| 易张辉,马小刚,刘震宁,等.西藏地区股骨转子间骨折手术质量评估及术后死亡的影响因素分析.骨科,2026,17(3): 237-242. |
| 西藏地区股骨转子间骨折手术质量评估及术后死亡的影响因素分析 |
| Evaluation of surgical quality and analysis of factors affecting postoperative mortality for elderly femoral intertrochanteric fractures in Tibet |
| 投稿时间：2026-01-11 |
| DOI：10.3969/j.issn.1674-8573.2026.03.007 |
| 中文关键词: 手术满意度 侧位复位质量 年龄 术后死亡 骨折复位及固定标准 股骨转子间骨折 |
| 英文关键词: Surgical satisfaction Lateral reduction quality Age Postoperative mortality Fracture reduction and fixation criteria Femoral intertrochanteric fracture |
| 基金项目:西藏自治区自然科学基金组团式医学援藏项目[XZ2023ZR-ZY16（Z）] |
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| 中文摘要: |
| 目的 评估西藏地区股骨转子间骨折的手术质量，并分析术后1年死亡的危险因素。方法 通过回顾文献制定股骨转子间骨折复位及固定的评分系统，选取2018年1月至2022年12月于西藏自治区人民医院骨科应用髓内钉手术治疗的老年股骨转子间骨折患者作为研究对象，共纳入患者95例，年龄为（73.72±8.07）岁，评估其手术满意率。收集并筛选可能影响术后死亡的指标，包括患者因素5项、手术因素7项、骨折复位及固定评价指标6项和手术满意度，统计分析这些因素与患者术后1年是否死亡的相关性。结果 所有患者均获得术后1年的随访。依据制定的骨折复位及固定标准评分后得到手术“满意”58例、“可接受”24例、“不满意”13例，满意率为61.1%。术后1年死亡9例（死亡率9.5%），各项指标的单因素分析结果显示年龄、美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级、侧位复位情况和手术满意度的组间差异有统计学意义（P＜0.05）。侧位复位情况与手术满意度存在共线性，结合考虑临床重要性，最终选取年龄、ASA分级、手术满意度、术前血红蛋白水平、术前白蛋白水平和手术时间进行Logistic回归分析，结果显示手术满意度、年龄是患者术后1年死亡的影响因素（P＜0.05）。结论 基于本研究的评分系统获得的“手术满意度”和年龄是西藏地区老年股骨转子间骨折患者术后1年死亡的影响因素，而侧位复位质量是该评分系统中与死亡关联尤为密切的关键指标，提高手术质量与预后改善相关。 |
| 英文摘要: |
| Objective To evaluate the surgical quality in patients with femoral intertrochanteric fractures in the Tibet region and analyze the risk factors for one-year postoperative mortality. Methods A scoring system for reduction and fixation of femoral intertrochanteric fracture was developed based on literature review. Elderly patients with femoral intertrochanteric fractures treated with intramedullary nailing in Tibet Autonomous Region People's Hospital from January 2018 to December 2022 were included. A total of 95 patients were included, with age of 73.72±8.07 years, and the surgical satisfaction was assessed. Possible factors affecting postoperative mortality were collected, including 5 patient-related factors, 7 surgery-related factors, 6 reduction and fixation evaluation indicators, and surgical satisfaction. The correlation between these factors and 1 year postoperative mortality was statistically analyzed. Results All patients were followed up for 1 year postoperatively. Based on the established reduction and fixation criteria, surgical quality were rated as “satisfactory” in 58 cases, “acceptable” in 24 cases, and “unsatisfactory” in 13 cases, yielding a satisfaction rate of 61.1%. Nine patients died within 1 year after surgery (mortality rate 9.5%). Univariate analysis showed that age, American Society of Anesthesiologists (ASA), lateral reduction quality, and surgical satisfaction were statistically significant (P＜0.05). Taking into consideration the collinearity existing between lateral reduction quality and surgical satisfaction, and others clinically important factors, age, ASA, surgical satisfaction, preoperative hemoglobin level, preoperative albumin level, and operative time were ultimately included in Logistic regression analysis. The results revealed surgical satisfaction and age were the influencing factors for patients mortality at 1 year postoperation (P＜0.05). Conclusion Surgical satisfaction obtained from the scoring system in this study and age are risk factors for 1 year postoperative mortality in elderly patients with femoral intertrochanteric fractures. The lateral reduction quality is a key indicator in this scoring system that is significantly associated with mortality. Improving surgical quality is associated with better prognosis. |
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