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首页> 外文期刊>Journal of orthopaedics and traumatology: official journal of the Italian Society of Orthopaedics and Traumatology >Neck of femur fractures in the over 90s: a select group of patients who require prompt surgical intervention for optimal results
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Neck of femur fractures in the over 90s: a select group of patients who require prompt surgical intervention for optimal results

机译：超过90年代的股骨颈骨折：一组需要及时手术干预以取得最佳效果的患者

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class="Heading">Background class="Para">Patients in the extremes of old age with a femoral neck fracture represent a challenging subgroup, and are thought to be associated with poorer outcomes due to increased numbers of comorbidities. Whilst many studies are aimed at determining the optimum time for surgical fixation, there is no agreed consensus for those over 90. The aim of this study is to report the surgical outcome of this population, to understand the role surgical timing may have on operative outcomes using the orthopaedic POSSUM scoring system and to identify whether medical optimization occurs during the period of admission before surgery. class="Heading">Materials and methods class="Para">We conducted a prospective observational study; data was collected from two district general hospitals over 32 consecutive months. All patients aged 90 and above who were deemed suitable for surgical fixation were included. Each one had their orthopaedic POSSUM score calculated at admission and at surgery, using their computerised and paper medical records. Assessment of outcome was based on morbidity and mortality at 30?days. class="Heading">Results class="Para">A total of 146 consecutive patients above the age of 90 underwent surgery and were followed. The average age of the patients was 93?years, 123 (84?%) were female and 23 (16?%) male. Sixty-one patients were operated on within 24?h from admission, 52 patients within 24 and 48?h and 33 had surgery after 48?h from admission. In total, 21 deaths (14.4?%) were recorded and 81 patients (55.5?%) had a post-operative complication within 30?days. The orthopaedic POSSUM scoring system predicted 30-day mortality in 23 patients and morbidity in 83 patients. This gave observed to predicted ratios of 0.91 and 0.98 respectively. Overall, there was a small improvement in physiological scores taken just prior to surgery compared to those at admission. Mortality and morbidity rates were higher for those operated on or after 24 and 48-h cutoffs compared to those proceeding to surgery within 24?h (P?=?0.071 and P?=?0.021 respectively and P?=?0.048 and P?=?0.00011 respectively). When stratified according to their POSSUM scores, patients with scores of 41+ and surgery after 48?h had a significantly higher mortality rate than if they had surgery earlier (P?=?0.038). Morbidity rates rose after 24?h of surgical delay (P?=?0.026). Patients with a total POSSUM score between 33 and 40 exhibited a higher morbidity after a 24-h delay to surgery (P?=?0.0064). class="Heading">Conclusion class="Para">As life expectancy increases, older patients are becoming commoner in our hospital systems. We believe the orthopaedic POSSUM scoring system can be used as an adjuvant tool in prioritising surgical need, and allow for a more impartial evaluation when changes to practice are made. Our findings show that timing of surgery has an important bearing on mortality and morbidity after hip surgery, and older patients with higher orthopaedic POSSUM scores are sensitive to delays in surgery.
机译：class =“ Heading”>背景 class =“ Para”>患有股骨颈骨折的高龄患者代表了一个具有挑战性的亚组，并被认为与增加有关的预后较差合并症的数量。尽管许多研究旨在确定最佳的手术固定时间，但对于90岁以上的人群尚无共识。该研究的目的是报告该人群的手术结局，以了解手术时机对手术结局的影响使用骨科的POSSUM评分系统，并确定手术前入院期间是否进行了医学优化。 class =“ Heading”>材料和方法 class =“ Para”>我们进行了前瞻性观察研究;连续32个月从两家地区综合医院收集数据。包括所有被认为适合手术固定的90岁及以上的患者。每个人在入院时和手术时都使用其计算机化的和书面的医疗记录来计算其骨科的POSSUM评分。对结局的评估是基于30天时的发病率和死亡率。 class =“ Heading”>结果 class =“ Para”>总共146名90岁以上的连续患者进行了手术并得到了随访。患者的平均年龄为93岁，女性为123岁（84％），男性为2​​3岁（16％）。入院后24小时内接受手术的患者为61例，入院后24和48小时内接受手术的患者为52例，入院48小时后接受手术的患者为33例。总共记录了21例死亡（14.4％），81例患者（55.5％）在30天内出现了术后并发症。骨科POSSUM评分系统预测23例患者的30天死亡率和83例患者的发病率。观察到的预测比率分别为0.91和0.98。总体而言，与入院时相比，手术前取得的生理评分略有改善。与在24小时之内进行手术的患者相比，在24小时和48小时之内或之后进行手术的患者的死亡率和发病率更高（ P ？=？0.071和 P ？=？0.021和 P ？=？0.048和 P ？=？分别为0.00011）。根据POSSUM评分进行分层时，得分≥41且在48小时后手术的患者的死亡率要比早于手术的患者高得多（ P ？=？0.038 ）。手术延迟24小时后发病率上升（ P ？=？0.026）。总POSSUM评分在33到40之间的患者在手术延迟24小时后表现出更高的发病率（ P ？=？0.0064）。 class = “标题“>结论 class =” Para“>随着预期寿命的延长，老年患者在我们的医院系统中变得越来越普遍。我们认为，骨科POSSUM评分系统可以作为辅助工具，用于优先考虑外科手术需求，并且可以在进行实践更改时进行更公正的评估。我们的研究结果表明，手术时机对髋关节手术后的死亡率和发病率具有重要影响，而骨科POSSUM评分较高的老年患者对手术延迟敏感。

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