Osteoporotik kalça kırığı nedeniyle opere olan hastaların risk faktörleri yönünden değerlendirilmesi
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Tarih
2021
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Osteoporotik kalça kırığı geçiren bireylerin operasyon sonrası 6 aylık dönemde ambulasyon, mortalite sıklığı ve yeni gelişen kırık açısından değerlendirilmesi; hastanın osteoporoz risk faktörleri ile mortalite ve morbidite ilişkisinin incelenmesi amaçlanmıştır.
Gereç ve yöntem: Çalışmamıza osteoporotik kalça kırığı nedeniyle Ege Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı’nca opere edilen hastalar alınmıştır. 79’u kadın, 26’sı erkek olmak üzere toplam 105 hasta çalışmaya dahil edilmiştir. Tüm hastalar yaş, cinsiyet, boy, kilo eğitim durumu, yeni kırık gelişimi, hastanın ambulasyon durumu, daha önce başka kırık geçirip geçirmediği, ek hastalıkları, kullandığı ilaçlar, sigara ve alkol tüketimi, erken menopoza giriş, ebeveynlerinde kırık öyküsü, eşlik eden osteoporotik kırık varlığı, varsa önceden yapılmış olan kemik ölçümleri, D vitamini ölçümü, PTH düzeyi, osteoporoz nedeniyle almış olduğu tedaviler ve tedaviye uyum açısından değerlendirilmiştir. Kırık sonrası 6. Ayda hastalar mortalite, ambulasyonu durumu açısından tekrar kontrol edilmiştir.
Bulgular: Toplam 105 hastanın 25’i ilk altı ayda vefat etmiştir. Vefat eden hastalar tüm hastaların %23,8’ini oluşturmaktadır. Ölümlerin %4’ü yatış sırasında, %24’ü taburculuk sonrası ilk ayda, %72’si 2 ila 6’ncı aylar arasında gerçekleşmiştir. Toplam 49 hastada kontrol vertebra grafisi çekilebilmiş ve grafi çekilen hastaların %89,8’inde osteoporotik vertebra kırığı tespit edilmiştir. Hastaların %49,5’i kırık öncesi ambulasyona destek olarak yardımcı cihaz kullanırken, kırık sonrası altıncı ayda bu oran %92’ye yükselmiştir. İmmobil hasta oranı kırık öncesi %1,9 iken, kırık sonrası hastaların %31,4’ü immobil hale gelmiştir. Kırık öncesi hastaların %36’sı bağımsız ambule iken, kırık sonrası altıncı ayda hastaların %15’i bağımsız ambule hale gelmiştir. Tekli regresyon analizinde yaş, sigara kullanım öyküsü, FRAX kalça skoru ve Modifiye Charlson komorbidite indeksi (CKİ) ile mortalite ilişkisi istatiksel olarak anlamlı bulunmuştur. Çoklu regresyon analizinde vücut kitle indeksi (VKİ) ve sigara kullanım öyküsü ile mortalite ilişkisi istatiksel olarak anlamlı bulunmuştur. Sonuç: Osteoporoz sık görülen ve komplikasyon gelişene kadar bulgu vermeyen bir hastalıktır. Kırık gelişen hastalarda fonksiyonel kayıp ve ölüm riski yüksek olmaktadır. Bu yüzden kırık gelişmeden hastalar tespit edilip tedavileri düzenlenmelidir. Ayrıca osteoporotik kalça kırığı gelişen bireyler, tüm dünyada yaygınlaşmaya başlayan fraktür liyezyon servislerinde tedavileri düzenlenerek takip edilirlerse mortalite ve morbiditede azalma sağlanabilir.
