老年髋部骨折患者术后功能恢复的长期强化家庭康复训练

文题释义： 家庭康复训练：主要由主管医师、康复医师、康复治疗师及护理人员指导康复训练,主管医师与康复医师共同评估病情并制定康复训练计划,康复治疗师指导训练内容,护理人员协助加强患者管理。出院时向患者及家属发放康复手册,通过文字及视频内容指导患者院外进行长期强化家庭康复训练。每周通过移动电话、网络工具对患者及家属进行线上随访,要求家属定期录制患者康复的视频,并根据实际状态及时调整康复训练处方。建立网络线上交流群,将患者纳入该群,及时向患者解答康复过程中的疑问,防止康复训练不足及康复过度等情况。 日常生活能力量表(Activity of DailyLiving Scale,ADL)：由美国的Lawton和Brody制定于1969年。由躯体生活自理量表(PSMS)和工具性日常生活能力量表组成。共有14项：一是躯体生活自理量表,共6项,包括上厕所、进食、穿衣、梳洗、行走和洗澡;二是工具性日常生活能力量表,共8项,包括打电话、购物、备餐、做家务、洗衣、使用交通工具、服药和自理经济。主要用于评定被试者的日常生活能力。 背景：老年髋部骨折患者术后存在极高的功能致残率,传统康复更多地关注患者住院期间的康复,而忽视院外家庭康复训练。6个月的强化家庭康复训练已被证实为一种确实有效的方法,但更长时间的家庭训练仍有待进一步研究。 目的：探究进行长期强化家庭康复训练法对老年髋部骨折患者术后功能恢复情况的影响。 方法：前瞻性纳入接受手术治疗的老年髋部骨折患者89例,采用随机数字表法分为试验组42例和对照组47例。对照组采用传统康复训练方法,试验组采用长期强化家庭康复训练法,指导功能锻炼并进行规律随访,利用网络工具及时调整康复计划。2组患者均规律随访12个月,分别在术后3,6,12个月进行日常生活能力评分、6分钟步行试验、髋关节Harris评分、功能独立性测量量表评分、SF-36评分,评估患者术后功能改善情况。研究方案的实施符合成都市第六人民医院的相关伦理要求,参与试验的患病个体对试验过程完全知情同意。 结果与结论：①2组患者术后功能逐渐恢复,试验组患者术后3,6,12个月的日常生活能力评分、功能独立性测量量表评分、6分钟步行试验、Harris评分及SF-36评分均优于对照组(P < 0.05);②结果说明,老年髋部骨折患者术后长期强化家庭康复训练法可提高患者日常生活能力,改善患者生活质量,但该康复计划及其疗效仍需要进一步研究。 ORCID: 0000-0002-0570-9065(王可心) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

老年髋部骨折术后实施延续性护理对患者远期功能恢复的影响

目的：研究术后实施延续性护理对提高老年髋部骨折患者远期功能恢复效果的价值。方法：纳入2013年7月至2015年7月于我院接受手术治疗的髋部骨折老年患者68例为对象,采用随机数字表法均分为2组各34例。所有患者院内均接受常规护理,对照组仅接受常规随访,观察组院外接受延续性护理,通过组建延续性护理服务小组、建立出院访视档案、组织成立延续护理俱乐部等措施,将系统、规范的院内护理延伸至院外。持续12个月后,对比2组康复锻炼依从性、生活质量、髋关节与膝关节功能评分、焦虑及抑郁评分、术后并发症情况。结果：观察组进行康复锻炼时,锻炼时间、锻炼动作严格遵嘱率明显高于对照组;干预12个月后观察组健康调查简表(MOS SF-36)量表各维度评分均明显高于对照组;干预3、6、12个月时Harris髋关节功能评分及HSS膝关节功能评分均明显高于对照组;干预12个月时观察组汉密尔顿焦虑及抑郁量表(HAMA及HAMD)得分均明显低于对照组。上述差异均有统计学意义(P<0.05)。观察组术后并发症发生率12.5%,明显低于对照组39.4%,差异有统计学意义(P<0.05)。结论：延续性护理有助于提升髋部骨折老年患者术后远期功能恢复效果,值得应用。     

