精神病患者住院期间发生骨折的临床特征

目的探讨精神病患者住院治疗期间发生骨折的临床特点。方法对2002年1月1日至2007年6月31日在我院住院期间发生骨折的患者资料进行记录和统计分析。结果108名患者发生骨折,男56人,女52人,平均年龄57.81岁,≥60岁的50人（46.30%）,住院时间≥3个月的81人（75.00%）,诊断为精神分裂症（70.37%）和器质性精神障碍（15.74%）的患者最多。常见的骨折部位是手（22.22%）及股骨颈（19.44%）。摔倒、攻击行为是最常见的原因,摔倒易导致股骨颈骨折（24.07%）,攻击行为易导致手及前臂骨折（均为18.75%）,并且男性是女性的2.7倍。结论精神科长期住院的老年患者容易发生骨折。摔倒是骨折最常见的原因,摔倒易导致股骨颈骨折,攻击行为易导致手及前臂骨折,且男性多于女性。     

精神病患者意外受伤特征分析

目的:了解住院精神病患者意外发生外伤的特点,为预防意外发生外伤提供依据。方法:回顾2007年1月1日-2012年6月31日我院住院期间发生外伤的患者,进行回顾性的调查研究和分析。结果:8753名住院精神病患者发生外伤148例(1.7%),男性(70.9%)明显多于女性(29.1%)(χ2=20.96,P=0.004);≥60岁者外伤最多(χ2=26.18,P=0.025);精神分裂症患者发生外伤100例(67.6%),明显多于其他疾病患者(χ2=104.43,P=0.005);外伤类型以摔伤最多(52.0%);外伤最常发生在普通病室、饭厅,每个地点均好发生摔伤。休息日发生外伤多于工作日(χ2=77.88,P=0.000);外伤在白班发生最多(χ2=39.95,P=0.008);长期住院者(≥3个月)发生外伤比例较高(χ2=21.11,P=0.099)。结论:住院精神病患者外伤多见于男性、老年人、长期住院、精神分裂症患者,休息日与白班多发,外伤以摔伤较多,地点以普通病室、饭厅较多,外伤与癫痫发作与否无关。     

新型冠状病毒肺炎疫情期间老年髋部骨折流行病学特征及术前患者的管理

目的 探讨新冠肺炎疫情期间老年髋部骨折的流行病学特征,就患者的术前管理提供新的建议。方法 回顾性分析2020年1月24日至3月11日（观察组,30例）及2019年2月4日至3月23日（对照组,54例）随州市中心医院骨科收治的共84例65岁以上老年髋部骨折患者资料,进行统计分析。比较两组患者的年龄、性别、骨折类型、合并疾病、致伤因素、术前等待时间、营养状况和贫血情况的差异。结果 本研究共纳入髋部骨折84例。观察组男11例,女19例,平均年龄（78.8±6.7）岁;对照组男21例,女33例,平均年龄（79.0±6.5）岁。观察组（16例,53.33%）合并陈旧脑梗塞患者,占比明显高于对照组（16例,27.78%,P<0.05）;跌倒患者（30例,100%）占比高于对照组（30例,79.63%,P<0.05）。术前等待时间观察组平均为（13.07±4.79） d,明显长于对照组（4.04±0.75）（P<0.05）; 营养不良情况观察组明显（20例,66.67%）多于对照组（19例,35.19%,P<0.05）;观察组（19例,63.33%）及对照组（31例,57.41%）均存在较多贫血患者,但两者比较差异无统计学意义（P>0.05）。结论 新冠肺炎疫情期间收治的新发骨折患者较去年同期明显减少,合并陈旧性脑梗塞的患者明显增多,以室内跌倒患者为主,术前均存在营养不良及贫血,新冠期间营养不良更严重,术前等待时间明显延长,故需要在较长的术前等待时间中注意患者的营养、血液管理。     

住院精神病患者攻击行为的临床特征

目的 了解精神病患者发生攻击行为特点,为减少攻击行为提供临床依据.方法 对2007年1月1日-2012年6月31日在我院住院期间发生攻击行为患者进行回顾性分析.结果 113名患者发生攻击行为133人次,男93人次,女40人次.平均年龄39.6岁,≤44岁者89名(66.9％).精神分裂症者最多(74.5％).攻击行为在白班(8:00～16:00)最多见,55人次(41.4％).好发地点为重病室(37.6％)、饭厅(24.8％)、普通病室(18.0％).以徒手伤人最多见,共发生118人次(88.7％).医护人员是患者攻击的主要对象,占84.2％.结论 住院精神病患者攻击行为高危因素:青年、男性、精神分裂症患者.攻击行为以徒手伤人最多见,对象主要为医护人员.     

