老年髋部骨折合并2型糖尿病术后延迟愈合的影响因素分析

Analysis of Factors Influencing Postoperative Fracture Healing in Elderly Patients with Hip Fractures and Type 2 Diabetes Mellitus

摘要: 目的：分析老年髋部骨折合并2型糖尿病患者术后预后的影响因素。方法：选取2017年1月1日至2024年2月1日在江苏省中医院骨伤科行股骨粗隆骨折内固定和股骨颈骨折内固定术合并2型糖尿病的154患者，参考骨折延迟愈合的标准，按照术后是否发生延迟愈合，将患者分为正常愈合组(Normal Union, NU) (100例)和延迟愈合组(Delayed Union, DU) (54例)。分析老年髋部骨折合并2型糖尿病术后延迟愈合的影响因素。结果：两组患者手术等待时间、住院时间、血红蛋白水平、Barthel自理评分和Harris髋关节评分存在统计学差异(P < 0.05)；DU组的患者中，术后1个月再入院、术后4个月再入院次数也显著高于NU组，差异具有统计学意义(P < 0.05)。发生术后并发症的DU组患者共31例，而NU组中发生术后并发症的患者仅有5例，存在显著统计学差异(P < 0.001)。多因素Logistic回归分析显示：术后并发症、住院时间、Barthel自理评分和Harris髋关节评分是老年髋部骨折合并2型糖尿病患者术后延迟愈合的相关影响因素(P < 0.05)。而吸烟史、术后1个月再次入院、术后4个月再次入院、手术等待时间和血红蛋白等指标对患者的术后愈合情况无显著影响(P > 0.05)。结论：术后并发症、住院时间、Barthel自理评分和Harris髋关节评分是老年髋部骨折合并2型糖尿病患者术后预后的相关影响因素，可指导临床制定个性化干预方案，优化患者预后。

Abstract: Objective: To analyze the factors influencing postoperative prognosis in elderly patients with hip fractures and type 2 diabetes mellitus (T2DM). Methods: A total of 154 patients with T2DM who underwent internal fixation for femoral trochanteric fractures or femoral neck fractures in the Department of Orthopedics and Traumatology at Jiangsu Provincial Hospital of Chinese Medicine between January 1, 2017, and February 1, 2024, were selected. Based on the criteria for delayed fracture union, patients were divided into a Normal Union (NU) group (100 cases) and a Delayed Union (DU) group (54 cases) according to their postoperative healing status. The factors influencing delayed union were analyzed. Results: Statistically significant differences (P < 0.05) were found between the two groups in terms of time to surgery, length of hospital stay, hemoglobin levels, Barthel Index score, and Harris Hip Score. The number of readmissions within 1 month and 4 months postoperatively was also significantly higher in the DU group compared to the NU group (P < 0.05). Postoperative complications occurred in 31 patients in the DU group, compared to only 5 patients in the NU group, showing a highly significant statistical difference (P < 0.001). Multivariate logistic regression analysis indicated that postoperative complications, length of hospital stay, Barthel Index score, and Harris Hip Score were influencing factors for delayed union in elderly hip fracture patients with T2DM (P < 0.05). Smoking history, readmission at 1 month, readmission at 4 months, time to surgery, and hemoglobin levels did not significantly affect postoperative healing outcomes (P > 0.05). Conclusion: Postoperative complications, length of hospital stay, Barthel Index score, and Harris Hip Score are influencing factors for postoperative prognosis in elderly patients with hip fractures and T2DM. These findings can guide the development of personalized clinical intervention plans to optimize patient outcomes.