髖部骨折老年病人手術後存活狀況之危險因素探討

Risk factors of survival after surgery in elderly patients with hip fracture

吳佳燕(Chia-Yen Wu)

指導教授 ： 黃貴薰

國立臺灣大學/醫學院/護理學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.01148

摘要

髖部骨折是導致老年人活動失能及高死亡率的重要因素之一，不但造成老年人生活相當大的負向衝擊，更耗費龐大醫療成本，對於後續照護之醫療資源亦不可小覷。目前手術是治療髖部骨折的主要方法，但由於影響髖部骨折手術後存活之危險因子相當多元，因之本研究藉由探討影響髖部骨折老年病人，手術後存活之預測因子，希能提供提供臨床照護之參考。
本研究採二次資料分析，研究資料收集期間為2004年4月至2006年1月，收案標準為≧60歲，初次發生低能量性創傷導致之髖部骨折，且無入住機構之老年人，於骨折後求治於臺北市某醫學中心，並接受髖部手術治療。本研究共收集217位符合條件之對象，同時配合2008年行政院衛生署國民健康局之死亡統計資料，利用Kaplan- Meier method分析髖部骨折老年人手術後存活時間，並以Log-Rank test分析各變項與存活率間之關係，再以Cox迴歸模式分析影響手術後存活之預後因子。
研究結果發現：老年人發生髖部骨折以年紀大於80歲的女性居多，手術後一年之存活率為87.6％，男性不論在手術後一年或手術後4.8年，其死亡率相較高於女性。經多變項Cox迴歸分析結果發現，影響手術後一年存活之重要預測因子，為男性、不識字者與身體質量指數≦20; 而在影響手術後4.8年存活之重要預測因子則為男性、不識字者、身體質量指數≦20、骨質密度T≦-2.16和ADLs有困難者等五個變項。 另外在存活率之分析結果方面，研究結果也發現教育程度與MMSE之時間定向感構面，對於手術後一年及4.8年之存活率影響具顯著意義，但在手術後死亡風險之影響則不具統計意義。

關鍵字

髖部骨折老年病人 ； 存活率 ； 危險因子

並列摘要

Hip fracture is one of major factor leading to morbidity and mortality in the elders. It causes negative impacts on older people’s lives and also costs enormous medical expenses. Previous studies has shown that older adults with hip fracture have a relatively higher risk of death. Currently, surgery is the primary treatment for hip fracture but there are several factors to influence post-surgery survival rate. In this study, we aim to explore some risk factors which could be used to predict the survival outcome in patients with hip fractures after surgery treatment.
This study used secondary analysis, the original data was collected from Apil 2004 to January 2006. The inclusion criteria were noninstitutionalized patients with age ≧ 60 years old and who had first low-trauma hip fractures treated by surgery in Taipei’s medical center was eligible. In this study, 217 patients were recuited and data analysis was combined with death of statistical data from Bureau of health promotion, department of health in Taiwan. Survival rate of post-surgery was analyzed by using Kaplan- Meier method. To analyize the influence factors of survival rate, Log-Rank test was performed for each variable. Cox proportional hazard models were used to calculate the hazard ratios (HRs) of the factors with regard to mortality.
Our data showed that hip fracture more commonly occurs in elder women with age over 80 years old. One-year survival rate of post-surgery was 87.6% in all subjects. For gender comparison, one-year and 4.8-year survival rate of post- surgery were all significant lower in men than those in women. From multivariate Cox regression analysis, we found that predictors for one-year survival rate of post-surgery were male, illiterate and body mass index (BMI) less than 20. For 4.8-year survival rate of post- surgery, there was five predictors which included male, illiterate, BMI≦20, T score of bone density≦-2.16 and ADLs difficult. In addition, we also noted that education and MMSE both reveal significant associations with one-year and 4.8-year survival rate, but no significant association with death-risk post-surgery.

並列關鍵字

elders with hip fracture ； survival rate ； risk factor

參考文獻

李瑋君、韓岳津、吳英黛、曹昭懿（2007）．骨質疏鬆相關骨折住院病患之健保申報分析．臺灣醫學，11（1），21-28。

林士程、李春松、鄭雅之、江秋蓉、陳怡家、侯清正…陳伯毅（2007）．老年髖部骨折住院病患的營養評估．台灣醫學，11（5），476-482。

林茂榮、王夷暐（2004）．社區老人跌倒的危險因子與預防．臺灣醫學雜誌，123（4），259-271。

洪秀娟、楊榮森、曹昭懿（2005）．台灣髖部骨折之流行病學．臺灣醫學，9（1），29-38。

胡愈寧、 酈欽菁、李佳、林榮輝、胡國琦（2009）．老年人各項日常生活活動功能與自評健康狀態之調查及相關性探討．臺灣復健醫學會雜誌，37（2），107-114。