老年髋部骨折病人术后抑郁水平追踪调查

[目的]了解老年髋部骨折病人住院期间及出院后3个月内抑郁水平及其变化趋势.[方法]运用老年抑郁量表(GDS)、Harris髋关节功能评分表、Barthel指数对68例符合纳入标准的老年髋部骨折病人进行问卷调查.[结果]老年髋部骨折病人术后早期至出院后1个月是抑郁程度最严重期,术后3个月有无合并症及是否参加康复锻炼其押都水平差异有统计学意义(P<0.05),活动能力与病人术后3个月抑郁水平相关(P<0.001).[结论]老年髋部骨折病人术后早期至出院后1个月抑郁程度最严重,建议临床护理人员在病人住院期间及出院后早期给予持续的护理干预,促进病人肢体功能和心理功能的恢复.     

老年髋部骨折术后对侧髋部再骨折的相关危险因素分析

目的探讨老年髋部骨折术后对侧髋部再骨折的危险因素。方法选取60例老年髋部初次骨折术后康复患者为非骨折组,同期60例髋部骨折术后对侧髋部再骨折患者为骨折组。对比两组年龄、骨质疏松、术后功能锻炼、医疗依从性与合并内科疾病情况。分析老年髋部骨折术后对侧髋部再骨折的危险因素。结果两组年龄、骨质疏松、术后功能锻炼、依从性、合并内科疾病及髋关节Harris评分比较差异有统计学意义(P 0. 05);两组性别、固定方式、骨折类型及卧床时间比较差异无统计学意义(P 0. 05)。高龄、骨质疏松、合并内科疾病、康复功能锻炼、依从性及Harris评分是导致老年髋部骨折患者术后髋部再骨折的危险因素。结论高龄、骨质疏松症、合并其它内科疾病、康复性锻炼、依从性及Harris评分是导致髋部骨折老年患者术后髋部再骨折的高危因素,临床应加以重视,并及时干预,改善老年髋部骨折患者术后康复质量。     

老年髋部骨折术后病人抑郁及康复状况的研究

目的调查老年髋部骨折病人术后的抑郁状况,并探讨抑郁对其康复状况及生活质量的影响。方法选取北京市某三级甲等医院7l例髋部骨折术后复查的老年病人,应用老年抑郁量表调查病人的抑郁情况,应用Barthel指数、Harris髋关节功能评分评价病人的身体康复状况,应用健康状况问卷调查病人的生活质量状况。结果髋部骨折术后老年病人的抑郁发生率为39．44％。抑郁组的Barthel指数、Harris髋关节功能评分和健康状况评分（除外躯体疼痛和情感职能）均低于非抑郁组（P〈0．0l或P〈0．05）。结论老年髋部骨折术后病人抑郁发生率较高,抑郁会影响病人的术后康复状况。     

老年髋部骨折患者手术治疗后对侧髋部再骨折发生情况及影响因素分析

目的探讨老年髋部骨折患者手术治疗后对侧髋部再骨折发生情况,并对其影响因素进行分析。方法选取老年髋部骨折206例作为研究对象,根据治疗方法不同将其分为手术治疗组(151例)和保守治疗组(55例)两组,比较两组出院后1年对侧髋部再骨折发生情况,并对老年髋部骨折151例手术治疗后对侧髋部再骨折发生的可能影响因素进行单因素和多元Logistic回归分析。结果出院后1年,手术治疗组对侧髋部再骨折发生率15.89%(24/151)低于保守治疗组对侧髋部再骨折发生率29.09%(16/55),差异有统计学意义(P0.05)。单因素分析结果显示,年龄、骨质疏松程度、手术时机、合并基础疾病、术后卧床时间、术后功能锻炼及锻炼依从性是影响老年髋部骨折患者手术治疗后对侧髋部再骨折发生的因素(P0.05或P0.01)。多元Logistic回归分析结果显示,年龄≥70岁、重度骨质疏松、合并基础疾病、未术后功能锻炼及锻炼依从性差是影响老年髋部骨折患者手术治疗后对侧髋部再骨折发生的独立危险因素(P0.01)。结论老年髋部骨折经手术治疗较保守治疗发生对侧髋部再骨折的概率低。年龄≥70岁、重度骨质疏松、合并基础疾病、未术后功能锻炼及锻炼依从性差是影响老年髋部骨折患者手术治疗后对侧髋部再骨折发生的独立危险因素。     

