بررسی نتایج کوتاه مدت و بلند مدت مرتبط با مرگ ومیردر شکستگی های ناحیه هیپ افراد بالای 65 سال

ﻫﺪف: ﻫﺪف اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮرﺳﯽ ﻣﯿﺰان اﺛﺮﻋﻮاﻣﻞ ﻣﺨﺘﻠﻒ در ﭘﯿﺶآﮔﻬﯽ ﺑﯿﻤﺎران ﻣﺴﻦ ﺑﺎ ﺷﮑﺴﺘﮕﯽ ﻧﺎﺣﯿﮥ ﻫﯿﭗ اﺳﺖ ﺗﺎ ﺑﺎ ﭘﯿﺶﺑﯿﻨﯽ دﻗﯿﻖﺗﺮ از ﭘﯿﺶآﮔﻬﯽ، اﻧﺘﺨﺎب ﻧﻮع درﻣﺎن ﺟﺮاﺣﯽ ﯾﺎ ﻏﯿﺮﺟﺮاﺣﯽ ﺑﺮای ﭘﺰﺷﮏ و ﺑﯿﻤﺎر راﺣﺖﺗﺮ ﺷﻮد. روش اﺟﺮا و ﻣﻮاد ﻣﻮرد اﺳﺘﻔﺎده: اﯾﻦ ﻣﻄﺎﻟﻌﮥ اﭘﯿﺪﻣﯿﻮﻟﻮژﯾﮏ ﺑﺮ روی ﺑﯿﻤﺎران ﺑﺎ ﺳﻦ ﺑﯿﺸﺘﺮ از 65 ﺳﺎل ﮐﻪ ﺑﺎ ﺗﺸﺨﯿﺺ ﺷﮑﺴﺘﮕﯽ ﻧﺎﺣﯿﮥ ﻫﯿﭗ در ﻃﯽ ﯾﮏ ﺳﺎل ﻣﺮاﺟﻌﻪ ﮐﺮده اﻧﺪ اﻧﺠﺎم ﺷﺪ. ﻣﺘﻐﯿﺮﻫﺎی ﻣﺴﺘﻘﻞ ﺷﺎﻣﻞ ﺟﻨﺲ، ﺳﻦ ﺑﯿﻤﺎر، ﺑﯿﻤﺎریﻫﺎی ﻫﻤﺰﻣﺎن، زﻣﺎن ﺳﭙﺮی ﺷﺪه از ﺷﮑﺴﺘﮕﯽ ﺗﺎ ﺟﺮاﺣﯽ و ﻧﻮع ﺑﯿﻬﻮﺷﯽ ﺑﻮد. در ﻣﻮرد ﻣﺘﻐﯿﺮﻫﺎی واﺑﺴﺘﻪ، اﻣﺘﯿﺎز ﺑﺎرﺗﻞ، ﻣﺮگ و ﻣﯿﺮ ﺑﻌﺪ از ﻋﻤﻞ و ﻧﻮع روش درﻣﺎن ارزﯾﺎﺑﯽ ﺷﺪ. ﯾﺎﻓﺘﻪﻫﺎ: 163 ﻧﻔﺮ ﺑﺎ ﺳﻦ ﻣﺘﻮﺳﻂ 78/7±7/7 ﺳﺎل و ﺑﺎزه‌ ﺳﻨﯽ 65 ﺗﺎ 97 ﺳﺎل وارد اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ. اﯾﻦ ﮔﺮوه ﺷﺎﻣﻞ 91 زن 55.8 % و 72 ﻣﺮد 44.2% ﺑﻮد. ﺑﯿﺸﺘﺮﯾﻦ ﺗﻌﺪاد ﺑﯿﻤﺎران در ﺑﺎزه‌ ﺳﻨﯽ 76 ﺗﺎ 85 ﺳﺎل 48% ﻗﺮار داﺷﺖ. ﺗﻌﺪاد ﻣﺮگ و ﻣﯿﺮ در ﺑﯿﻤﺎراﻧﯽ ﮐﻪ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮاﺣﯽ ﻗﺮار ﻧﮕﺮﻓﺘﻪ ﺑﻮدﻧﺪ در ﻣﺎه ﻧﺨﺴﺖ ﭘﺲ از ﺷﮑﺴﺘﮕﯽ، در ﺷﮑﺴﺘﮕﯽ ﮔﺮدن ﻓﻤﻮر 3ﻧﻔﺮ 11.5% و در ﺷﮑﺴﺘﮕﯽ اﯾﻨﺘﺮﺗﺮوﮐﺎﻧﺘﺮﯾﮏ ﻧﯿﺰ 3 ﻧﻔﺮ 11/5 ﺑﻮد. ﺗﻌﺪاد ﻣﺮگ و ﻣﯿﺮ ﭘﺲ از 11 ﻣﺎه ﭘﯽﮔﯿﺮی، در ﺷﮑﺴﺘﮕﯽ ﮔﺮدن ﻓﻤﻮر ﯾﮏ ﻧﻔﺮ 3%/8 و در ﺷﮑﺴﺘﮕﯽ اﯾﻨﺘﺮﺗﺮوﮐﺎﻧﺘﺮﯾﮏ 3 ﻧﻔﺮ 11.5% ﺑﻮد. ﺗﻌﺪاد ﻣﺮگ و ﻣﯿﺮ در ﺑﯿﻤﺎراﻧﯽ ﮐﻪ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮاﺣﯽ ﻗﺮار ﮔﺮﻓﺘﻪ ﺑﻮدﻧﺪ در