目的:已知股骨颈骨折(FNF)具有显著的发病率和死亡率。多种慢性疾病(MCC)被定义为存在两种或多种慢性疾病,这些疾病极大地影响了老年人的生活质量。这项研究的目的是探讨MCC和Charlson合并症指数(CCI)对FNF患者手术结局的影响。
方法:选择接受关节置换手术的FNF患者进行本研究。同时患有两种或多种疾病的患者分为两组:MCC组和非MCC(NMCC)组。计算CCI以评估MCC组患者合并症的严重程度。基线数据,手术细节,并对两组患者的预后相关指标进行分析比较。采用Spearman相关分析评估CCI与住院时间的关系,哈里斯得分,骨骼肌指数(SMI),和年龄。单因素和多因素logistic回归分析确定FNF患者术后1年和5年死亡的危险因素。
结果:共103例患者纳入MCC组,而NMCC组由40例患者组成。然而,MCC组的患者年龄较大,肌肉减少症的发病率较高,和较低的SMI值(p<0.001)。MCC组患者住院时间较长,哈里斯得分较低,重症监护病房(ICU)入院率较高,和更高的并发症发生率(p=0.045,p=0.035,p=0.019,p=0.010)。Spearman相关分析显示,CCI与住院时间、年龄呈正相关(p<0.001,p<0.001)。与Harris评分和SMI值呈负相关(p<0.001,p<0.001)。单因素和多因素logistic回归分析显示MCC患者1年和5年死亡率较高。住院时间是FNF患者关节置换术后1年死亡的危险因素(p<0.001),而CCI和年龄被确定为术后5年死亡的危险因素(p<0.001,p<0.001)。Kaplan-Meier生存分析结果显示,两组MCC和NMCC患者的死亡时间差异有统计学意义(p<0.001)。Cox比例风险模型分析显示,CCI、年龄和SMI是影响患者死亡的危险因素。
结论:MCC患者的手术预后,CCI与FNF有关。CCI越高,患者功能越差,长期死亡风险越高。
OBJECTIVE: Femoral neck fractures (FNF) are known to have significant morbidity and mortality rates. Multiple chronic conditions (MCC) are defined as the presence of two or more chronic diseases that greatly affect the quality of life in older adults. The aim of this study is to explore the impact of MCC and Charlson comorbidity index (CCI) on surgical outcomes in patients with FNF.
METHODS: Patients with FNF who underwent joint replacement surgery were selected for this study. Patients who had two or more diseases simultaneously were divided into two groups: the MCC group and the non-MCC (NMCC) group. The CCI was calculated to assess the severity of patients\' comorbidities in the MCC group. Baseline data, surgical details, and prognosis-related indicators were analyzed and compared between the two patient groups. Spearman correlation analysis was performed to assess the relationship between CCI and length of hospital stay, Harris score, skeletal muscle index (SMI), and age. Univariate and multivariate logistic regression analysis was conducted to identify the risk factors for mortality in FNF patients at 1 and 5 years after surgery.
RESULTS: A total of 103 patients were included in the MCC group, while the NMCC group consisted of 40 patients. However, the patients in the MCC group were found to be older, had a higher incidence of sarcopenia, and lower SMI values (p < 0.001). Patients in the MCC group had longer hospitalization times, lower Harris scores, higher intensive care unit (ICU) admission rates, and higher complication rates (p = 0.045, p = 0.035, p = 0.019, p = 0.010). Spearman correlation analysis revealed that CCI was positively correlated with hospitalization and age (p < 0.001, p < 0.001), while it was negatively correlated with Harris score and SMI value (p < 0.001, p < 0.001). Univariate and multivariate logistic regression analysis demonstrated that MCC patients had higher 1-year and 5-year mortality rates. Hospitalization time was identified as a risk factor for death in FNF patients 1 year after joint replacement (p < 0.001), whereas CCI and age were identified as risk factors for death 5 years after surgery (p < 0.001, p < 0.001). Kaplan-Meier survival analysis results showed that the difference in death time between the two groups of patients with MCC and NMCC was statistically significant (p < 0.001). Cox proportional hazard model analysis showed that CCI, age and SMI were risk factors affecting patient death.
CONCLUSIONS: The surgical prognosis of patients with MCC, CCI and FNF is related. The higher the CCI, the worse the patient\'s function and the higher the long-term risk of death.