老年髋部骨折术后家庭康复情况及影响因素的研究

目的描述老年髋部骨折术后患者家庭康复情况及探讨影响因素。方法应用方便抽样方法随访82例患者,测量工具有 SF-36问卷、Harris 髋关节功能评分表、功能独立性测评表和家庭康复需求调查表等。结果部分评分较国内外同类研究报道的水平低。影响因素有：治疗情况、抑郁程度、社会支持和对家庭康复的需求程度等,其中抑郁程度对康复的影响最大。结论老年髋部骨折术后患者的家庭康复水平较低,其康复情况受生理、心理、社会和需求满足程度等因素影响；提示出院后尽旱进行个体化的康复指导,将促进功能恢复。     

老年髋部骨折术后患者自我效能的影响因素及护理对策

目的 探讨老年髋部骨折术后患者自我效能的影响因素,为制订科学的护理干预措施提供参考。 方法 采用康复锻炼自我效能量表(SER)对78例髋部骨折术后康复患者进行调查,并对其影响因素进行单因素分析和多元线性回归分析。 结果 ①自我效能水平总得分为(67.94±11.88)分,其中应对自我效能(30.13±5.02)分,身体锻炼自我效能(37.81±6.51)分。②年龄、文化程度、人均月收入、陪护类型、医疗费用来源、抑郁与髋部骨折术后患者自我效能明显相关。③年龄、人均月收入、抑郁、社会支持是影响髋部骨折术后患者自我效能的主要因素。 结论 髋部骨折术后患者自我效能多处于中等水平,年龄、经济收入、抑郁和社会支持是影响自我效能的重要因素,应制定针对性的康复护理计划,采取有效的康复护理措施,提高患者的自我效能水平。     

老年骨折患者抑郁程度与康复效果的相关性研究

目的：研究老年髋部骨折术后患者抑郁程度与家庭康复的相关性。方法：应用方便抽样方法随访82例患者。测量工具包括个人一般情况问卷、老年抑郁量表（GDS）、SF-36问卷、Harris评分表和FIM量表。统计并分析其相关性。结果：患者抑郁症占30．49％；抑郁与家庭康复有关（P值〈0．001）；抑郁程度与生存质量、髋关节功能和功能独立性评分呈负相关（r=-0．32—0．54，P〈0．001）。结论：老年髋部骨折术后出院患者抑郁症状较社区老年人高，抑郁程度明显影响术后患者家庭康复水平。提示要重视并鼓励患者以积极的心态参与适时的功能康复和适合的活动，减少抑郁症状，提高患者生存质量。     

日常生活活动能力评分对老年髋部骨折患者术后1年生存率的影响

目的:探讨日常生活活动能力评分对老年髋部骨折患者术后1年生存率的影响。方法:对92例老年髋部骨折手术治疗患者术前采用日常生活活动能力量表进行评估,并在术后1年内进行随访观察,分析患者术后1年生存率。采用Logistic回归方程分析老年髋部骨折患者术后1年生存率的影响因素。结果:92例患者中有83例正常生存,9例死亡,术后1年生存率为90.22%。年龄及术前生活能力评分是影响老年髋部骨折患者术后1年生存率的重要因素,高龄是老年髋部骨折患者术后1年存率的危险因素,术前生活能力评分60分是老年髋部骨折患者术后1年生存率的保护因素。结论:对老年髋部骨折患者术前采用日常生活活动能力量表进行评估,可有效掌握患者生活能力情况,同时可提高患者术后1年生存率。     