影响高龄股骨转子间骨折术后功能恢复的相关因素

目的 分析高龄股骨转子间骨折术后功能恢复的相关因素,为提高对患者预后的预测准确性,促进患者术后的早期功能恢复提供参考资料.方法 收集80例60岁以上高龄股骨转子间骨折患者的临床资料,主要包括年龄、性别、骨折类型、手术时机、术中输血情况、骨质疏松水平及术后功能恢复情况等,进行回顾性分析.结果 手术时机、患者既往所患疾病、骨折类型、骨质疏松水平与术后功能恢复密切相关.结论 高龄股骨转子间骨折患者术后功能恢复受手术时机的延迟、患者全身情况差、不稳定骨折及骨质疏松等因素影响,这些因素预示着患者术后功能恢复较差.     

麻醉方式对老年髋部骨折患者术后睡眠的影响

目的 探讨椎管内麻醉和全身麻醉(GA)两种麻醉方式对老年髋部骨折患者术后睡眠质量的影响.方法 本研究是一项前瞻性队列研究,连续选取2019年11月至2020年8月于北京积水潭医院收治的年龄大于65岁的髋部骨折患者,根据麻醉方式分为腰硬联合麻醉组(CSEA组)和全身麻醉组(GA组),每组69例.CSEA组实施腰硬联合麻醉...     

老年髋部骨折后对侧髋部的再骨折

背景：老年髋部骨折后发生对侧髋部再骨折数目在逐年增加。 目的：阐述老年髋部骨折后对侧髋部再骨折的临床特征,提高对再次对侧髋部骨折的认识。 方法：于2001-01/2011-07对老年单侧髋部骨折患者567例和老年再发对侧髋部骨折患者30例,分析再发对侧骨折病例的发生率、骨折类型、年龄、性别、骨密度、骨质疏松、再骨折时间间隔和合并症。 结果与结论：单侧髋部骨折与再发对侧髋部骨折患者年龄、性别比例和骨密度值接近。老年髋部骨折患者中,对侧髋部再骨折发生率为5.0%。转子间骨折再发对侧髋部骨折率高于股骨颈骨折再发对侧髋部骨折率(P=0.018)。再发对侧骨折组骨质疏松发生率高于单侧骨折组(P=0.032)。初次骨折后发生对侧骨折的间隔时间平均2.4年,其中1年发生的最多,占40.1%。提示老年髋部骨折患者对侧髋部再骨折发生率较高,对于伴有骨质疏松和合并症的转子间骨折患者在术后1年内应加强预防,防止对侧髋部骨折的再次发生。 关键词：再发对侧髋部骨折;髋部骨折;股骨颈骨折;转子间骨折;骨密度;骨质疏松 doi:10.3969/j.issn.1673-8225.2012.04.042     

及早经皮穴位电针刺激对高龄老年髋部骨折术后认知的影响

目的:研究经皮穴位电针刺激及早干预对老年髋部骨折术后认知功能及炎症因子的影响。方法:80岁以上髋部 骨折患者40例,随机分为对照组（A组, 20例）和电刺激组（B组,20例）。两组患者均采用腰-硬联合麻醉。B组患者术前 2 d选取百会穴和风池穴行经皮电针刺激,3次/d,30 min/次;麻醉操作完成后行穴位持续刺激至手术结束。A组患者仅在 相应穴位贴电极未行电针刺激。于入院时、术后24、72 h 3个时点对患者进行MMSE评定,若术后评分降低一个标准差或 以上者即认定发生术后认知功能障碍（POCD）。所有患者在入院时、术毕即刻、术后24 和72 h 抽取静脉血,测定血清 IL-6、IL-10 和S100β 蛋白水平。结果:A组术后24、72 h POCD 发生率分别为65%（13/20）和60%（12/20）,高于B组的 35%（7/20）和25%（5/20）,差异有统计学意义（P<0.05）;B组术后各时间点血清IL-6、IL-10和S100β蛋白水平均显著低于 对照组同时间点,差异有统计学意义（P<0.05）。结论:及早经皮穴位电针干预有利于改善高龄老年髋部骨折术后的认知 功能状态,有效降低患者POCD的发生率。这可能与抑制其血清IL-6、IL-10、S100B蛋白的过度表达、减轻患者脑损伤的 程度有关。     

