoring system. METHODS: One hundred and sixty-six cases of hip fractures with the age of above 70 years admitted in the Zhengzhou Orthopaedics Hospital from January 2016 to January 2017 were collected, and assigned into hemiarthroplasty group(bipolar artificial femoral head replacement, n=85, femoral neck fracture), and proximal femoral nail antirotation group(n=81, intertrochanteric fracture). All patients signed the informed consents, and the study was approved by the ethics committee of the hospital. The total mortality rate of 166 patients was calculated, and then the actual mortality rate in the two groups was calculated. The predictive mortality rate of all patients and two groups was calculated by Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity system. The actual and predictive data were compared and analyzed. RESULTS AND CONCLUSION:(1) The actual mortality rate of 166 patients(including 12 cases of death) was 7.2%, and the predictive mortality rate was 5.4%.(2) The actual mortality rate in the hemiarthroplasty group(totally 85 cases, 4 cases of death) was 4.7%, and the predictive mortality rate was 3.5%.(3) The actual mortality rate in the proximal femoral nail antirotation group(totally 81 cases, 8 cases of death) was 9.9%, and the predictive mortality rate was 6.2%.(4) There was no significant difference in the actual mortality rate and predictive mortality rate(P > 0.05).(5) In summary, Portsmouth-Physiological and Operative Severity Score system for the Enumeration of Mortality and Morbidity system can objectively and effectively predict the risk of the older adults with hip fractures undergoing hemiarthr oplasty and internal fixation of proximal femoral nail antirotation.
引文
[1]Neary WD,Heather BP,Earnshaw JJ.The physiological and operative severity score for the enumeration of mortality and morbidity(possum).Br J Surg.2003;90:157-165.
[2]Copeland GP Jones D,Walters M.POSSUM:a scoring system for surgical audit.Br J Surg.1991;78:355-360.
[3]Whiteley MS,Prytherch DR,Higgins B,et al.An evaluation of the POSSUM surgical scoring system.Br J of Surg.1996;83:812-815.
[4]白晓冬,李强,郭艾.POSSUM系统对老年患者骨科手术风险的预测研究[J].中国骨科肿瘤病,2009,8(3):149-153.
[5]Mohamed K,Copeland GP.An assessment of the POSSUMsystem in orthopaedic surgery.J Bone Joint Surg.2002;84-B:735-739.
[6]de Cássia Braga Ribeiro K,Kowalski LP.APACHE II,POSSUM,and ASA scores and the risk of perioperative complications in patients with oral or oropharyngeal cancer.Arch Otolaryngol Head Neck Surg.2003;129(7):739-745.
[7]Tekkis PP,Kocher HM,Kessaris NJ,et al.How accurate is POSSUM and p-POSSUM in predictingmortality in emergency surgery and in old age.Br J of Surg.2001;88(Supp l1):42-43.
[8]张延龄.外科患者的危机:重点介绍POSSUM评分系统[J].国外医学(外科学分册),2003,30(5):275.
[9]谷贵山,张德宝,白岩.P-POSSUM评分系统预测骨科手术风险的价值[J].中国骨肿瘤骨病,2006,5(1):42-48.
[10]Copeland GP,Sagar P,Brenaan J,et al.Risk-adjustd analysis of surgeon performance:a year study.Br J of Surg.1995;85:408-411.
[11]谷贵山,张博皓,李子川.POSS UM评分系统简介及在骨科推广应用的建议[J].中国骨肿瘤骨病,2005,4(3):172-174.
[12]饶忠,黄谦,周红菊.改良POSSUM评分系统预测老年烧伤患者术后并发症的价值[J].广西医科大学学报,2004,21(1):49-50.
[13]谷贵山,张德宝,孙乃坤,等.P-POSSUM和POSSUM评分系统预测老年髋关节置换死亡率和并发症发生率的对比研究[J].中国老年学杂志,2005,25(12):1440-1442.
[14]林岳平,林佩达,王友.高龄髋部骨折围手术期死亡原因及时间探讨[J].医学研究杂志,2007,36(9):77-79.
[15]Rose FR,Oreffo RO.Bone tissue engineering:hope vs hype.Biochem Biophys Res Commun.2002;292(1):1-7.