ﻣﺎه ﻧﺨﺴﺖ ﭘﺲ از ﺷﮑﺴﺘﮕﯽ، در ﺷﮑﺴﺘﮕﯽ ﮔﺮدن ﻓﻤﻮر 7 ﻧﻔﺮ 1.5% و در ﺷﮑﺴﺘﮕﯽ اﯾﻨﺘﺮﺗﺮوﮐﺎﻧﺘﺮﯾﮏ 10 ﻧﻔﺮ 7.3% ﺑﻮد. ﺗﻌﺪاد ﻣﺮگ و ﻣﯿﺮ ﭘﺲ از 11 ﻣﺎه ﭘﯽﮔﯿﺮی، در ﺷﮑﺴﺘﮕﯽ ﮔﺮدن ﻓﻤﻮر 4 ﻧﻔﺮ 9.2% و در ﺷﮑﺴﺘﮕﯽ اﯾﻨﺘﺮﺗﺮوﮐﺎﻧﺘﺮﯾﮏ 12 ﻧﻔﺮ 8.8% ﺑﻮد. ﻧﺘﯿﺠﻪﮔﯿﺮی: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ﻣﯿﺰان ﻣﻮرﺗﺎﻟﯿﺘﯽ ﺑﺮای ﻫﺮ دو ﻧﻮع ﺷﮑﺴﺘﮕﯽ و ﻫﻤﭽﻨﯿﻦ درﻣﻘﺎﯾﺴﻪ دوﻧﻮع ﺷﮑﺴﺘﮕﯽ ﺑﺎﻫﻢ در ﻃﯽ ﻣﺎه اول ﭘﺲ از اﯾﺠﺎد ﺷﮑﺴﺘﮕﯽ در ﺑﯿﻦ ﺑﯿﻤﺎران ﻧﺴﺒﺖ ﺑﻪ 11 ﻣﺎه ﺑﻌﺪ از آن از ﻧﻈﺮ آﻣﺎری ﺗﻔﺎوت ﻣﻌﻨﺎدار ﻧﺪاﺷﺖ. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺳﻦ ﺑﯿﻤﺎران ﯾﮏ ﻓﺎﮐﺘﻮر ﺗﻌﯿﯿﻦ ﮐﻨﻨﺪه‌ ﻣﻬﻢ ﻣﯿﺰان ﻣﺮگ و ﻣﯿﺮ ﺑﻮد، ﺑﻪ ﮔﻮﻧﻪای ﮐﻪ ﺑﺎ اﻓﺰاﯾﺶ ﺳﻦ، ﻣﯿﺰان ﻣﻮرﺗﺎﻟﯿﺘﯽ ﻧﯿﺰ اﻓﺰاﯾﺶ ﭘﯿﺪا ﻣﯽﮐﺮد، وﻟﯽ ﻧﻮع ﺟﻨﺴﯿﺖ در اﻓﺰاﯾﺶ ﻣﺮگ و ﻣﯿﺮ ﻣﺆﺛﺮ ﻧﺒﻮد. در ﺑﯿﻤﺎراﻧﯽ ﮐﻪ ﺟﺮاﺣﯽ ﺷﺪه ﺑﻮدﻧﺪ، ﻣﯿﺎﻧﮕﯿﻦ زﻣﺎن ﺳﭙﺮی ﺷﺪه ﺑﯿﻦ اﯾﺠﺎد ﺷﮑﺴﺘﮕﯽ ﺗﺎ اﻧﺠﺎم ﻋﻤﻞ ﺟﺮاﺣﯽ در ﺑﯿﻤﺎراﻧﯽ ﮐﻪ ﻓﻮت ﮐﺮده ﺑﻮدﻧﺪ ﻧﺴﺒﺖ ﺑﻪ ﮐﺴﺎﻧﯽ ﮐﻪ ﭘﺲ از ﺟﺮاﺣﯽ ﺗﺎ ﯾﮏ ﺳﺎل زﻧﺪه ﻣﺎﻧﺪﻧﺪ ﺗﻔﺎوت ﻣﻌﻨﺎداری ﻣﺸﺎﻫﺪه ﻧﺸﺪ. ﻫﻤﭽﻨﯿﻦ ﻧﻮع ﺑﯿﻬﻮﺷﯽ ﺑﻪ ﮐﺎر رﻓﺘﻪ ﺗﻔﺎوت ﻣﻌﻨﺎداری در ﻣﯿﺰان ﻣﻮرﺗﺎﻟﯿﺘﯽ ﯾﮏﻣﺎﻫﻪ و ﯾﮏﺳﺎﻟﻪ ﺑﯿﻤﺎران ﺟﺮاﺣﯽ ﺷﺪه اﯾﺠﺎد ﻧﮑﺮد. ﺑﺮرﺳﯽ اﻣﺘﯿﺎز ﺑﺎرﺗﻞ در ﺑﯿﻤﺎران ﻧﺸﺎن داد ﮐﻪ ﮐﺎﻫﺶ اﻣﺘﯿﺎز ﺑﺎرﺗﻞ ﺑﺎ اﻓﺰاﯾﺶ ﻣﯿﺰان ﻣﻮرﺗﺎﻟﯿﺘﯽ در ﺑﯿﻤﺎران ﺷﮑﺴﺘﮕﯽ ﻫﯿﭗ ﻫﻤﺮاه اﺳﺖ ﮐﻪ ﺑﯿﺎﻧﮕﺮ اﻫﻤﯿﺖ روشﻫﺎی ﺑﻬﻨﺮ ﺗﺜﺒﯿﺖ ﺷﮑﺴﺘﮕﯽ، راهاﻧﺪازی و ﺑﺎزﺗﻮاﻧﯽ زودﺗﺮ ﺑﯿﻤﺎر اﺳﺖ.

evaluation of short-term and long-term outcomes related to mortality in hip fractures in people over 65 years of age

objective: the aim of this study was to evaluate the effect of various factors on the prognosis of elderly patients with hip fractures to make it easier for physicians and patients to choose the type of surgical or non-surgical treatment with more accurate prognosis.methods and materials used: this epidemiological study was performed on patients older than 65 years who presented with a diagnosis of hip fracture within one year. independent variables including sex, age of the patient, concomitant diseases, time elapsed from fracture to surgery and type of anesthesia were evaluated for bartel score, postoperative mortality and type of treatment.results: the mean age of the study population 163 people was 7.7 ± 78.7- with the age range of 65-97 which included 91 women 55.8% and 72 men 44.2% . the highest number of our patients was in the age range of 76 to 85 years 48% . the number of deaths in patients who did not undergo surgery in the first month after the fracture was 3 1 11.5 in femoral neck fractures and 3 5 11.5 in intracentric fractures. in the next eleven months of follow-up, mir had one patient 8 3.8 in femoral neck fractures and three patients 11.5 ٪ in intracentric fractures.conclusion: in this study, the age of patients was an important determinant of mortality, so that mortality has increased with age, but the type of gender is not effective in increasing mortality.