髋部肌肉密度下降对老年股骨近端骨折的影响研究

目的 观察髋部肌肉密度下降对老年股骨近端骨折的影响。方法 选择2016年5月15日~2017年5月15日我院收治的老年股骨近端骨折患者50例设置为实验组,另收集50例健康体检人群设为常规组,分析两组前群肌肉、后群肌肉、内侧群肌肉的CT检测值。结果 实验组髋部健侧与患侧的前群、后群、内侧群肌肉的CT检测值比较,差异均无统计学意义（P＞0.05）;常规组的前群肌肉、后群肌肉CT值分别为（44.23±5.36）Hu与（39.23±5.36）Hu,实验组的前群肌肉、后群肌肉CT值分别为（35.66±4.15）Hu与（22.36±5.47）Hu,组间比较,差异有统计学意义（P＜0.05）;两组受检者的内侧群肌肉CT值比较,差异无统计学意义（P＞0.05）。结论 髋部肌肉密度降低,不会对股骨近端骨折患侧髋部肌肉的密度造成明显的影响,但可能会增加患者发生股骨近端骨折的风险。     

老年髋部骨折术后并发肺部感染:影响因素及风险预测列线图模型构建

背景:建立髋部骨折术后肺部感染列线图预测模型,采取早期干预措施,对于提高患者的生活质量及降低医疗成本至关重要。目的:构建髋部骨折老年患者术后肺部感染的列线图风险预测模型,为可行性预防和早期干预提供理论依据。方法:回顾性分析2020年1-10月于南京中医药大学附属无锡市中医医院行手术治疗的305例老年髋部骨折患者(训练集)的病例资料,采用单因素和多因素Logistics回归分析,Hosmer-Lemeshow拟合优度检验,通过受试者工作特征曲线分析各独立危险因素和联合模型对术后肺部感染的预测效能,运用RStudio软件中的glmnet、pROC、rms等工具构建了一个列线图模型,用于预测老年髋部骨折患者术后肺部感染的风险,并进一步绘制校准曲线,验证列线图模型的预测准确性。在对2022年11月至2023年3月同院行手术治疗的133例老年髋部骨折患者(验证集)进行受试者工作特征曲线、校准曲线以及决策曲线的分析后,进一步评估列线图模型的预测性能。结果与结论:①此组髋部骨折老年患者术后肺部感染率为9.18%(28/305);②单因素和多因素分析、森林图显示,术前住院天数、白细胞值、超敏C-反应蛋白、血清钠水平是独立危险因素(P<0.05),Hosmer-Lemeshow拟合优度检验示拟合良好(χ2=4.57、P=0.803);对以上各独立危险因素及其联合模型进行受试者工作特征曲线分析,各独立危险因素、联合模型均区分度良好,有统计学意义(P<0.05);③图形校准法、C指数、决策曲线验证列线图预测模型,预测校准曲线位于标准曲线和可接受线之间,该列线图模型预测风险与实际发生风险一致性良好;④验证集运用受试者工作特征曲线、图形校准法、决策曲线验证预测模型,显示预测结果与临床实际相比有良好的一致性,表明该模型的拟合度较好;构建的髋部骨折老年患者术后肺部感染的列线图风险预测模型具有较好的预测效能,利用列线图风险预测模型可筛选出高危人群,为早期干预提供理论依据。     

影响踝关节骨折术后踝关节功能恢复的相关危险因素分析

目的 探讨影响踝关节骨折术后踝关节功能恢复的相关危险因素.方法 回顾性分析2018年2月至2020年1月在我院行手术治疗的106例踝关节骨折患者临床资料,分析影响踝关节骨折术后踝关节功能恢复的相关危险因素.结果106例患者术后踝关节功能优50例,良33例,可15例,差8例,优良率为78.30％(83/106);踝关节功...     

