“胸部下巴征”，如何预测髋部骨折患者术后死亡率？

老龄患者脆性骨折对社会造成巨大的医疗负担，对该类骨折手术治疗需常规摄胸片，国外学者观察到老年人虚弱患者可能无法有效抬起头部，摄片时会出现下颌骨贴近胸骨表现，可能预测术后患者虚弱程度和短期死亡率，并进行了相关研究。

上述结果发表在2021.06 Injury期刊上。

Introduction（介绍）

脆性骨折是一个重大的公共卫生挑战，经常因身体虚弱而发生。识别有不良后果风险增加的患者可以帮助治疗团队适当地管理这些患者。我们假设入院胸片中患者头部与肺野重叠的外观，称为股骨颈胸部下巴征（Chin on Chest in Neck of Femur sign (COCNOF))是术后3个月、6个月和12个月死亡率增加的预测因素

[Introduction: Fragility fractures are a significant public health challenge often occurring as a result of frailty. Identifying patients who have increased risk of adverse outcomes can aid treating teams in managing these patients appropriately. We hypothesise that the appearance of the patient’s head overlapping the lung fields (named Chin on Chest in Neck of Femur sign (COCNOF)) in the admission chest radiograph was a predictor of increased mortality at 3, 6 and 12 months.]

Methods（方法）

对2019年1月1日至12月31日期间所有连续收治的髋部骨折患者进行分析。我们收集了患者特征、AMTS评分、ASA分级、住院时间、出院地点、诺丁汉髋部骨折评分、洛克伍德虚弱评分、查尔森共病指数和COCNOF征。主要观察指标是入院后90天、6个月和12个月的死亡率。。

[Methods: All consecutive patients admitted with hip fracture between 1st January – 31st December 2019 were analysed. We collected patient characteristics, AMTS score, ASA grade, length of stay, place of discharge, Nottingham Hip Fracture Score, Rockwood Frailty score, Charlson Comorbidity Index and presence of COCNOF sign. The main outcome measures were mortality at 90 days, six months and 12 months following admission.]

Results（结果）

纳入469名患者，平均年龄81.9岁(标准差8.4)。18%的患者COCNOF征阳性（阳性定义：在普通X线片上，下颌骨出现在肺野水平及以下）。单变量分析显示阳性COCNOF征与90天(19.1% vs 10.8%；相对风险1.95，95%CI 1.05–3.63，p=0.03)、6个月(31.5% vs 14.2%；相对风险2.77，95%CI 1.62–4.72，p<0.001)和12个月(41.6% ns 17.1%；RR 3.45，95%CI 1.62-4.72，p<0.001)的较高死亡率相关。在多变量回归模型中，死亡率的最强预测因子是年龄、性别和CCI，因此，在单变量模型中，COCNOF征可能作为这些变量的替代标记。

[Results: 469 patients with a mean age of 81.9 (SD 8.4) were included. 18% of patients were COCNOF positive. Univariate analysis showed positive COCNOF sign to be associated with higher mortality at 90 days (19.1 vs 10.8%; RR 1.95, 95%CI 1.05 – 3.63,p=0.03), six months (31.5% vs 14.2%; RR 2.77, 95%CI 1.62 –4.72, p<0.001) and twelve months (41.6% vs 17.1%; RR 3.45, 95%CI 1.62-4.72, p<0.001). In the multivariate regression models the strongest predictors of mortality were age, gender and CCI it is therefore likely that the COCNOF sign is acting as a surrogate marker of these variables within the univariate models.]

图1 COCNOF阳性。a，下颌骨位于肺野尖部；b，下颌骨位于胸锁关节水平。

Conclusion（结论）

我们的结果表明，COCNOF征是一种简单的影像学标志，可用于识别髋部骨折后虚弱程度较高和死亡风险增加的患者。

[Conclusion: Our results suggest that COCNOF sign is a simple radiographic marker which can be used to identify patients with higher levels of frailty and increased risk of mortality following hip fracture.]

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