胆红素吸附联合血浆置换治疗肝功能衰竭和高胆红素血症的并发症防治

目的分析胆红素吸附（BA）联合血浆置换（PE）治疗肝功能衰竭和高胆红素血症的并发症发生情况,提出防治措施。方法采用BA联合PE治疗肝功能衰竭和高胆红素血症患者51例（共66例次）,其中男性41例,女性10例;平均年龄47.89岁。在治疗过程中出现的并发症,分析并发症发生类型和比例,制定防治方案。结果并发症总发生率16.67%（11/66）,其中血浆过敏反应最多见,占10.61%（7/66）,其次是循环管路压力异常增高,占4.55%（3/66）,最严重的并发症是一过性低血压1例次,占1.52%（1/66）,无畏寒、发热、出血等并发症发生。结论 BA联合PE治疗肝功能衰竭和高胆红素血症是安全有效的新型人工肝治疗方法,并发症发生率低,且是可以防治。     

鼻外伤致脑脊液鼻漏的护理体会

脑脊液鼻漏比较少见,多因颅面外伤致额、筛和蝶骨骨折撕伤硬脑膜所致,偶见于先天发育畸形和筛板部分骨缺损者。它可在受伤时立刻发生,也可在伤后经过一段潜伏期才发生。而因鼻外伤所致者,在临床则为少见。本科于近日收治一名因鼻部外伤后发生脑脊液鼻漏十年的患者。现将护理体会报告如下。 病例:男,13岁,中学生。3岁时不慎跌倒,一把电工起子插入右鼻腔内,流血不止,在当地医院给予填塞止血。半月后,     

根因分析在内科住院患者跌倒风险管理中的应用分析

目的 分析住院患者发生跌倒的原因,探讨根因分析（RCA）在住院患者跌倒中的应用效果。方法 选取我院2016年1月~12月的38起跌倒事件,采用RCA方法分析近端原因、根本原因,通过改变环境、优化防跌倒流程、加强人员培训等措施预防跌倒发生,比较实施前后患者跌倒发生率。结果 实施后,跌倒发生率为0.14%,低于实施前的0.38%,差异具有统计学意义（P＜0.05）。结论 RCA应用于内科住院患者跌倒风险管理,对预防住院患者跌倒具有很好的导向作用。     

住院老年精神患者跌倒/坠床的原因分析及护理干预

目的探讨老年精神病患者跌倒/坠床原因及有效的护理干预措施，降低住院患者跌倒/坠床的发生。方法采用我院精神科2012年~2013年收治的所有精神患者904例，对其中发生跌倒的48例老年精神患者进行调查。结果女性高龄及自主活动障碍、疾病因素、精神科药物反应、躯体有合并症、环境设施等，是老年患者跌倒的主要因素。结论对老年精神病患者在住院期间进行护理干预，能有效减少跌倒/坠床的发生。     