大于等于80岁的老年髋部骨折患者术后1年内死亡的独立危险因素

目的探讨高龄（≥80岁）老年髋部骨折患者术后1年内死亡的危险因素。方法以2016~2019年204例经手术治疗的高龄髋部骨折患者作为研究对象,记录年龄、性别、术前合并疾病、骨折类型、麻醉方式、美国麻醉医师协会（ASA）评分、术前血红蛋白水平、术前白蛋白水平、术前血钙水平、住院时间等临床资料,以术后1年内死亡为观察结局。采用多因素logistic回归模型分析高龄老年髋部骨折患者术后1年内死亡的独立危险因素。结果术后1年内,共有82例患者术后死亡,死亡率为40.2%。性别、BMI、骨折类型、麻醉方式、术前血红蛋白水平、术前血钙水平及住院时间不影响80岁患者髋关节术后死亡率,差异无统计学意义（P>0.05）;年龄、术前合并疾病数量、ASA评分以及术前白蛋白水平是高龄老年髋部骨折患者术后1年内死亡的独立危险因素（P < 0.05）。结论年龄、术前合并疾病数量、ASA评分、术前白蛋白水平是高龄老年髋部骨折患者术后1年内死亡的独立危险因素。      

痴呆对老年髋部骨折预后影响及老年髋部骨折预后危险因素分析

目的探讨痴呆对老年髋部骨折预后影响及老年髋部骨折预后危险因素。方法选取老年髋部骨折521例作为研究对象,根据术前认知功能状态将其分为痴呆组和非痴呆组两组,痴呆组49例,非痴呆组472例;根据术后1年随访结局将其分为病死组和存活组,病死组103例,存活组418例。分析比较患者一般数据、术中情况、住院期间并发症、术后1年病死率及独立生活能力等,并对老年髋部骨折术后1年内死亡的危险因素进行分析。结果本研究老年髋部骨折合并痴呆患者占老年髋部骨折患者的9. 4%。与非痴呆组比较,痴呆组≥80岁、其他神经系统合并症、全身麻醉、呼吸系统并发症、脑卒中及谵妄发生率较高,住院时间较长,围手术期及术后1年病死率较高,差异有统计学意义(P 0. 05)。单因素分析结果显示,年龄≥80岁、男性、痴呆、心血管系统合并症、呼吸系统合并症、合并症≥3项及美国麻醉协会麻醉(ASA)分级Ⅲ~Ⅳ级是老年髋部骨折术后1年内死亡的危险因素。多因素Logistic回归分析显示仅有呼吸系统合并症、合并症≥3项及ASA分级Ⅲ~Ⅳ级是老年髋部骨折术后1年内死亡的独立危险因素。结论痴呆在老年髋部骨折人群中发病率较高。与非痴呆老年髋部骨折患者相比,老年髋部骨折合并痴呆患者住院时间长、术后并发症多,且病死率高。呼吸系统合并症、合并症≥3项及ASA分级Ⅲ~Ⅳ级是老年髋部骨折术后1年内死亡的独立危险因素。     

Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture

OBJECTIVE: To identify factors associated with postacute rehabilitation outcome of disabled elderly patients with proximal hip fracture. SETTING: Geriatric rehabilitation center. PARTICIPANTS: One hundred thirty-three older patients. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM instrument, motor FIM score, absolute functional gain on the FIM and motor FIM scores, relative functional gain on the FIM and motor FIM scores, rate of improvement on the FIM and motor FIM scores, proportion of patients discharged to home, and length of stay (LOS). RESULTS: Mean FIM score improved by 14 points (22%) with a functional gain rate of .56 point per day. No significant differences (P>.05) were found between weight-bearing and non-weight-bearing patients regarding the above outcome measures. Functionally independent and cognitively intact patients achieved significantly better score changes and rates of improvement and showed a higher ability to extract their rehabilitation potential than dependent and cognitively impaired patients. Their LOSs were significantly shorter. Patients with latency time (time delay from fracture to operation) of more than 5 days and patients with a history of stroke had significantly longer LOSs. Mini-Mental State Examination score, albumin levels on admission, and prefracture functional status were the most important parameters associated with FIM discharge scores (r=.756) and relative functional gain on the FIM (r=.583). Depression was the most important factor associated with LOS in patients with weight-bearing instructions on admission. The presence of a caregiver was the significant predictive value variable for returning home. CONCLUSIONS: Cognitive function, nutritional status, preinjury functional level, and depression were the most important prognostic factors associated with rehabilitation success of older patients with proximal hip fracture. Of these, depression and nutritional status are correctable, and early intervention may improve rehabilitation outcome.     

