49—老年髋部骨折术后对侧髋部再骨折的危险因素分析北仑人民医院贺振年.doc

老年髋部骨折术后对侧髋部再骨折的危险因素分析 贺振年，徐洪伟，康信勇，顾杰，李永甫，郭剑，张斌 （宁波市北仑区人民医院，浙江，宁波，315800） 摘　要 目的：探讨老年髋部骨折术后再发对侧髋部再骨折的相关危险因素，为预防二次髋部骨折提供临床依据。方法：回顾性分析2008年12月~2014年2月北仑区378例老年髋部初次骨折患者的资料，32例患者发现对侧髋部再骨折。根据患者术后有无对侧髋部骨折分为骨折组和无骨折组，比较两组患者的年龄、性别、初次骨折类型、内固定方式、卧床时间、骨质疏松情况、合并内科疾病情况、术后功能锻炼、治疗的依从性、生活环境（农村/城市）和末次随访时Harris评分，对于P＜0.05的因素进行logistic回归性分析。结果：骨折组与无骨折组的年龄、骨质疏松情况、合并内科疾病情况、术后功能锻炼、医疗依从性及末次随访时Harris评分比较差异均有统计学意义（P＜0.05）。多因素logistic分析结果显示：骨质疏松（OR=6.793，P=0.001）、高龄（OR=4.170，P=0.002)、合并内科疾病（OR=3.828，P=0.005）、术后功能锻炼（OR=0.297，P=0.005）以及医疗依从性（OR=0.295，P=0.007）是老年髋部骨折术后对侧髋部再骨折的主要危险因素。结论：老年髋部骨折术后对侧再骨折主要危险因素是高龄、骨质疏松、合并内科疾病、术后功能锻炼和医疗依从性。术后需加强抗骨质疏松治疗、积极治疗内科疾病，坚持功能锻炼，以预防髋部再次骨折的发生。 关键词 髋骨折；再骨折；老年；风险因素 Analysis of the risk factors of the contra-lateral hip re-fractures after hip fracture in elderly patients Zhennian He,Hongwei Xu,Xinyong Kang,Jie Gu,Yongfu Li,Jian Guo,Bin Zhang Beilun district peoples hospital of Ningbo,Ning Bo,Zhe Jiang,315800 ABSTRACT Objective: To analyze the related factors of the contra-lateral hip re-fractures after hip fractures in elderly patients, in order to provide basis for the prevention of secondary fractures. Methods: A retrospective study was conducted of the 378 elderly patients with hip fracture who had been treated at our department from December 2008 through February 2014 in Beilun district. Along them, 32 patients had the re-fractures of the contra-lateral hip. They were divided into a re-fracture group and no-re-fracture group according to presence or absence of re-fracture of the contra-lateral hip after surgery. Aged, gender, fracture type, internal fixation type, bed time, osteoporosis, combined disease, postoperative functional training, theraphy compliance，living environment（rural/town）and Harris score at the last follow-up were compared between patients with or without re-fractures．Factors with P＜0.05 were analyzed by multivariate logistic regression. Results: There were significant differences between the refracture group and the no-fracture group in age,