合并脑卒中史的老年髋部骨折患者的临床特征及治疗效果分析

目的 探讨合并脑卒中病史的老年髋部骨折患者的临床特征,以及在老年髋部骨折共管模式下的治疗效果。方法 回顾性队列分析。纳入2018年11月—2019年11月在北京积水潭医院手术治疗的1 092例老年髋部骨折患者的临床资料,其中男306例,女786例,年龄65~95岁（平均79.6岁）。根据既往是否有脑卒中病史分为脑卒中组155例和非脑卒中组937例。脑卒中组患者发生脑卒中至髋部骨折手术时间均大于30 d。观察指标：（1）分析脑卒中组患者的临床特征（脑卒中类型、发病史、后遗症发生率、遗留肢体不利情况,以及肢体不利侧与肢体利侧发生骨折的占比）。（2）比较2组患者的年龄、性别、骨折类型、骨折侧别、伤前能否户外活动、伤前行走是否需要辅具等临床特征的差异。（3）比较2组患者的入院48 h内手术率、术前等待时间、住院时间,比较不同观察时间的死亡率、再手术率,以及并发症发生率、活动恢复情况、健康相关生活质量等结果的差异。结果 （1）脑卒中组155例患者的临床特征：其中,脑梗死141例（91.0%）,脑出血14例（9.0%）;1次脑卒中发病史148例（95.4%）,≥2次发病史7例（4.5%）;有脑卒中后遗症60例（38.7%）;遗留肢体不利的患者43例（27.7%）,其中81.4%（35/43）骨折发生在肢体不利侧,18.6%（8/43）发生在利侧。（2）2组患者的性别、骨折侧别比较差异均无统计学差异（P值均>0.05）;脑卒中组患者较非脑卒中组患者的中位年龄小（79岁与81岁）,脑卒中组患者股骨颈骨折发生率（58.7%,91/155）、辅具帮助行走的比例（43.9%,68/155）及无法户外活动的比例（11.6%,18/155）均较非脑卒中患者高（49.6%,465/937;23.5%,276/937;5.7%,53/937）,差异均有统计学意义（P值均<0.05）。（2）2组患者的入院48 h内手术率、术前等待时间、住院时间、再手术率及并发症发生率比较差异均无统计学意义（P值均>0.05）;院内死亡率及入院后30 d、120 d、1年死亡率差异均无统计学意义（P值均>0.05）;入院后30 d、120 d、1年骨折术后并发症发生率与再手术率差异均无统计学意义（P值均>0.05）;患者恢复伤前活动能力的比较,入院后30、120 d差异均无统计学意义（P值均>0.05）,入院后1年随访脑卒中组（48.9%,68/139）低于非脑卒中组（59.8%,468/782）,差异有统计学意义（χ²=5.79,P<0.001）。脑卒中组入院后30 d、120 d、1年健康相关生活质量评分为0.62（0.46,0.74）、0.78（0.57,0.90）和0.83（0.57,0.94）分均低于非脑卒中组的0.69（0.51,0.78）、0.83（0.73,0.94）和0.93（0.75,1.00）分,差异均有统计学意义（Z=-3.12、-2.97、-4.83,P值均<0.05）。结论 合并脑卒中史的老年髋部骨折患者,骨折总体发病年龄稍早于无脑卒中史者,既往多有1次脑梗死病史发作,少部分人遗留有后遗症,伤前活动能力较差,髋部骨折多发生在脑卒中后遗留肢体活动不利侧。共管模式下对于脑卒中病史超过30 d的老年髋部骨折患者尽早实施手术是安全有效的。     

“前向后”螺钉和“后向前”螺钉固定治疗Haraguchi Ⅰ型后踝骨折的疗效比较

目的 比较“前向后”螺钉和“后向前”螺钉固定治疗三踝骨折中的Haraguchi Ⅰ型后踝骨折的疗效。方法 回顾性分析2014年1月 ～ 2019年7月收治的83例伴有Haraguchi Ⅰ型后踝骨折的三踝骨折。其中,男33例,女50例;年龄18 ～ 77岁,平均47.5岁,均为单侧骨折,旋后外旋型Ⅳ度61例及旋前外旋型Ⅳ度22例; 后踝骨折块面积占比平均19.8%（15% ～ 32%）;其中38例采用间接复位由“前向后”螺钉内固定后踝骨折,45例采用后外侧入路直接复位螺钉内固定后踝骨折。比较两组手术时间、后踝骨折复位质量及临床功能疗效。结果 所有患者术后获得平均15.6个月随访（6 ～ 26个月）,骨折均获得愈合。“前向后”组手术时间明显少于“后向前”组（P<0.05）。在关节面复位影像学评价中,“前向后”组中优13例（34.2%）、良19例（50.0%）及差6例（15.8%）;“后向前”组中优26例（57.7%）、良16例（35.6%）及差3例（6.7%）,两组间差异有统计学意义（P<0.05）。末次随访AOFAS踝与后足评分：“前向后”组（83.05±7.85）分,“后向前”组（87.84±7.22）分,两组间差异有统计学意义（P<0.05）。结论 与“前向后”间接复位螺钉固定Haraguchi Ⅰ型后踝骨折相比,通过后外侧入路直接复位螺钉内固定可以获得更好的骨折复位质量及临床功能疗效。     

Hospitalisations due to falls in older persons

This paper describes hospitalisations due to falls among people aged 65 years and over resident in the Eastern Region of Ireland. Of the 2,029 hospitalisations recorded for 2002, 78% were female and 68% were aged 75 years and over. Fractures accounted for 1,697 or 84% of cases with nearly half of them (841) sustained to the hip. Females were more likely to have a limb fracture whereas males were more likely to have a head injury. The total inpatient costs of the 2,029 hospitalisations were estimated at 10.6 million euros. Hip fractures were the costliest injuries as they accounted for 7.4 million euros (70%) of inpatient costs. There are also substantial additional costs implications for hip fractures as they constituted the majority (56%) of cases transferred to nursing/convalescent homes or long-stay health facilities. In keeping with an ageing population, the problem of injuries in older people is likely to increase over time and as falls are the dominant cause of those injuries, all acute and long-stay health facilities need to develop and implement fall prevention strategies for older people.     