[16]Karres J,Heesakkers NA,Ultee JM,et al.Predicting 30-day mortality following hip fracture surgery:evaluation of six risk prediction models.Injury.2015;46(2):371-377.
[17]Toson B,Harvey LA,Close JC.The ICD-10 Charlson Comorbidity Index predicted mortality but not resource utilization following hip fracture.J Clin Epidemiol.2015;68(1):44-51.
[18]Makary MA,Segev DL,Pronovost PJ,et al.Frailty as a predictor of surgical outcomes in older patients.J Am Coll Surg.2010;210(6):901-908.
[19]van Zeeland ML,Genovesi IP,Mulder JW,et al.POSSUM predicts hospital mortality and long-term survival in patients with hip fractures.J Trauma.2011;70(4):E67-72.
[20]Merad F,Baron G,Pasquet B,et al.Prospective evaluation of in-hospital mortality with the P-POSSUM scoring system in patients undergoing major digestive surgery.World J Surg.2012;36(10):2320-2327.
[21]Midwinter MJ,Ashley S.An evaluation of the POSSUMsurgical scoring system.Br J Surg.Br J Surg.1996;83(11):1653.
[22]Revenig LM,Canter DJ,Taylor MD,et al.Initial results of a large multidisciplinary prospective study examining pre-operative variables predictive of poor surgical outcomes.J Am Coll Surg.2013.
[23]Sohail I,Jonker L,Stanton A,et al.Physiological POSSUM as an indicator for long-term survival in vascular surgery.Eur JVasc Endovasc Surg.2013;46(2):223-226.
[24]Menendez ME,Neuhaus V,van Dijk CN,et al.The elixhauser comorbidity method outperforms the charlson index in predicting inpatient death after orthopaedic surgery.Clin Orthop Relat Res.2014;472(9):2878-2886.
[25]Hu F,Jiang C,Shen J,et al.Preoperative predictors for mortality following hip fracture surgery:A systematic review and meta-analysis.Injury.2012;43(6):676-685.
[26]Gunasekera N,Boulton C,Morris C,et al.Hip fracture audit:the Nottingham experience.Osteoporos Int.2010;21(Suppl4):S647-653.
[27]Brooks MJ,Sutton R,Sarin S.Comparison of Surgical Risk Score,POSSUM and p-POSSUM in higher‐risk surgical patients.Br J Surg.2005;92(10):1288-1292.
[28]Makary MA,Segev DL,Pronovost PJ,et al.Frailty as a predictor of surgical outcomes in older patients.J Am Coll Surg.2010;210(6):901-908.
[29]Wright DM,Blanckley S,Stewart GJ,et al.The use of orthopaedic POSSUM as an audit tool for fractured neck of femur.Injury.2008;39(4):430-435.
[30]Moppett IK,Parker M,Griffiths R,et al.Nottingham Hip Fracture Score:longitudinal and multi-assessment.Br JAnaesth.2012;109(4):546-550.
[2]Copeland GP Jones D,Walters M.POSSUM:a scoring system for surgical audit.Br J Surg.1991;78:355-360.
[3]Whiteley MS,Prytherch DR,Higgins B,et al.An evaluation of the POSSUM surgical scoring system.Br J of Surg.1996;83:812-815.
[4]白晓冬,李强,郭艾.POSSUM系统对老年患者骨科手术风险的预测研究[J].中国骨科肿瘤病,2009,8(3):149-153.
[5]Mohamed K,Copeland GP.An assessment of the POSSUMsystem in orthopaedic surgery.J Bone Joint Surg.2002;84-B:735-739.
[6]de Cássia Braga Ribeiro K,Kowalski LP.APACHE II,POSSUM,and ASA scores and the risk of perioperative complications in patients with oral or oropharyngeal cancer.Arch Otolaryngol Head Neck Surg.2003;129(7):739-745.
[7]Tekkis PP,Kocher HM,Kessaris NJ,et al.How accurate is POSSUM and p-POSSUM in predictingmortality in emergency surgery and in old age.Br J of Surg.2001;88(Supp l1):42-43.
[8]张延龄.外科患者的危机:重点介绍POSSUM评分系统[J].国外医学(外科学分册),2003,30(5):275.