系统化康复护理在老年髋部骨折患者围手术期中的应用

目的 研究系统化康复护理对老年髋部骨折手术患者的影响。方法 选取2016年7月~2018年6月我院收治的老年髋部骨折患者125例,随机分为观察组（63例）和对照组（62例）。对照组给予常规护理,观察组在常规护理基础上给予系统化康复护理,比较两组护理前、术后1个月、术后3个月Harris髋关节功能评分和Barthel 指数评分,住院费用、住院时间及术后并发症发生率。结果 两组护理后Harris髋关节功能评分、Barthel 指数评分、住院时间及住院费用、术后并发症发生率比较,差异均有统计学意义（P＜0.05）。结论 系统化康复护理能有效改善老年髋部骨折手术患者的关节活动功能,缩短住院时间,减少住院费用,提高生活质量及生活自理能力。     

聚焦解决模式对老年股骨隆间骨折患者术后康复的影响

目的 探讨基于聚焦解决模式的心理干预联合渐进式功能锻炼对老年股骨粗隆间骨折术后患者负性情绪及生活质量的影响。方法 采用随机数字表法将134例老年股骨粗隆间骨折患者分为对照组和观察组,各67例。对照组术后给予渐进式功能锻炼,观察组在对照组的基础上给予基于聚焦解决模式的心理干预联合渐进式功能锻炼。比较两组术后6个月内功能锻炼的依从性、术前（干预前）、术后6个月（干预后）Harris髋关节评分、术前、术后3 d、1个月、3个月、6个月抑郁自评量表（SDS）和焦虑自评量表（SAS）评分及术后6个月生活质量综合评定问卷（GQOLI-74）评分。结果 观察组功能锻炼的时间依从性、次数依从性均高于对照组（P＜0.05）;两组术后6个月Harris评分均较术前升高（P＜0.05）,且观察组高于对照组（P＜0.05）;观察组术后3 d、1个月、3个月、6个月时SAS和SDS评分均低于对照组（P＜0.05）;观察组躯体职能、心理职能、情绪职能、认知职能和社会职能均高于对照组（P＜0.05）。结论 基于聚焦解决模式的心理干预联合渐进式功能锻炼可增加患者康复的信心,缓解患者的负性心理,提高患者康复锻炼依从性,加速术后康复,提高生活质量,值得临床借鉴应用。     

Poor Prognosis in Elderly Patients Who Refused Surgery Because of Economic Burden and Medical Problem After Hip Fracture

Although many studies have assessed mortality and morbidity of conservative treatment after hip fracture in elderly patients, the mortality of conservative treatment done because of economic burden is unclear. Among 451 patients diagnosed with displaced hip fracture during 3 yr, 28 patients (Group I) were enrolled as conservative treatment. Fifty-six patients matched in age, gender, ASA score, and diagnosis (Group II) who had undergone surgical treatment were used as the control group. The causal factors of non-operative treatment and mortality rate and functional recovery were evaluated according to the causal factors of patients with surgical procedure. Ten patients (36%) in Group I involved medical problems and 18 (64%) by economic burdens. The cumulative mortality rate over 3, 6, 12, and 24 months was 54%, 61%, 64%, and 82% in Group I and 9%, 11%, 14%, and 21% in Group II, respectively. At the latest follow-up, all five patients in Group I displayed a nonfunctional ambulatory state, whereas only seven of 44 patients in Group II were in a nonfunctional ambulatory state. Non-surgical treatment following hip fracture that is done because of the economic burden is associated with substantially high mortality and serious functional loss.     

