Kalça Grafilerinde Vasküler Kalsifikasyon Varlığı İntertrochanterik Femur Kırığında Postoperatif Mortalite Öngörücüsü Müdür?

Yıl 2022, , 365 - 372, 31.08.2022

Harun Altınayak , Yavuz Selim Karatekin

https://doi.org/10.24938/kutfd.1105541

Öz

Amaç: Altmış beş yaş üstü intertrokanterik femur kırığı (İTFK) olan hastalarda radyolojik femoral arteryel kalsifikasyon (FAC) varlığı ile sağ kalım arasındaki ilişkiyi araştırmayı amaçladık.

Gereç ve Yöntemler: 2014-2019 yılları arasında, unstabil İTFK tanısı ile kısa proksimal femur çivisi (PFN) kullanılarak ameliyat edilen 303 hasta retrospektif olarak değerlendirildi. Araştırma verileri elektronik hasta kayıt sistemi kullanılarak preoperatif anestezi kayıtları ve hasta tıbbi kayıtlarından elde edildi. Ölüm kayıtları ulusal nüfus yönetim sisteminden elde edildi. Röntgenografilerde FAC tespit edilen hastalar çalışma grubunu, tespit edilemeyen hastalar kontrol grubunu oluşturdu. Yaş, cinsiyet, ASA skoru, CCİ Skoru, hastanede yatış süresi, yoğun bakımda yatış süresi, ameliyata kadar bekleme süresi, kan replasmanı, ameliyat sonrası yoğun bakım gereksinimi ve ilk 30 gün, ilk 1 yıl ve genel mortalite oranları değerlendirildi.

Bulgular: Yüz on yedi (%38.6) hastada FAC tespit edilirken 186 (%61.4) hastada FAC tespit edilmedi. Çalışma grubundaki hastalar daha yaşlıydı (p<0.05) ve erkek cinsiyet daha fazlaydı (p<0.001). Gruplar arasında yapılan karşılaştırmada ASA sınıfı ve CCİ’i toplam puanı arasında istatistiksel olarak anlamlı fark tespit edilmiştir (p<0.05). Gruplar arasında hastanede yatış süresi, yoğun bakımda yatış süresi, ameliyata kadar bekleme süresi, kan replasmanı ve ameliyat sonrası yoğun bakım gereksinimi açısından istatistiksel olarak anlamlı fark tespit edilmedi (p>0,05). FAC varlığı genel mortalite ve operasyon sonrası ilk 1 aylık mortalite açısından karşılaştırıldığında istatistiksel olarak anlamlı fark tespit edilmiştir (p<0.05). FAC olan hastalarda genel mortalite riski 1.63 kat, ilk 1 ayda mortalite riski 1.99 kat ve ilk 1 yıl mortalite riski 1.57 kat artmıştır.

Sonuç: Çalışmamız, FAC varlığının kısa PFN ile osteosentez yapılan yaşlı İTFK’lı hastalarda mortalite öngörücüsü olarak değerlendirilebileceğini göstermiştir.

Anahtar Kelimeler

Arteriyel kalsifikasyon, Kalça kırığı, mortalite, yaşlı

Destekleyen Kurum

Araştırmanın tüm giderleri çalışmacılar tarafından karşılanmıştır. Gerçek yada tüzel kişilerden herhangi bir fon alınmamıştır.

Proje Numarası

Araştırma herhangi bir proje altında gerçekleşmemiştir.

IS THE PRESENCE OF VASCULAR CALCIFICATION IN HIP X-RAYS A PREDICTOR OF POSTOPERATIVE MORTALITY IN INTERTROCHANTERIC FRACTURE OF THE FEMUR?

Öz

Objective: We aimed to investigate the relationship between the presence of radiological femoral arterial calcification (FAC) and mortality in patients over 65 years of age with intertrochanteric femur fracture (ITFC).

Material and Methods: Between 2014 and 2019, 303 patients diagnosed with ITFC who were operated on using a short proximal femoral nail (PFN) were evaluated retrospectively. Research data were obtained from preoperative anesthesia records and patient medical records using the electronic patient record system. Death records were obtained from the national population management system. Patients with FAC detected in roentgenography formed the study group, and patients in whom it could not be detected constituted the control group. Age, gender, ASA score, waiting time until surgery, need for postoperative intensive care, length of stay in the intensive care unit, and the first 30 days, first-year and general mortality rates were evaluated.

Results: While FAC was detected in 117 (38.6%) patients, FAC was not detected in 186 (61.4%) patients. The patients in the study group were older (p<0.05), and the male population was more prominent (p<0.001). A statistically significant difference was found between the ASA scores compared between the groups (p<0.05). There was no statistically significant difference between the groups regarding waiting time until surgery, need for postoperative intensive care, and length of stay in the intensive care unit (p>0.05). A statistically significant difference was found when the presence of FAC was compared in terms of overall mortality and postoperative first-month mortality (p<0.05). In patients with FAC, the overall mortality risk increased 1.63 times, the risk of mortality in the first one month increased 1.99 times and the risk of mortality in the first one year increased 1.57 times.

Conclusion: Our study showed that the presence of FAC could be evaluated as a predictor of mortality in elderly patients with ITFC who underwent osteosynthesis with short PFN.

Anahtar Kelimeler

Arterial calcification, Hip fracture, mortality, elderly

Proje Numarası

Araştırma herhangi bir proje altında gerçekleşmemiştir.

Kaynakça

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