聚焦解决模式在老年髋部骨折术后患者早期离床坐心理干预中的应用效果观察

目的探讨聚焦解决模式在老年髋部骨折术后早期离床坐患者心理干预的效果。方法选取老年髋部骨折术后患者206例为研究对象,按入院先后顺序分为实验组和对照组各103例,对照组术后第2~3天早期离床坐,在指导常规功能锻炼的基础上结合踩单车运动;观察组在此基础上采用聚焦解决模式进行5个步骤(即评估患者、建构目标、探查例外、给予反馈、评价进步)的心理干预。结果观察组焦虑程度、对早期离床坐锻练的顾虑均减轻(P0.01或P0.05),能采取积极应对方式配合锻炼。结论应用聚焦解决模式对老年髋部骨折术后早期离床坐患者进行心理干预,有利于减轻患者焦虑情绪,增强患者康复训练信心,积极配合锻炼,促进康复。     

Functional dependence after hip fracture

OBJECTIVES: To identify patients at high risk of functional dependence and examine the progression of disability after a hip fracture. DESIGN: This was a population-based prospective inception cohort study of all patients aged 65+ yr who fractured a hip between July 1996 and August 1997. Demographic, socioeconomic, social support, and health status information was assessed in the hospital and 3 mo postfracture. RESULTS: The analysis included 367 patients. Almost all patients with cognitive impairment were functionally dependent postfracture, with new disabilities frequently occurring in transferring. Among patients of high mental status, increased risk of functional dependence was associated with advanced age, more co-morbidities, hip pain, poor self-rated health, and previous employment in a prestigeous occupation. Bathing disability was most likely in those who functioned independently prefracture; a disability in dressing was most common otherwise. CONCLUSION: Hip pain is amenable to treatment and may improve chances of functional recovery. Patients can be assisted in regaining prefracture function if they are targeted for rehabilitation on the basis of mental status. The focus should be on bathing and dressing among patients of high cognition and transferring among those patients with mental impairment.     

四种金属植入物内固定修复老年股骨转子间骨折的比较

背景：对于老年股骨转子间骨折如何选择金属植入物,应根据不同患者的年龄、骨质疏松程度、围手术期状态、骨折类型等多因素进行考虑,制定个性化的治疗方案。目的：比较4种不同金属植入物内固定修复老年股骨转子间骨折的疗效。方法：回顾2009年9月至2012年9月收治的180例老年股骨转子间骨折患者,采用4种不同金属植入物内固定进行骨折修复,动力髋螺钉组、防旋型股骨近端髓内钉组、Gamma 钉组和解剖型髋动力带锁钢板组各45例。比较各组手术时间、出血量、住院时间、内固定后Harris评分、骨折愈合时间和并发症发生情况。结果与结论：解剖型髋动力带锁钢板组和防旋型股骨近端髓内钉组手术时间、出血量及住院时间均短于动力髋螺钉组和Gamma钉组（P 〈0.05）,内固定后Harris评分优良率均高于动力髋螺钉组和Gamma 钉组（P 〈0.05）,而前两组间差异无显著性意义（P〉0.05）。解剖型髋动力带锁钢板组和防旋型股骨近端髓内钉组内固定后并发症发生率明显低于Gamma组和动力髋螺钉组（P〈0.05）。提示解剖型髋动力带锁钢板和防旋型股骨近端髓内钉治疗老年转子间骨折内固定可靠、内固定后并发症少,是老年股骨转子间骨折植入物内固定治疗较为理想的选择。     

Functional recovery after hip fracture

This investigation was designed to describe the 12-month functional recovery following hip fracture, testing the hypothesis that intensive rehabilitation would enhance the level of functional recovery. The study included 50 patients with intertrochanteric, and 25 patients with subcapital hip fractures who were admitted to the Massachusetts General Hospital teaching service (67% women, mean age = 78 yr). Twenty-nine percent of the patients died in the year after fracture. Among survivors, only 33% and 21% regained their prefracture function in five basic and six instrumental activities of daily living, respectively. Twenty-six percent regained their prefracture level of social/role functioning. There were no statistically significant differences in mortality, hospital discharge status, or pattern and level of functional recovery, between patients receiving experimental and standard approaches to hospital rehabilitation.     