Falls and the use of health services in community-living elderly people.

Falls are common and often preventable in older people. This short report describes substantial unmet need in relation to falls. Although falling, nearly falling, fear of falling, and activity restriction are common, many people do not seek assistance from healthcare professionals. Only 2% of those who had attended their general practioner (GP), a casualty department, or had been admitted to hospital after a fall were taking drugs to protect against osteoporosis. People who have fallen or are at a risk of falling need to be identified, and local policies and information regarding treatment for osteoporosis are needed.     

Preventing accidental falls among older people in long stay units

A fall prevention programme for older long-stay patients in a 95 bedded District Hospital was undertaken. Data on falls and resulting injuries for the year prior to the intervention were compared with equivalent data after one year (Year 1) and after two years (Year 2) of the intervention. In the pre-intervention year 25% of patients had at least one fall compared with 20.9% and 17.4% in Year 1 and Year 2 respectively. This difference was not statistically significant. However, there were 21% fewer falls in Year 1 and 49.3% fewer in Year 2 than in the pre-intervention year. This difference was significant in Year 2. In both intervention years there was a significant reduction in the incidence of fracture from 20.5% of falls (pre-intervention) to 2.8% in Year 1 and no fractures occurred in Year 2. Significant reductions in soft tissue injuries occurred in Year 2 but not in Year 1, dropping from 38.5% (pre-intervention) to 36.1% and 15.4% respectively. The percentage of patients uninjured after a fall increased from 41% to 61.1% to 84.6%. This intervention reduced falls and their adverse consequences for older people living in the long stay unit. The effect of the intervention escalated in Year 2. The intervention cost IR4,800 pounds. Fall prevention should be part of the routine care of older people in all types of long stay care.     

基于表面肌电分析老年人负重跨障行走跌倒风险

目的研究老年人在手部不同负重分布条件下跨越障碍物时导致跌倒风险性增加的因素,并探讨预防老年人在负重跨障时跌倒的步态策略。方法 12名老年人和12名青年人(对照组)以日常行走步速在不同负重分布方式下进行跨越障碍物和无障碍物行走任务,采集股外侧肌、股直肌和股内侧肌双侧的表面肌电信号,进行平均肌电值分析对比,同时记录受试者跨越障碍时触碰障碍物的情况。结果年龄、负重及跨障因素均对老年人下肢肌肉的活动水平产生显著影响。1 152次跨障试验中共发生9次触障事件。另外,老年人和青年人在完成负重和跨障任务时右股内侧肌的肌肉贡献量最大。结论老年人在负重物均匀分布下利用腿部优势侧率先跨障的情况下跌倒的风险性最低。研究结果为系统评估老年人跌倒风险提供参考,对老年人针对性下肢运动锻炼或康复训练具有一定的指导意义。     

Impact of gait problems and falls on functioning in independent living persons of 55 years and over: a community survey

In a cross-sectional, population-based study among community-dwelling persons of 55 years and over the incidence of falls, risk indicators for falls, specifically age, and the impact of gait problems, falls and other risk factors on functioning was determined. A randomly age-stratified sample (n = 655) was taken from all independent living persons of 55 years and over (n = 2269) and registered in a primary health care centre. They received a mail questionnaire concerning demographic data, history of falls and injuries due to falls, physical and mental health status, gait problems, functional status, including social activities. The response rate was 62% (n = 405). Of the subjects aged 55 years and of those aged 65 years and over, 25% and 31% respectively fell at least once in the previous year. Half of the people reporting falls fell more than once. Serious injury occurred in 9% of the fallers, with 4% fractures. There is a significant association between falling and age and, even more clearly, between gait problems and age. The main risk factors of single and recurrent falls were female gender, physical health status and gait problems. Logistic regression analysis reveals that the main determinants of falling in general are gait problems and female gender and, of recurrent falling female gender, physical complaints and gait problems. Falls have some negative effect on functioning, i.e. mobility range and social activities, but this is overshadowed by mental status indicators and gait problems.     

Fall risk in an active elderly population – can it be assessed?

Background  

Falls amongst elderly people are often associated with fractures. Training of balance and physical performance can reduce fall risk; however, it remains a challenge to identify individuals at increased risk of falling to whom this training should be offered. It is believed that fall risk can be assessed by testing balance performance. In this study a test battery of physiological parameters related to balance and falls was designed to address fall risk in a community dwelling elderly population.     