[9]谷贵山,张德宝,白岩.P-POSSUM评分系统预测骨科手术风险的价值[J].中国骨肿瘤骨病,2006,5(1):42-48.
[10]Copeland GP,Sagar P,Brenaan J,et al.Risk-adjustd analysis of surgeon performance:a year study.Br J of Surg.1995;85:408-411.
[11]谷贵山,张博皓,李子川.POSS UM评分系统简介及在骨科推广应用的建议[J].中国骨肿瘤骨病,2005,4(3):172-174.
[12]饶忠,黄谦,周红菊.改良POSSUM评分系统预测老年烧伤患者术后并发症的价值[J].广西医科大学学报,2004,21(1):49-50.
[13]谷贵山,张德宝,孙乃坤,等.P-POSSUM和POSSUM评分系统预测老年髋关节置换死亡率和并发症发生率的对比研究[J].中国老年学杂志,2005,25(12):1440-1442.
[14]林岳平,林佩达,王友.高龄髋部骨折围手术期死亡原因及时间探讨[J].医学研究杂志,2007,36(9):77-79.
[15]Rose FR,Oreffo RO.Bone tissue engineering:hope vs hype.Biochem Biophys Res Commun.2002;292(1):1-7.
[16]Karres J,Heesakkers NA,Ultee JM,et al.Predicting 30-day mortality following hip fracture surgery:evaluation of six risk prediction models.Injury.2015;46(2):371-377.
[17]Toson B,Harvey LA,Close JC.The ICD-10 Charlson Comorbidity Index predicted mortality but not resource utilization following hip fracture.J Clin Epidemiol.2015;68(1):44-51.
[18]Makary MA,Segev DL,Pronovost PJ,et al.Frailty as a predictor of surgical outcomes in older patients.J Am Coll Surg.2010;210(6):901-908.
[19]van Zeeland ML,Genovesi IP,Mulder JW,et al.POSSUM predicts hospital mortality and long-term survival in patients with hip fractures.J Trauma.2011;70(4):E67-72.
[20]Merad F,Baron G,Pasquet B,et al.Prospective evaluation of in-hospital mortality with the P-POSSUM scoring system in patients undergoing major digestive surgery.World J Surg.2012;36(10):2320-2327.
[21]Midwinter MJ,Ashley S.An evaluation of the POSSUMsurgical scoring system.Br J Surg.Br J Surg.1996;83(11):1653.
[22]Revenig LM,Canter DJ,Taylor MD,et al.Initial results of a large multidisciplinary prospective study examining pre-operative variables predictive of poor surgical outcomes.J Am Coll Surg.2013.
[23]Sohail I,Jonker L,Stanton A,et al.Physiological POSSUM as an indicator for long-term survival in vascular surgery.Eur JVasc Endovasc Surg.2013;46(2):223-226.
[24]Menendez ME,Neuhaus V,van Dijk CN,et al.The elixhauser comorbidity method outperforms the charlson index in predicting inpatient death after orthopaedic surgery.Clin Orthop Relat Res.2014;472(9):2878-2886.
[25]Hu F,Jiang C,Shen J,et al.Preoperative predictors for mortality following hip fracture surgery:A systematic review and meta-analysis.Injury.2012;43(6):676-685.
[26]Gunasekera N,Boulton C,Morris C,et al.Hip fracture audit:the Nottingham experience.Osteoporos Int.2010;21(Suppl4):S647-653.
[27]Brooks MJ,Sutton R,Sarin S.Comparison of Surgical Risk Score,POSSUM and p-POSSUM in higher‐risk surgical patients.Br J Surg.2005;92(10):1288-1292.
[28]Makary MA,Segev DL,Pronovost PJ,et al.Frailty as a predictor of surgical outcomes in older patients.J Am Coll Surg.2010;210(6):901-908.
[29]Wright DM,Blanckley S,Stewart GJ,et al.The use of orthopaedic POSSUM as an audit tool for fractured neck of femur.Injury.2008;39(4):430-435.
[30]Moppett IK,Parker M,Griffiths R,et al.Nottingham Hip Fracture Score:longitudinal and multi-assessment.Br JAnaesth.2012;109(4):546-550.