Objective: To evaluate the relationship between patients with osteoporotic hip fractures and their ambulation, mortality frequency and new fracture in the 6-month postoperative period; also, the relationship between osteoporosis risk factors and mortality/ morbidity of the patients. Material and method: We have included a total of 105 patients (79 women; 26 men), who were operated for osteoporotic hip fractures at the Ege University Faculty of Medicine Orthopedics and Traumatology Department in this study. We evaluated age, gender, height, weight, educational status, new fracture development, ambulation status, whether there was any previous fracture, additional diseases, medications used, smoking and alcohol consumption, early menopause, history of fractures in parents, accompanying osteoporotic fracture, bone mineral density, if any, blood vitamin D and parathormone levels, the treatments he received for osteoporosis and compliance with the treatment of all patients. At the 6th month after the fracture, the patients were evaluated again in terms of mortality and ambulation status. Results: 25 of 105 patients in total died in the first six months. Deceased patients constitute 23.8% of all patients. 4% of deaths occurred during hospitalization, 24% in the first month after discharge, and 72% between 2 and 6 months. Control vertebral x-ray was obtained in 49 patients in total and osteoporotic vertebral fractures were detected in 89.8% of the patients who had radiography. While 49.5% of the patients were using an assistive device before fracture, this rate increased to 92% in the sixth month after fracture. Rate of immobile patients was 1.9%, but after the fracture this rate became 31.4%. 38 patients were ambulatory before the fracture, on the other hand only 16 patients were ambulatory in the sixth month after the fracture. According to single regression analysis, the relationship between age, smoking history, FRAX hip score and Modified Charlson comorbidity index (CCI) and mortality was found to be statistically significant. In the multiple regression analysis, the relationship between body mass index (BMI) and smoking history and mortality was found to be statistically significant. Conclusion: Osteoporosis is a common disease that does not show any symptoms until complications develop. Functional loss and mortality risk are high in patients with fractures. Therefore, patients should be identified and treated before fractures develop. In addition, if individuals with osteoporotic hip fractures are followed up in fracture liaison services, which are becoming widespread worldwide, mortality and morbidity can be reduced.
Objective: To evaluate the relationship between patients with osteoporotic hip fractures and their ambulation, mortality frequency and new fracture in the 6-month postoperative period; also, the relationship between osteoporosis risk factors and mortality/ morbidity of the patients. Material and method: We have included a total of 105 patients (79 women; 26 men), who were operated for osteoporotic hip fractures at the Ege University Faculty of Medicine Orthopedics and Traumatology Department in this study. We evaluated age, gender, height, weight, educational status, new fracture development, ambulation status, whether there was any previous fracture, additional diseases, medications used, smoking and alcohol consumption, early menopause, history of fractures in parents, accompanying osteoporotic fracture, bone mineral density, if any, blood vitamin D and parathormone levels, the treatments he received for osteoporosis and compliance with the treatment of all patients. At the 6th month after the fracture, the patients were evaluated again in terms of mortality and ambulation status. Results: 25 of 105 patients in total died in the first six months. Deceased patients constitute 23.8% of all patients. 4% of deaths occurred during hospitalization, 24% in the first month after discharge, and 72% between 2 and 6 months. Control vertebral x-ray was obtained in 49 patients in total and osteoporotic vertebral fractures were detected in 89.8% of the patients who had radiography. While 49.5% of the patients were using an assistive device before fracture, this rate increased to 92% in the sixth month after fracture. Rate of immobile patients was 1.9%, but after the fracture this rate became 31.4%. 38 patients were ambulatory before the fracture, on the other hand only 16 patients were ambulatory in the sixth month after the fracture. According to single regression analysis, the relationship between age, smoking history, FRAX hip score and Modified Charlson comorbidity index (CCI) and mortality was found to be statistically significant. In the multiple regression analysis, the relationship between body mass index (BMI) and smoking history and mortality was found to be statistically significant. Conclusion: Osteoporosis is a common disease that does not show any symptoms until complications develop. Functional loss and mortality risk are high in patients with fractures. Therefore, patients should be identified and treated before fractures develop. In addition, if individuals with osteoporotic hip fractures are followed up in fracture liaison services, which are becoming widespread worldwide, mortality and morbidity can be reduced.
Açıklama
Anahtar Kelimeler
Osteoporoz, Kalça Kırığı, Risk Faktörleri, Mortalite, Ambulasyon, Osteoporosis, Hip Fracture, Risk Factors, Mortality, Ambulation