Distinguishing fall activities from normal activities by angular rate characteristics and high-speed camera characterization

Distinguishing sideways and backward falls from normal activities of daily living using angular rate sensors (gyroscopes) was explored in this paper. Gyroscopes were secured on a shirt at the positions of sternum (S), front of the waist (FW) and right underarm (RU) to measure angular rate in lateral and sagittal planes of the body during falls and normal activities. Moreover, the motions of the fall incidents were captured by a high-speed camera at a frame rate of 250 frames per second (fps) to study the body configuration during fall. The high-speed camera and the sensor data capture system were activated simultaneously to synchronize the picture frame of high-speed camera and the sensor data. The threshold level for each sensor was set to distinguish fall activities from normal activities. Lead time of fall activities (time after threshold value is surpassed to the time when the hip hits the ground) and relative angle of body configuration (angle beta between the vertical line and the line from the center point of the foot or the center point between the two legs to that of the waist) at the threshold level were studied. For sideways falls, lead times of sensors at positions FW and S were about 200-220ms and 135-182ms, respectively. The lead time of the slippery backward fall (about 98ms) from the sensor at position RU was shorter than that of the sideways falls from the sensors at positions FW and S. The relative angle of body configuration at threshold level for sideways and backward falls were about 40-43 degrees for the sensor at position FW, about 43-52 degrees for the sensor at position S and about 54 degrees for the sensor at position RU, respectively. This is the first study that investigates fall dynamics in detection of fall before the person hits the ground using angular rate sensors (gyroscopes).     

Vision and falls: A multidisciplinary review of the contributions of visual impairment to falls among older adults

Falls are a leading cause of mortality among older adults worldwide. With the increasing aging population, falls are rapidly becoming a public health concern. Numerous internal and external factors have been associated with an older adult's increased risk of falling. Most notably visual impairments are gaining recognition for their critical role in fall events, particularly related to trips, slips and falls due to environmental hazards. This review presents the issue of vision and falls from a multidisciplinary health professional perspective. Discussions include the influence of visual impairment on mobility and activities of daily living, the effects of medications on vision, visual cognitive factors on falls risk and visual training interventions. Finally, implications for multidisciplinary health professional practice and suggestions for future research are offered.     

Reasons for discrepancies in hip fracture risk estimates using FRAX and Garvan calculators

ObjectivesBoth the FRAX and Garvan calculators are used to estimate absolute risk of fracture, but they sometimes produce different estimates. We sought to determine which patient characteristics contribute to these discrepancies.Study designTen-year hip fracture risk was estimated for 122 women, using both FRAX and Garvan with bone mineral density (BMD).Main outcome measuresDifferences in estimates of hip fracture were assessed, both in absolute terms and with respect to a treatment threshold of 3%.ResultsGarvan estimates were higher than FRAX estimates across the range of ages and BMDs studied. A history of falls or of multiple fractures increased risk calculated by Garvan 3–6-fold, but did not account for all differences between calculators. Discrepancies around a 3% treatment threshold occurred in 31/122 (25%). Women aged 70–74 years, and women with osteopenia were most likely to have discordant estimates. Most discordant estimates (29/31) had a Garvan estimate ≥3% and FRAX <3%. Falls, multiple fractures, ethnicity and a history of parental hip fracture contributed to some discordant estimates.ConclusionsHip fracture risk estimates are usually higher with Garvan than FRAX, and these differences could impact on treatment decisions in about a quarter of patients. Falls and multiple fractures have a strong influence on Garvan risk estimates, when present. Clinically important discrepancies tend to occur in patients who are at borderline fracture risk. In patients with hip fracture risks near the treatment threshold with one calculator, use of the other calculator should be considered to help guide treatment decisions.     

Accidental traumatic head injury in infants and young children

Abstract This article will discuss accidental head injuries in infants and young children. The first category of injury is the crushing head injury. Static forces applied slowly to the head result in multiple fractures of the skull and contusions and lacerations of the brain resulting from the bone fragments striking the brain. This article will discuss the subject of short falls in young children and the resulting head injuries. Because falls are frequent events in early life, many cases have been collected and many papers written on the subject. Study of these cases is informative about the injuries likely to occur in these falls. Most often, only a minor contact injury such as scalp bruise or laceration results. In a 2 to 3% of falls, a simple linear skull fracture occurs and the majority of these are uneventful in terms of neurological deficit or intracranial bleeding. In about 1% of the fractures, an epidural or subdural hemorrhage occurs. Each of these forms of contact hemorrhages will be discussed and illustrated. While these are relatively rare injuries, it is essential that they can be identified as consistent with an accidental mechanism so that an erroneous diagnosis of inflicted injury is not made.