Outcome after hip fracture in different health care districts. Rehabilitation of 837 consecutive patients in primary care 1986-88.

The social and functional outcome for 837 consecutive hip fracture patients rehabilitated in primary care was studied during 1986-1988. Of patients coming from their own home (59%) the majority (76%) were back at home four months after fracture and had a good functional status, while 9% were dead. Predictors of managing ADL (dressing/personal hygiene) four months after hip fracture were age, type of fracture, sex, and having regular social contacts outside the home before fracture. Health care districts differed in the incidence of hip fractures, the patients hospital stay, housing, type of fracture, and age. These differences had consequences on costs. Total costs per patient were lowest in districts where most of the patients were discharged to their own homes. No significant differences in fracture incidence were seen between rural and urban primary health care districts.     

老年髋部骨折患者抑郁焦虑情绪原因分析及心理干预

目的:探讨老年髋部骨折患者产生抑郁、焦虑情绪的原因及心理干预方法.方法:对194例老年髋部骨折患者抑郁、焦虑情绪的发生原因进行分析,并给予2周心理干预,比较干预前后焦虑自评量表(SAS)和抑郁自评量表(SDS)的评分情况.结果:本组患者产生焦虑、抑郁的原因包括无法接受突发意外伤害、康复训练未达到预期效果、疼痛、担心切口裂开、出血、骨折处移位等.本组患者心理干预后主动参与肢体功能锻炼185例,被动参与9例;急躁、发怒等负性情绪明显改善137例,基本改善57例;抑郁、焦虑症状明显减轻143例,有所减轻51例;家属配合159例,基本配合35例.患者干预前后SDS、SAS评分比较差异有统计学意义(P<0.01).结论:心理干预能显著改善老年髋部骨折患者的抑郁、焦虑情绪,值得临床推广应用.     

Factors affecting functional prognosis of patients with hip fracture

Having a hip fracture is considered one of the most fatal fractures for elderly people, resulting in impaired function, and increased morbidity and mortality. This challenges clinicians in identifying patients at risk of worse outcome, in order to optimise and intensify treatment in these patients. A variety of factors such as age, prefracture function and health status, fracture type, pain, anaemia, muscle strength, and the early mobility level have been shown to influence patient outcome. Thus, the outcome of patients with hip fracture is considered multi-factorial, and can therefore not be related to just one or two single factors. The current article reviews important factors affecting the functional prognosis, and clinicians are encouraged to include all factors potentially influencing the outcome of patients with hip fracture in their individualised treatment and rehabilitation plan. Especially, older age and having a low prefracture functional level are considered strong factors.     

Depressive symptoms in long-term care residents in Taiwan

AIM: This paper reports a study to investigate the prevalence of and risk factors for depressive symptoms in elders in long-term care facilities in Taiwan. BACKGROUND: Depression has been identified as a major health concern and is very common among frail elders in Western nursing homes. It is under-diagnosed, and may be associated with eating difficulties and subsequent malnutrition, functional ability and sociodemographic factors. There have been no previous studies of these issues in Taiwan. METHODS: Residents of 18 long-term care facilities were recruited. Those able to communicate in the Mandarin or Taiwanese dialect, resided in long-term care facilities including skilled nursing facilities and intermediate care facilities, and who scored three or above on the Short Portable Mental Status Questionnaire were selected. Data were collected using the Geriatric Depression Scale, Barthel Index and Masticatory Index, and age, duration of institutionalization, and level of impaired swallowing were also measured. RESULTS: The number of participants identified as depressed was 267 (52.05%). There was no significant difference noted relating to age, gender, duration of institutionalization, type of institution, mental status and masticatory ability between the depressed and non-depressed groups, but significant differences of functional status and impaired swallowing between the two groups were found. However, functional status, impaired swallowing, and type of institution were three independent factors associated with depressive symptoms after controlling for all other factors. CONCLUSIONS: Future studies on the detection of symptoms of depression should use a validated observational measure to overcome under-reporting of symptoms by the frailest residents.