Effect of Dementia on Postoperative Mortality in Elderly Patients with Hip Fracture

BackgroundThe aim of this study was to assess the prevalence of dementia as an underlying disease in elderly patients with hip fracture, to investigate the effect of dementia on postoperative mortality after surgery of hip fracture, and to analyze the differences in postoperative mortalities according to the severity of dementia through subgroup analysis.MethodsThis study selected 2,346 elderly patients who were diagnosed with unilateral intertrochanteric or femoral neck fractures who underwent surgery between January 2004 and December 2018. The patients were classified into the non-dementia group (2,196 patients) and dementia group (150 patients; no-medication [66 patients] and medication [84 patients] subgroups). The cumulative crude mortality rate was calculated, and 30-day, 60-day, 3-month, 6-month, and 1-year mortality rates were compared between the groups. A univariate regression test was performed using age, sex, diagnosis, surgery type, and Charlson''s comorbidity index (CCI), as these variables had P values of < 0.10. Multivariate regression analysis was performed to identify independent risk factors associated with mortality.ResultsThe 30-day, 60-day, 3-month, 6-month, and 1-year postoperative cumulative mortality rates were 1.8%, 3.8%, 5.6%, 8.9%, and 13.6%, respectively, in the non-dementia group, and 2%, 7.3%, 14%, 19.3%, and 24%, respectively, in the dementia group (P = 0.748, P = 0.048, P < 0.001, P < 0.001, and P = 0.001). The factors that affected the 1-year mortality were age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02–1.08; P < 0.001), sex (OR, 2.68; 95% CI, 2.07–3.47; P < 0.001), CCI (OR, 1.34; 95% CI, 1.23–1.47; P < 0.001), and dementia (OR, 1.70; 95% CI, 1.46–1.08; P = 0.016). In subgroup analysis, severity of dementia influenced the 6-month mortality (OR, 1.41; 95% CI, 1.70–2.01; P = 0.018), and 1-year mortality (OR, 1.30; 95% CI, 1.17–1.90; P = 0.027).ConclusionIn elderly hip fracture patients, the comparison between patients with and without dementia revealed that dementia was an independent risk factor for mortality at a minimum of 1 year of follow-up, and the severity of dementia in hip fracture patients was a risk factor for mortality within 6 months and 1 year, postoperatively.     

早期康复护理对股骨颈骨折患者全髋关节置换术后功能恢复的影响

目的 观察早期康复护理对股骨颈骨折患者全髋关节置换术后功能恢复的影响。方法 将于本院行全髋关节置换术治疗的股骨颈骨折患者84例,随机分为观察组和对照组,各42例。对照组予以常规护理,观察组在此基础上配合早期康复护理,比较两组患者护理后Harris、VAS评分情况、护理满意度及并发症发生率。结果 观察组的Harris、VAS评分改善程度优于对照组,差异有统计学意义（P＜0.05）;观察组护理满意度高于对照组（95.24% vs 76.19%）,差异有统计学意义（P＜0.05）;观察组并发症发生率低于对照组（9.52% vs 33.33%）,差异有统计学意义（P＜0.05）。结论 将早期康复护理应用于股骨颈骨折患者行全髋关节置换术治疗中,不仅能加快其髋关节功能恢复进度和缓解机体疼痛感,还利于减少患者并发症发生率,提高患者护理满意度。     

Identification and Treatment of Osteoporosis among Elderly Patients with Hip Fractures

OBJECTIVE:

To evaluate the profile of osteoporosis treatment among patients hospitalized due to hip fractures at a tertiary-level university hospital. To compare the impact of hospitalization on approaches toward treating bone mass losses.

METHOD:

The medical records of 123 hip fracture patients aged 60 years and over at the Institute of Orthopedics, Hospital das Clínicas, University of São Paulo School of Medicine, between 2004 and 2006 were reviewed and analyzed with respect to approaches towards investigating osteoporosis and treatments before and after fracture.

RESULTS:

The patients’ mean age was 78 ± 8.3 years, and the majority were women (71.54%). The patients had a mean of 2.72 comorbidities and used 3.26 medications on average. Among these patients, 12.3% reported a previous diagnosis of osteoporosis, and 5.83% were on medication for this. The mean waiting time for surgery was 6.3 ± 7.54 days, and seven patients (5.7%) died during the hospitalization. There were no investigations using bone densitometry, no changes in osteoporosis therapy between admission and discharge (p = 0.375), and no reports of referrals for the patient to have access to treatment.

