ABSTRACT
Objective:To investigate the clinical characteristics and prognosis of hip fractures in patients aged 90 and over.Methods:Clinical data of hip fracture patients aged 90 years and older admitted to Beijing Hospital from January 2016 to June 2020 were retrospectively analyzed.Patients were divided into a surgical treatment group and a conservative treatment group according to treatment received.Mortality and walking function 30 days and 1 year after injury were followed up.The mortality and walking function 1 year after injury in the two groups of patients were compared and analyzed, and related factors affecting the 1-year mortality rate of the surgical treatment group were analyzed.Results:Eventually 114 cases were included, with 18 in the conservative treatment group and 96 in the surgical treatment group.There were no significant differences in age, sex, American Society of Anesthesiologists(ASA)score, comorbidities, fracture type, hemoglobin, total protein, albumin and coagulation function at admission, walking ability before injury, and length of stay between the two groups(all P>0.05). Of the 18 conservatively treated patients, 9 died within 1 year(50.0%). Among 96 surgically treated patients, 20 died within 1 year(20.8%). The difference between the two groups was statistically significant( χ2=6.789, P=0.016). Among the 9 patients who survived 1 year after injury under conservative treatment, 1(11.1%)was able to walk independently, 2(22.2%)were able to walk with a walker, and 6(66.7%)were unable to walk; Among the 76 surviving patients 1 year after injury under surgical treatment, 16(21.1%)were able to walk independently, 50(65.8%)were able to walk with a walker, and 10(13.1%)were unable to walk.There was a statistically significant difference in walking ability between the two groups( χ2=20.030, P<0.001). Univariate analysis results showed that ASA score, walking ability before injury and total protein were correlated with 1-year mortality after injury( χ2 or t=5.803, -2.176, 29.400, all P<0.05). Multivariate logistic regression results showed that the inability to walk independently before injury was an independent risk factor for death within 1 year after injury[ HR(95% CI)=15.95(4.42-57.55), P<0.001]. Conclusions:The prognosis of surgical treatment of hip fractures in patients aged 90 and over is better than that of conservative treatment.The inability to walk independently before injury is an independent risk factor for death within 1 year after injury.
ABSTRACT
RESUMO Objetivo: comparar dados clínicos, laboratoriais e densitométricos de pacientes com osteoartrose e com fratura do colo femoral. Métodos: estudo transversal de pacientes com fratura do colo femoral e osteoartrose do quadril, submetidos à artroplastia de quadril. Dados clínicos, laboratoriais e densitométricos foram coletados. Resultados: cinquenta e três pacientes foram incluídos, 22 com fraturas do colo femoral e 31 com osteoartrose. Pacientes com fratura do colo do fêmur apresentaram maior idade do que os pacientes com osteoartrose, tendo valores de IMC, densidade mineral óssea e força de preensão palmar (pacientes sarcopênicos) inferiores, estando mais incapacitados neurologicamente e apresentando um pior escore ASA. Entre os vários parâmetros bioquímicos analisados, diferenças estatisticamente significantes foram encontrados no cálcio sérico total, cálcio ionizado, vitamina D, tiroxina livre, eritrócitos, hemoglobina, hematócrito, glóbulos brancos totais, neutrófilos, linfócitos e creatinina entre os dois grupos. Outros hormônios analisados e parâmetros bioquímicos não diferiram significativamente, apesar de mostrarem tendências entre os dois grupos. Conclusão: pacientes com fraturas do colo do fêmur são mais idosos do que pacientes com osteoartrose, apresentam um menor peso e IMC, são mais debilitados, muitos com anemia e massa óssea reduzida, além de terem uma diminuição significativa no cálcio total, cálcio ionizado, vitamina D e creatinina e um aumento significativo na tiroxina livre.
ABSTRACT Objective: to compare clinical, laboratory and densitometric data from patients with osteoarthrosis and femoral neck fractures. Methods: we conducted a cross-sectional study of patients with femoral neck fracture and hip osteoarthrosis submitted to hip arthroplasty. We collected clinical, laboratory and densitometric data. Results: we included 53 patients, 22 with femoral neck fractures and 31 with osteoarthrosis. Patients with femoral neck fractures were older than patients with osteoarthrosis, with lower BMI values, bone mineral density and palmar grip strength (sarcopenic patients), being more neurologically impaired and presenting a worse ASA score. Among the various biochemical parameters analyzed, we found statistically significant differences in total serum calcium, ionized calcium, vitamin D, free thyroxine, erythrocytes, hemoglobin, hematocrit, total white blood cells, neutrophils, lymphocytes and creatinine between the two groups. Other hormones analyzed and biochemical parameters did not differ significantly, although they showed trends between the two groups. Conclusion: patients with femoral neck fractures are older than patients with osteoarthrosis, have a lower weight and BMI, are more debilitated, many with anemia and reduced bone mass, and have a significant decrease in total calcium, ionized calcium, vitamin D and creatinine and a significant increase in free thyroxine.