CONCLUSIONS:

Investigations and treatments of osteoporosis and strategies for preventing new fractures were not implemented during the hospitalization of these elderly patients with hip fractures, even though this is the most feared complication of osteoporosis. These data need to be disseminated so that professionals dealing with elderly patients are attentive to the need for primary and secondary prevention of osteoporosis because of the impact of fractures on these patients’ quality of life, independence, morbidities, and mortality.     

心理治疗对创伤骨折患者心理状况的效果研究

目的 探讨心理治疗对创伤骨折患者心理状态的影响,以便为骨折患者心理干预治疗提供科学依据.方法 将符合条件的创伤骨折患者分为干预组和非干预组.非干预组行常规治疗,干预组在常规治疗的基础上进行心理治疗,应用焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活质量评定问卷(SF-36)对两组患者在心理治疗前后进行测查.结果 与常模比较创伤骨折患者的SAS、SDS的总分高于常模(t=4.88,3.57;P＜0.01);心理治疗后,干预组SAS、SDS总分低于非干预组(t＝ 2.54,P＜0.05;t=2.65,P＜0.01);SF-36除生理机能外各因子分高于非干预组(P＜0.05).结论 创伤骨折患者存在明显的焦虑、抑郁情绪,心理治疗可以明显的改善患者的心理健康状况及其生活质量.     

Effect of Opioids on All-cause Mortality and Sustained Opioid Use in Elderly Patients with Hip Fracture: a Korea Nationwide Cohort Study

BackgroundThe purpose of our study was to assess the use of opioids before and after hip fracture in elderly patients in order to determine the effect of opioid use on all-cause mortality, and to analyze how the history of opioid use before fracture increases the risk of sustained use following hip fracture using a Korea nationwide cohort.MethodsOur study identified hip fracture patients from the Korean National Health Insurance Service-Senior cohort. The index date was defined as 90-days after admission to the acute care hospital that fulfilled the eligibility criteria of elderly hip fracture. Patients were classified into past user, current user, and sustained user according to the use of opioid at each period based on the time of admission and index date. The opioids were classified into strong opioids and tramadol. A generalized estimating equation model with a Poisson distribution and logarithmic link function was performed to estimate the adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) to assess the association between past use and sustained use. A multivariable-adjusted Cox proportional hazard model was used to investigate the effects of strong opioid and tramadol use on all-cause mortality.ResultsA total of 12,927 patients were included in our study. There were 7,384 (57.12%) opioid past-users, 11,467 (88.71%) opioid current-users, and 7,172 (55.48%) sustained users. In comparison of the death risk according to current use or the defined daily dose of the opioids or past opioid use, there were no significant differences in the adjusted hazard ratio for death in all groups, compared to the current non-users (P > 0.05). Among survivors 1 year after hip fracture, opioid past-use increased the risk of opioid sustained use by 1.52-fold (aRR; 95% CI, 1.45–1.8; P < 0.001).ConclusionCurrent use and past use of opioid did not increase all-cause mortality after hip fracture in elderly patients over 65 years of age. Past use of opioid before hip fracture increased risk of sustained use of opioid compared to the current opioid used without past use.     

老年髋部骨折术后下肢深静脉血栓形成的预防及护理干预效果分析

目的 探析老年髋部骨折术后下肢深静脉血栓形成的预防和护理措施。方法 将2015年1月~2017年1月我院接收的老年髋部骨折术后患者90例进行回顾性分析,给予预防与护理措施,分析措施实施后患者下肢深静脉血栓形成形成发生率、住院时间及生活质量改善的情况。结果 患者下肢深静脉血栓形成发生率、住院时间、生存质量显著优于预防及护理措施实施前,P<0.05表示有统计学意义。结论 将预防与护理干预措施应用在老年髋部骨折术后患者临床护理中可有效降低下肢深静脉血栓形成发生率,改善患者生活质量,促进患者尽快康复。